The Hidden Impact of COVID-19: Expanding Public Access to Community Pharmacy Services Beyond the COVID-19 Pandemic, Part 2
The following is part 2 of 6 in a series of articles titled, "Expanding Public Access to Community Pharmacy Services Beyond the COVID-19 Pandemic" by Jason Ausili, PharmD, MSLS, Head of Pharmacy Transformation for EnlivenHealth.
How the Pandemic Affected Public Health
The demand for testing, vaccinations, and treatment brought about by the COVID-19 pandemic has overwhelmed local and state health departments, health systems, emergency rooms, urgent care centers, primary care physicians' offices. The impact of the pandemic on public health was most notably observed through a desperate increase in demand for healthcare workers, an unsettling increase in mental health problems, and a dramatic reduction in non-COVID-19 treatments and services. According to an article in the World Economic Forum, "COVID-19 has caused the largest cut to life expectancy since World War II," with the greatest decrease seen in U.S. males who have experienced "a drop by 2.2 years relative to 2019 ".
Vulnerabilities in the Healthcare Workforce
One of the more pronounced impacts of COVID-19 has been the increased demand on an already overstressed healthcare workforce. A recent issue brief published by HHS's Assistant Secretary for Planning and Evaluation (ASPE) announced key challenges and policy responses related to the healthcare staffing impact. The brief states, "The COVID-19 pandemic has put extreme stress on the health care workforce in the United States, leading to workforce shortages as well as increased health care worker burnout, exhaustion, and trauma. "
It is predicted that many of these workforce vulnerabilities, which have roots that predate COVID-19, will continue beyond the pandemic. Of particular concern is the trending shortage of primary care physicians (PCPs) that has been brewing over the last decade and was amplified by the pandemic.
According to a recent report by the Association of American Medical Colleges (AAMC), "The United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034," including a gap of 17,800 to 48,000 PCPs. AAMC President and CEO David J. Skorton, MD, added, "The COVID-19 pandemic has highlighted many of the deepest disparities in health and access to health care services and exposed vulnerabilities in the health care system."
An Increase in Health Disparity
The provider gap was further exploited by the pandemic as many Americans in desperate need of testing, vaccinations, treatment, and routine care were unable to make appointments with their physician in a timely manner.
In my professional opinion, health equity can be achieved through a greater understanding of each person's social and economic environment, the barriers preventing them from achieving optimal health, and personalized solutions that are readily available to all. One of the primary goals of the CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) is to "achieve health equity by eliminating health disparities and achieving optimal health for all Americans."
The CDC defines health equity as, "when all members of society enjoy a fair and just opportunity to be as healthy as possible " and further reinforces that health disparities are "preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic states, geographic location, and environment."
A Detrimental Effect on Minority Groups
The growing physician deficit is likely to become a key challenge to the CDC's goal to achieve health equity, especially among medically underserved racial and ethnic minority groups, who experienced significantly higher rates of COVID-19 cases, hospitalizations, and deaths. Recent data collected by the CDC on COVID-19-associated hospitalizations shows significant disparities among Non-Hispanic American Indian or Alaska Native, Non-Hispanic Black or African American, and Hispanic or Latino populations when compared to their Non-Hispanic White counterparts.
The data collected by the CDC reports that the risk for contracting COVID-19 is up to 1.5 times more likely among those in these race/ethnicity groups, the risk of hospitalization is up to 3.0 times higher, and the risk of death is up to 2.1 times higher. Further expanding convenient and accessible care services provided by pharmacists, who are embedded in the communities in which they serve, will help offset the impact of the growing physician shortage on health inequities and will play a key role in preventing health disparities.
The Growth of Mental Health Problems
In parallel to the overstretched healthcare workforce, the nation experienced a disturbing exacerbation of mental health problems. According to the World Health Organization (WHO), "Fear, worry, and stress are normal responses to perceived or real threats, and at times when we are faced with uncertainty or the unknown ". In fact, a recent scientific brief released by the WHO reported that the COVID-19 pandemic has caused a "25% increase in prevalence of anxiety and depression worldwide."
A multitude of factors are likely at play as enormous stress from social isolation, loss of employment, changing working conditions, school closures, loss of community engagement, loneliness, fear of infection, grief after bereavement, and financial problems exploited the mental vulnerabilities of people across the globe. As the National Institutes of Health (NIH) links a strong connection between mental illness and substance use disorders, a recent White House briefing room statement reported that, "More than 104,000 Americans died due to a drug overdose in the 12-month period ending in September of 2021 ", an average increase of 15.7% across the states compared to the prior period.
When the Pandemic Takes Priority
The public health impact of COVID-19 was both magnified and broadened as routine annual visits, screenings, non-COVID-19 related vaccinations, check-ups, wellness and prevention appointments, non-emergent surgeries (elective and routine), and other standard healthcare procedures went to the wayside as resources were fully focused on pandemic-related services. In March of 2021, the HHS's Office of Disease Prevention and Health Promotion (ODPHP) stated, "In the past year, many people may have put off routine healthcare and preventative services like screenings and vaccines because they're worried about getting COVID-19."
One of the more troubling concerns with the decline in regular visits is the significant drop in routine childhood vaccines during the pandemic, increasing the risk of other preventable outbreaks, such as, measles, whooping cough, among other serious communicable diseases.