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It has now been several months since #COVID19 first entered our consciousness. We still have much to learn about it. But, to my thinking, three key points have become clear. I will try to summarize them here.
First, #COVID19 is really two pandemics. One is how the virus threatens physical health. The other is the threat to mental health. We have not much discussed the latter, but we should. The mental health burden of this pandemic is real and will likely be with us for years to come.
The mental health threat of #COVID19 comes from many directions. There is the baseline of anxiety many feel just knowing the disease is out there. Then there are the acute fears that come with getting sick, or witnessing the sickness of others.
Finally, there is the psychological strain caused by the physical distancing measures we have adopted on an unprecedented scale to slow the spread of #COVID19. This new confinement is something for which few of us have a frame of reference. We have never seen anything like it.
Over a decade ago, I worked on a study of the psychological effects of the quarantine used to control the 2003 SARS outbreak. We found a link between quarantine and psychological distress manifesting as depression and PTSD.
We also found a link between PTSD/depressive symptoms and simply knowing someone diagnosed with SARS. The study looked at populations in Toronto, Canada. Today, the affected population is global. https://bit.ly/3clDxHh
We also know the psychological sequelae of large-scale traumatic events can last a lifetime, their effects mediated by contextual factors like income, community social capital, and prior experience of trauma. https://bit.ly/3ctAmNB
If we ignore this second epidemic, limiting our focus to the physical effects of #COVID19, we risk leaving populations vulnerable to a disease burden that will be all the heavier for being, for many, unexpected.
This leads to the next key point about #COVID19, the matter of who is most vulnerable to this disease. #COVID19 threatens us all, but not equally. As always, it is the vulnerable who suffer most.
We know who they are. They are the low-wage worker who cannot telecommute, the older parent in a nursing home, the homeless family torn between sleeping on the streets or risking exposure in a crowded shelter, or any of the millions of Americans living with chronic disease.
Their vulnerability is our vulnerability. In a time of pandemic, pockets of poor health rarely stay pockets for long. This crisis has revealed the web of connection that defines population health and that is shaped by socioeconomic structures.
To be healthy, we need to address these structures, focusing especially on how they affect marginalized populations. We need to place equity at the heart of our near-term response to #COVID19 and future efforts to promote health.
For more on how we can maintain an equity focus as we address #COVID19, see our work on the @MAPublicHealth Emergency Task Force on Coronavirus and Equity. https://bit.ly/33HkEvd v @CommonWealthMag @PavlosCarlene @CherylABartlett
Inequity – and, perhaps more fundamentally, injustice – creates poor health. #COVID19 reflects this. But it did not reveal it, because this is something we in public health have long known. We know because the data told us.
The data have consistently shown that marginalized populations have poorer health. This was true before #COVID19, and it is especially, urgently true now. We know these data, but we have so far lacked the political will to act on them. This must change.
So, my final point is simply this: we need to listen to science guided by the right values. Amid the present uncertainty, with its potential for confusion and misinformation, we need to #letsciencespeak, to follow where the data lead, in our pursuit of a healthier world.
The task of addressing #COVID19 is twofold. We must mitigate the disease’s near-term effects. And we must build a world where something like this can never happen again. Creating a scientific foundation for this world is the work of population health.
Mental health, vulnerable populations, science with purpose – these three focus areas should guide our navigation of #COVID19. We cannot turn back the clock to be better prepared for what we now face, but we can make this moment prologue to a better future.
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