COVID-19 Lockdown: Impact on Mental Health and Literacy

Primum non nocere (but first do no harm) from the Hippocratic Oath.

Does the harm from school closures and stay-at-home orders outweigh the benefits of preventing COVID-19 spread?
According to the Kaiser Family Foundation, 4 in 10 American adults surveyed have had increased anxiety and/or depression during the pandemic (2020) vs. 1 in 10 adults in 2019. Medical requests for behavioral health care have increased 40-50% at Miami’s Banyan Health Systems, and there was already a shortage of psychiatric beds and providers. In some places, patients requiring psychiatric inpatient help are being boarded at emergency departments for up to 3 days before admission. Budget and staffing cuts, lower reimbursements and a shifting of hospital resources from psychiatric care towards COVID-19 care have had a dramatic impact on the availability of inpatient mental health beds and staff nationwide.
Up to 75,000 excess deaths from suicide and addiction may result from the consequences of COVID-19 lockdowns. Specifically, it is the PAIN, DESPAIR, ECONOMIC FAILURE (DUE TO MASSIVE UNEMPLOYMENT) and ISOLATION that is driving suicides and death by addiction. The SAMHSA (Substance Abuse & Mental Health Services – div. of DHHS) Dec. 2020 Executive Order 13594 “Saving Lives Through Increased Support for Mental and Behavioral Health Needs” emphasized helping individuals who are most susceptible to prolonged state and local COVID-19 restrictions
The rationale:

  • 62% of Americans reported feeling more anxious than the previous year.
  • 40% of Americans experienced significant emotional upheaval (anxiety, depression, trauma, increased use of substances and suicidal ideation).
  • 11% reported seriously considering suicide.
  • The Disaster Distress Helpline saw a 1000% spike in call volume in April 2020 compared with April 2019.

The lockdown and school closures contributed to a rise in mental health issues for young adults:
  • 25% of 18-24 year-olds surveyed by the CDC contemplated suicide in the previous 30 days.
  • 80% of students experienced some negative impact on their mental health.
  • 20% of students said their mental health has significantly worsened.

As we reported in our June 30, 2020 Unintended Medical Consequences blog, drug and alcohol use have skyrocketed during the COVID-19 lockdown. A large survey from Recovery Village documents an 18% increase in significant alcohol consumption and a 36% increase in illicit drug use compared to the prior year. Early in the pandemic (April/May), urine tests showed that use of cocaine use was up 10%, fentanyl up 32%, meth up 20% and heroine up 13%. By June 2020, 25% of essential workers started or increased their substance and/or alcohol use. As a whole, alcohol and substance use increased 12% during the pandemic.

The support systems that many at-risk parents rely on, such as extended family, child care, schools, religious groups and other community organizations are not available due to stay-at-home orders. Since children are not going to school, teachers and counselors are unable to witness any signs of abuse and report them to the proper authorities. In a pre-pandemic year, 10 million Americans are abused by an intimate partner (20,000 calls per day are made to domestic abuse hotlines). In the first two months of the pandemic lockdown, abuse statistics increased 9%.

While unemployment has dropped to 6.3%, it is significantly higher than it was pre-pandemic (February, 2020 recorded 3.6%). The 2020 Real GDP decreased 3.5% from 2019. It had gained 2.2% in the previous year, equating to a 5.7% negative swing. For people already living on the economic edge, any income decrease causes disproportionate harm. An excellent post from the Well Being Trust Organization analyzes the death fallout from increased unemployment

An expert analysis published by Bavli, et al in November titledHarms of public health interventions against covid-19 must not be ignoredstates that:

  • Despite increasing evidence on the unintended, adverse effects of public health interventions, such as social distancing and lockdown measures, “there are few signs that policy decisions are being informed by a serious assessment and weighing of their harms on health. Instead, much of the discussion has become politicized.”
  • Policy makers, acting to protect public health, need to weigh the possible side effects when deciding on, implementing and evaluating specific public health interventions.
  • The underlying assumption of any public health intervention is that it will enable more people to live longer and healthier. The positive outcomes of interventions need to outweigh the negative effects. Public health is not simply to consider the lives that may be saved by policy efforts to limit viral spread, but more importantly, to consider the total number of lives saved and lost as a result of the pandemic and responses to it.
  • The health consequences of economic downturns are worse for socioeconomically vulnerable populations.
  • The economic shock caused by efforts to contain COVID-19 is even larger than the 2007-2009 financial crisis. Policy-makers must understand the effect of COVID-19 policies on health AND consider lives lost as a result of the economic consequences due to lockdowns.
  • Restrictive measures on social mobility, school closings and business shut-downs are associated with increased anger, confusion, and symptoms of post-traumatic stress disorder (PTSD).
  • For up to 10-15% of those suffering from mental health issues, life will not return to normal due to the impact of the pandemic on their mental wellbeing (according to psychiatrist Steven Taylor).

Are policy-makers making the wrong choice between the economy and health?

2020 spring school closures set 5th and 6th graders’ test scores approximately 12 weeks behind schedule, while 2nd and 3rd graders’ math test scores were 4-7 weeks behind schedule. In general, most students made some learning gains in both reading and math since the pandemic started, but were 5-10% lower than expected. Other studies project around a 33% drop in students’ learning gains. The Brookings Institute calculates ~30% fewer learning gains (across subjects), but a 50% drop in math gains for 12th graders. One quarter of students were not able to even take the MAP tests in the fall of 2020 (most of whom were minorities).

An excellent Feb. 25, 2021 WSJ post interviewed Stanford University economists, Blanchard and Summers, who stated:
  • On average, children lost 116 days of reading time and 215 days of math work.
  • States with large Black and Hispanic populations were hit the hardest, particularly (South Carolina & Illinois).
  • Over the next century, the “skill shock of 2020” will produce $25 to $30 trillion of lost economic output – in today’s dollars.
  • Lifetime household incomes of affected students will be 6 - 9% lower.
  • Longitudinally, the lost class time will reduce the incomes of today’s students by 5% over their lifetimes.

We think the boredom from lockdowns and a 55% increase in screen time with a digital device has increased peoples’ irrationality. Consider the rise of extreme beliefs:

  1. Conspiracy theorists (QAnon) believe that the COVID-19 vaccine will change their DNA. They believe it will place a microchip in them or that the vaccines are made from mouse turds! Between 12% and 25% of Americans believe in vaccine conspiracies. A May Yahoo News survey showed that 50% of Fox TV viewers believe that the COVID-19 vaccine is an attempt to implant microchips into recipients.
  2. Beyond those delusionists, irrational pandemic paranoia takes many forms. The continuous spread of misinformation and limited censorship exacerbates this problem.

It is staggering that half a million Americans have now perished from Covid-19. Without downplaying the severity of the pandemic, it is important to consider the age distribution of fatalities. A Franklin-Templeson-Gallup research project on behavioral response to COVID-19 revealed that Americans overestimate the risk of the virus. Here are a few of their findings: 
  • Americans believe that 50% of all COVID-19 deaths are people age 55 and older. The actual number is 92%.
  • Americans believe that people age 44 and younger account for about 30% of total deaths. The actual number is 2.7%. 
  • Americans overestimate the risk of death from COVID-19 for people 24 and younger by a factor of 50 times what it actually is. 

Coronaphobia is an actual term – coined for people with an unreasonable fear of COVID-19. Phobia is an anxiety disorder characterized by a persistent, excessive, unrealistic fear of an object, person, animal, activity or situation. Phobia makes people avoid the triggers of fear. When such avoidance is not possible, it causes anxiety and distress. Coronaphobia is similar to other phobias, except the fear in it is not limited to public places/situations/objects, and is expressed by fear of coming in contact with other humans.

The following considerations need serious deliberation in order to fully reopen schools and businesses:
  1. Is the curve flattened, or is it bottoming out? On Feb. 12, 2021, only 12% of hospitals were under “extreme stress” from COVID-19 (vs. >40% on Jan. 1).
  2. Has the weekly COVID-19 new case rate dramatically dropped, and are we nearing herd immunity?  The CDC reports that there have been 28 million cases, and only 1 in 4.6 cases are reported. Thus, our true case rate in the USA is actually ~ 129 million cases (or 39% of the US population). Combining prior infections with 14% of the population already being vaccinated, we are nearing herd immunity.

  3. Have the Phase 1a medical professionals and long-term care facility residents (~24 million) and phase 1b frontline essential workers and people >75 (49 million) been vaccinated? As of Feb. 25, 14% of US population has been vaccinated. (~43 million have received at least 1 dose) and in the next month, another 12% of the US population will get vaccinated. 

Policy needs to balance ALL of the risks. We FIRMLY believe, the teeter totter has shifted: the mental health and literacy risks outweigh the COVID-19 fatality risks. Note that 1 out of every 7 deaths in the USA involves COVID-19. It is still a very serious pandemic, and ~2,000 people a day are dying from it. The average age of COVID-19 death is ~82, and we question if it is appropriate to suggest it is more important to save a 17-year-old suicide victim or an 82-year-old who will die from COVID-19. That would be up to the reader.

Because the collateral damage (suicides, mental health hospitalizations and literacy failures) outweighs the risk of COVID-19 deaths. COVID-19 cases and death rates have swiftly fallen, and will drop further. While highly-contagious variants pose a greater risk for transmission, we do not understand how a future “wave” will be possible. Who is left to get infected with COVID-19? As of February 28, our calculations show ~31% of the USA at risk for developing COVID-19. The CDC is likewise forecasting a 50% drop in daily case counts by March 15 (from 500K new cases today to 250K new cases). The CDC trend line appears to lead to ~100,000 new daily cases by March 31 (1/5 of what it is on February 25).

Fast forward to March 31, 2021, we predict that only ~13% of Americans will be at risk for developing COVID-19.

Notes: As posted in our September 28, 2020 COVID-19 Immunity Blog, ~6% of people have cross-reactive IgG antibodies that appear to neutralize the COVID-19 spike protein. We also reported that children are ~3x less likely to get COVID-19 than adults (since 15% of the US population is <12 years old; 2/3 of that = 10%). As we posted in our January 12, 2021 COVID-19 Reinfection Risk post, the risk for reinfection within 6-8 months after a COVID-19 infection remains very rare. We noted in our COVID-19 Endgame Timeline post that prior immunity wanes over time. The other four common cold coronaviruses cycle around every other year. We surmise that COVID-19 will follow their pattern, and people will eventually get reinfected. Not enough is known about reinfection incidence and severity to make any predictions.

The science does not support waiting until sometime in May to fully reopen schools (and suggests SUMMER SCHOOL). Students, parents and teachers have already been burdened by stay-at-home policies.

Brock Fitzpatrick, Graduate of the University of Wisconsin, B.S. in Microbiology and Economics

Kevin Fitzpatrick, MBA

Sarah Sheats, BA, University of Minnesota

Copyright © 2013 - 2019 Fitzpatrick Translational Science | All Rights Reserved