Effects of pandemic on alcohol use, mental health, primary care, and hospitalizations

Recent studies found that the pandemic was associated with increases in alcohol use and internet searches for mental health issues. The rise of telemedicine meant fewer blood pressure and cholesterol evaluations, and hospitalizations for several non-COVID-19 conditions stayed below normal.

The effects of the pandemic on other aspects of Americans' health were highlighted by several new studies. First, a study published as a research letter by JAMA Network Open on Sept. 29 reported on 1,540 U.S. adults who had been surveyed about their alcohol use last year and then again during the pandemic. It found that the frequency of alcohol consumption increased overall by 14% and slightly more than that in women. Women also reported an increase in days of heavy drinking. The authors calculated that on average, alcohol was consumed one day more per month by three of four adults. They suggested that “health systems may need to educate consumers through print or online media about increased alcohol use during the pandemic” and noted that “excessive alcohol use may lead to or worsen existing mental health problems, such as anxiety or depression, which may themselves be increasing during COVID-19.”

Regarding mental health, another study published by JAMA Internal Medicine on Oct. 5 used Google data to see how often residents of New York State searched the terms “suicide,” “anxiety,” “panic attack,” “insomnia,” and “depression” after March 22, when a statewide lockdown was instituted. They found that “anxiety” was searched significantly more often than expected for three consecutive weeks, while searches for “panic attack” increased 56% in the week after lockdown and remained high for five weeks. Searches for “insomnia” increased 21% during the entire lockdown. Searches for “suicide” and “depression” did not significantly change. The results suggest “the need to provide focused competent online and telemedicine services during quarantines,” including ensuring that “individuals searching the internet can rapidly obtain reliable information on strategies to cope with distress and online help from authoritative sources.”

Another study, published by JAMA Network Open on Oct. 2, looked at how telemedicine was used during the pandemic. Using the IQVIA National Disease and Therapeutic Index, it found that the total number of primary care encounters decreased by 21.4% in the second quarter of 2020 compared to previous years. Telemedicine visits increased from 1.1% of the total in previous years to 4.1% in the first quarter of 2020 and 35.3% in the second. The content of the visits changed, too. Blood pressure level assessment decreased by 50.1%, cholesterol level assessment decreased by 36.9%, and new medication visits decreased by 26.0%. The adoption of telemedicine did not differ between Black and White patients, but did vary by region of the U.S. (range, 15.1% to 26.8%), not correlated with regional COVID-19 burden. An accompanying commentary said that the absence of disparities in telemedicine use was a reassuring finding and that the decreases in blood pressure and cholesterol measurement “could be mitigated by focusing on reliable ways of capturing objective information at home.” The commentary authors noted, however, that discrepancies still exist in access to technology and that the study did not distinguish between telephone and video visits. They called for shared decision making for which visits to conduct in person and careful stewardship of the expansion of telehealth.

Finally, a study published by Health Affairs on Sept. 24 looked at how hospital admissions for other conditions were affected as the COVID-19 pandemic wore on, using data from a large hospitalist group. After an across-the-board drop of more than 20% in February through April, admissions for conditions other than COVID-19 had rebounded to 16% below their usual volume. However, there were more significant ongoing decreases among patients living in majority-Hispanic neighborhoods and those who were self-paying, as well as for certain conditions: pneumonia (−44%), COPD/asthma (−40%), sepsis (−25%), urinary tract infection (−24%), and acute ST-elevation myocardial infarction (−22%). “Our results provide empirical support for concerns about the broad public health impact of the pandemic on non-COVID-19 populations. Some medical conditions (e.g., stroke, STEMI) require effective hospital treatment to avoid adverse outcomes; therefore fewer hospitalizations for such medical conditions are almost certainly associated with patient harm,” the authors said.

In other COVID-19 news, ACP released new living practice points on remdesivir. The practice points, published by Annals of Internal Medicine on Oct. 5 and based on a rapid systematic review of best available evidence, find that the evidence indicates a net benefit from remdesivir in COVID-19. They recommend five days of therapy in patients with moderate COVID-19 or severe COVID-19 not requiring mechanical ventilation or extracorporeal membrane oxygenation (ECMO). Clinicians should consider extending the use of remdesivir to 10 days in patients with severe COVID-19 requiring mechanical ventilation or ECMO within a five-day course.