Unintended Medical Consequences of the COVID-19 Lock-Down


The COVID-19 lock-down, which has driven panic, mass unemployment, poverty and homelessness, may ultimately cause more deaths than COVID-19 itself.  In this blog, we are including some economic and jobs data, as the stress induced by job and income loss parlay into many medical outcomes. Our intention for publishing this post is to provide context for the flip side of the COVID-19 stay at home orders; to see beyond the immediate threat of COVID and recognize the unexpected complications that arise from trying to keep the country safe.

SUICIDE: 
  • A study from the Great Recession (beginning in 2007) showed that for every 1% increase in unemployment, there is a 1.6% increase in suicides.

  • It was reported that a year’s worth of suicide attempts occurred in just a 4 weeks span.

CHILDREN NOT GETTING VACCINATED:
  • Although the CDC has requested that health care providers continue immunizations, many children are not getting them.

  • In recent decades, the USA’s successful vaccination strategy has declined mortality from preventable infectious disease by 92 – 100%.  Until now, vaccination levels have met or exceeded Herd Immunity.

  • Vaccination programs in at least 68 countries have been paused.

  • In the USA, ~3,000,000 less MMR doses were ordered from January 6 – April 19, 2020 (through the VFC program, which accounts for ~1/2 of the childhood vaccine supply). It is reasonable to assume that in total, ~6,000,000 less MMR doses were ordered.

  • For children </= 2 years, approximately 1/3 of the number of measles & other vaccines were administered than the prior year.

  • For children >2 years, measles & other vaccines were administered at approximately 1/10th the rate compared to the prior year.

  • According to the WHO & UNICEF, around the world, 80 million babies are at risk for diphtheria, measles and polio because of vaccine disruption.

  • Parents’ fears of getting COVID-19 and leaving the home because of stay-at-home orders contributed to the drop in vaccinations.

Childhood Vaccines: Percent Vaccinated and Percent Required for HERD Immunity in 2018. 
HERD IMMUNITY from a cascade of infectious diseases is at risk. Note that prior to the “stay-at-home” orders, the percent required for HERD Immunity had been hovering around the actual percent vaccinated level. Our team has researched the calculations of several preventable childhood infectious diseases that have likely already lost Herd Immunity effect in the USA. We predict that child death rates for preventable infectious diseases will soar far beyond the total of 28 COVID-19 deaths of children under age 15 that were published on 6/24/2020. 


Up to 1/3 of Americans, for whatever reason, have an anti-science, anti-vaccine attitude which may influence their decision to not vaccinate their own children.  Unless parents get their children caught up on vaccine schedules, we will see outbreaks for measles, mumps, rubella, varicella, meningitis, pertussis, pneumonia and influenza. It is also entirely possible that polio and diphtheria will come back. Ask your grandparents about some of these diseases – they all know somebody that died or who was crippled from them.

DOMESTIC VIOLENCE INCREASE:
  • It is estimated that a 3-month quarantine would increase “intimate partner violence” by 20%.  Women and children become trapped with verbally and physically abusive spouses day after day. 

  • In 2018, 1770 children died due to abuse and/or neglect in the USA. We do not yet have the domestic violence statistics for this year’s COVID-19 data. 

  • 1 in 4 women and 1 in 7 men have been a victim of severe physical violence by an intimate partner. Imagine a 20% increase in violence that was unleashed during the past 3+ months of stay-at-home with a violent person.

DEPRESSION, STRESS, SUBSTANCE ABUSE & ANXIETY:
  • 49% of Americans reported some level of depression in April, 2020 vs. 37% in 2006.  This ~50% depression & anxiety figure is confirmed by a 2020 Kaiser Family Foundation poll.

  • 60% of Americans are scared of contracting COVID-19.

  • Prescriptions for antidepressants and benzodiazepines have risen ~14-34%.

  • Alcohol sales have skyrocketed as high as 243%.  Other reports show more modest increases, such as a 34% increase (compared to 2019).

CANCER, CARDIOVASCULAR AND OTHER MEDICAL THERAPIES HAVE DECLINED:
  • Suspending cancer treatment, procedures and chemotherapy (due to stay-at-home orders) will likely have a significant downstream impact (we do not yet know the extent).

  • The New York Times reported a 40% decrease in emergency procedures for heart attacks.  Patients are scared of going to the hospital and potentially contracting COVID-19.  They actually thought they were violating “stay at home” policies by not getting their heart attack attended to.

  • Cardiac admissions were down >70% in many institutions.

  • Cancer care, including surgeries, dosing of immunosuppressive therapies, tumor resections and a variety of inpatient treatments have been delayed. Many of these delayed treatments will have negative consequences that have just not yet been quantified.

DELAYED PROCEDURES AND EMERGENCY ROOM VISITS DROP:
  • The CDC has published that ER visits dropped 42% during the stay-at-home orders.  We do not yet know the repercussions.

  • Worldwide, an estimated 28 million elective surgeries were delayed.

  • It is estimated that 5 million US surgeries were delayed due to COVID with a continued backlog.

  • The “burden of disease” continues for a patient when their surgery is delayed. Risks include CABG & lung infections. Delays in cancer surgeries not only adversely affect a patient’s life, but add ~$50,000 per case of lung, colorectal and breast cancer patients. 

DENTAL COMPLICATIONS:
  • Interestingly, Google searches for “Dental Emergency” were 3x greater during the “stay at home” period.

  • Large academic dental practices have been forced to close to everyone except for severe dental emergencies.

  • It is unknown how many non-emergency dental procedures have accumulated – but I’m one.🙁

WEIGHT GAIN:
  • 70% of WebMD survey readers reported lack of exercise during the stay at home orders. 

  • 59% of readers indicated they did not exercise and had stress that caused eating problems.

  • 55% of men and 34% of women reported weight gain during the stay-at-home. 

  • Fitness centers are (and many remain) closed – thus preventing many from getting their daily workouts.

JOBS LOST:
  • 40 million (& counting). 

  • The job loss due to COVID-19 is said to be comparable to the number lost during the Great Depression

BUSINESSES LOST:
  • In America, up to 7.5 million small businesses may shut permanently (according to a Main Street America survey). 

  • In NY alone, 100,000 small businesses closed permanently

Perspective: 
There have been approximately 40,000,000 jobs lost and over 125,000 deaths due to COVID-19; a 320 to 1 ratio. The average age of Covid-19 death is 80 years.  The average age of the US worker is 42.

Today, there have been ~2.4 million positive COVID-19 US cases. This accounts for ~0.72% of the US population (331 million). On 6/25/2020, CDC Chief, Dr. Redfield, publicly announced that the likely seroprevalence of the disease is actually about 10x the above number.  Redfield believes that in reality, between 5 – 8% of the US has been infected so far.

In early March, there were so many unknowns about COVID-19 that governments cannot truly be faulted for issuing “stay-at-home” orders in an effort to “flatten the curve”. Every day, more is known about transmission, who is most at risk (and to isolate them), mitigation strategies, potential treatments and vaccine development. However, the duration of some of the stay-at-home orders and the labeling of “essential vs. nonessential” businesses (that determine which businesses get to stay open vs. those that had to close - permanently?) are questionable. Any defense for the “stay-at-home” orders needs to consider the enormous number of unintended medical consequences. Primum non nocere.

Kevin Fitzpatrick, Fitzpatrick Translational Science


Child Vaccination Table References:

1 https://www.cdc.gov/nchs/fastats/immunize.htm 


2 https://www.uspharmacist.com/article/measles-and-the-mmr-vaccine#:~:text=The%20threshold%2C%20or%20minimum%20percentage,is%2080%25%20to%2086%25


3 https://www.cdc.gov/nchs/fastats/immunize.htm#:~:text=Percent%20of%20children%20aged%2019,(1%2B%20doses)%3A%2091.5%25


4 https://www.ijidonline.com/article/S1201-9712(18)34410-2/pdf#:~:text=With%20a%20basic%20reproduction%20number,Anderson%20and%20May%2C%201992)


5 https://onlinelibrary.wiley.com/doi/pdf/10.1111/1753-6405.12732


6 https://www.cdc.gov/vaccines/vac-gen/whatifstop.htm


7 https://www.sciencealert.com/why-herd-immunity-will-not-save-us-from-the-covid-19-pandemic#:~:text=And%20that's%20herd%20immunity%2C%20in,estimated%20R0%20of%20roughly%203


8 https://www.who.int/immunization/monitoring_surveillance/burden/laboratory/manual_section1.8/en/#:~:text=The%20Ro%20for%20rubella%20is,%25%20is%20required%20%5B18%5D


9 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/#__sec4title


10 https://www.cdc.gov/nchs/fastats/immunize.htm


11 https://pubmed.ncbi.nlm.nih.gov/26566273/


12 https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70241-4/fulltext


13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/#__sec4title


14 https://www.cdc.gov/nchs/fastats/immunize.htm#:~:text=Percent%20of%20children%20aged%2019,(1%2B%20doses)%3A%2091.5%25


15 https://www.tandfonline.com/doi/full/10.4161/hv.18444#:~:text=Based%20on%20the%20Ro,for%20polio%20(Table%201)


16 https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm


17 https://www.nfid.org/2018/02/12/influenza-vaccination-protecting-yourself-by-protecting-your-community/#:~:text=The%20Ro%20for%20influenza,most%20other%20vaccine%2Dpreventable%20diseases


18 https://www.cdc.gov/nchs/fastats/flu.htm



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