Clinically Speaking: Impacts of COVID-19 on Population Health

We explore three ways the COVID-19 pandemic is affecting overall population health, beyond the short-term impacts of the virus.

A potential increase in cancer diagnoses and mortality

Due to precautions taken to prevent the spread of COVID-19, especially at the start of the pandemic, we saw a decrease in preventive care, particularly cancer screenings.

Between March and July 2020, Evernorth data showed a decrease in cancer screenings of more than 80%, as well as 25% fewer cancer diagnoses. Even 17 months later, as of December 2021, these numbers had not returned to pre-pandemic levels.

Delays in diagnosis and treatment means we can expect an increase in cancer mortality and also in the cost of treatment for cancer care. In fact, data shows that cancer costs are expected to increase 40% over the next decade.

However, plan sponsors, in collaboration with providers, can work to mitigate this trend by promoting proper screening, encouraging telehealth visits when appropriate, and by supporting more systemic planning of care.

An increase in diabetes diagnoses

The second impact on population health is around obesity and diabetes, or what we call “diabesity”.

The American Psychological Society found 42% of those surveyed reported gaining 29 pounds or more between March 2020 and 2021. And it’s not just adults. Pediatric providers are seeing gains of 15 to 20 pounds in middle-schoolers across the U.S.

The COVID-19 virus has been associated with worsening insulin sensitivity, pancreatic cell death, and fatty liver infiltration. This means people with diabetes – already more prone to COVID-19 infection – experienced a worsening of their diabetes progression after their COVID infection.

Similar to the effects on cancer diagnoses, a study in the U.K. found a 30% increase in expected diabetes diagnosis from 2020 to 2021 due to patients avoiding primary care.

As primary care resumes, plan sponsors can expect significant increases in diabetes diagnoses in the next two years, as well as increased spending on diabetes care through 2025.

The impacts of long COVID

Long COVID is the appearance of prolonged, debilitating symptoms more than 90 days from an initial COVID-19 infection. There are varying reports on the prevalence of long COVID – with some studies indicating it affects 2 to 10% of people who contract the virus and others citing up to 30%.

There are different syndromes associated with long COVID. Convalescent COVID syndrome is characterized by brain fog, ongoing irregularity in heartbeat and shortness of breath. Chronic fatigue syndrome includes ongoing tiredness not improved by rest. Post-intensive care unit-like syndrome occurs when people have a prolonged loss of conditioning after a hospital stay. And post-traumatic stress disorder is driven by the experience of losing loved ones, a lack of community or socialization, and other related long-term impacts of the pandemic.

In many cases, treatment recommendations include increased access to behavioral health care, physical therapy, primary care and specialty care.

However, in the next 2 to 5 years, these syndromes may result in increased costs among certain disease classes, including blood disorders, heart disease, pulmonary conditions, kidney disease and diabetes.

While the pandemic has created sizeable challenges for health care, plan sponsors have more opportunities to address them as we move into this next phase. Increased access to telehealth, advances in home monitoring, and greater investment in coordinating care across pharmacy, medical, and mental health can all significantly improve outcomes.