Experts: COVID mental health issues aren't going away soon

By Brice Wallace 

As Utah continues to deal with the physical health impacts from COVID-19, long-term consequences to both physical and mental health could linger for many years, according to several healthcare experts.

Speaking at a Newsmaker Breakfast hosted by the University of Utah’s Kem C. Gardner Policy Institute, those experts listed the virus’ impacts on people’s health and the healthcare system. Many are short-term but others will be longer-term, including some tied to issues related to job loss, difficult economic times and financial strain, they said.

“This pandemic has pan-effects, and it’s going to have a continued impact on our health, our mental health in particular,” said Dr. Amy Khan, executive medical director at Regence BlueCross BlueShield of Utah. “And not just things like anxiety and depression, which we know are going to be legion, but things like bereavement, complicated loss … this idea that our lives have permanently changed until we get back to a place where we can live life as we’ve previously known it.

“But I think if we think about economic impacts, there will be some profound effects related to angst, despair, illness related to despair, and then truly the consequences of poverty that may end up continuing to be present as we work through this, particularly if our economic engine fails us.”

Despite having a relatively healthy population physically, Utah fares worse than other states when it comes to overall mental health and well-being, suicide rates, drug overdoses and overall prevalence of depression and anxiety — issues compounded during the virus, according to Mikelle Moore, senior vice president and chief community health officer at Intermountain Healthcare.

Moore said that heading into the pandemic, between one-fourth and one-third of Utahns had a mental health concern. Applying national data, it’s about one of every two young adults. “It’s really alarming to think about half of our people experiencing a mental health concern exacerbated by COVID-19,” she said.

That exacerbation was reflected in the use of telehealth, which increased 10-fold in March as the virus took hold. “No longer was it conjunctivitis and a sore throat; people were calling in with mental health and anxiety concerns,” Moore said.

Those issues stemmed from the stress of the economic downturn, anxiety from children being at home rather than in school, fear of the disease itself and coping with social isolation.

Some statistics cited during the Newsmaker event showed that about half of telehealth visits were for mental health issues. Overall in-person office visits dropped dramatically in mid-March, to about one-third their 2019 level. The number of vaccinations also slipped.

All of that has prompted the healthcare system to reassess how to best provide services and improve access, especially to communities that have economic or other barriers to receiving services. People of color, people in populations vulnerable to the virus and others have a lack of information or misinformation about healthcare overall, access to it and paying for it, speakers said.

Steve Walston, director of the Master of Healthcare Administration Program at the University of Utah, said Utah’s Hispanic population accounted for 40 percent of COVID-19 cases, 39 percent of COVID-19-related hospitalizations and 24 percent of deaths while being only 14 percent of the state’s population. They, and other groups, often are not paid well, have inadequate housing, use public transportation, live in multi-generation housing and face other issues that limit their access to healthcare, he said.

Khan suggested “embracing” virtual care, which would not only assure timely access to care but also to broaden access to that care. Payment systems also need to be reformed so that it is better tied “to keeping the population healthy,” she said.

“We need to change the affordability of healthcare,” Moore added. “We overall have an affordability problem, and given the economic downturn that is likely to last for some time, if we can’t, in healthcare, change the cost structure that we pass on to those we serve, then we can’t actually change the health outcomes in our communities.”

In many ways, the speakers said, Utah entered the pandemic well-positioned from a health standpoint. Its population generally exercises, eats a healthy diet; avoids excess drug, alcohol and tobacco use; and has good access to quality healthcare and insurance coverage. But all of that could change if the virus impacts last a long time, they cautioned.

In fact, Utahns’ relative healthiness has resulted in a healthcare system tailored to those characteristics. Walston noted that Utah is No. 48 among states both in the number of hospital beds per capita and nurses per capita and is No. 46 for the number of doctors per capita.

“If we have a surge with the coronavirus or other kinds of pandemics, we’ve structured the capacity of our healthcare services based on our healthy population,” Walston said. “So, if we do have surges, we may have problems still.”

Surges or not, Utahns already infected could have long-term health issues, Walston warned. While viewed primarily as a respiratory problem, in serious cases, the virus can affect the heart, liver and kidneys, he said.

“COVID’s going to be here for a while,” Khan said. “This is a virus that appears to behave very aggressively and is likely will be what we’re going to be living with, going forward.”