A Reflection on MHST-601 Learnings
Through The Lens of The COVID-19 Pandemic
The COVID-19 pandemic has emerged as the biggest health care crisis and has had an unparalleled impact on the health of Canadians and our healthcare system. The impact COVID-19 has had on my practice as a respiratory therapist in critical care has been equally profound.
In my quest to better understand the scope of the impact of COVID-19, I will be exploring the impact of COVID-19 infections as well as the effect of public health measures on the social determinants of health. A multilevel framework will be used to help elucidate barriers to public health measures and I will also explore the direct and indirect impact of COVID-19 as it relates to chronic disease, vulnerable populations and virtual care.
COVID-19 In Canada,
As of April 4, 2022,
Total Number of COVID-19 Cases: 3,498,713
Total Number of COVID-19 Deaths: 37,690
Total Number of Resolved Cases: 3,295,799
(Government of Canada, 2022b)
In these unprecedented times, Canadians are experiencing the profound health, social and economical consequences brought on by the COVID-19 pandemic (Public Health Agency of Canada, 2020). Existing health inequities have further been impacted by COVID-19 infections and by the implementation of public health measures, the consequences of which has significantly contributed to the differences seen in COVID-19 cases, hospitalizations, and deaths (Public Health Agency of Canada, 2020).
Social Determinants of Health
Although everyone is susceptible to the COVID-19 virus, known as SARS-CoV-2, disparities in the social determinants of health profoundly impact an individual’s risk of exposure, susceptibility to the virus, and severity of disease (Burström & Tao, 2020). The social determinants of health (Table 1) are defined as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life" (World Health Organization, n.d.).
An individual’s risk of exposure is increased when upstream factors such as employment, housing and transportation does not afford an individual the ability to adhere to the public health measures of physical distancing (Public Health Agency of Canada, 2020). These factors are further detailed in Table 2.
Furthermore, factors such as age and individual health behavior (i.e, smoking) not only increase an individual’s risk of becoming infected with SARS-CoV-2, but also increases an individual’s susceptibility to the virus (Public Health Agency of Canada, 2020). Susceptibility to infection following exposure to SARS-CoV-2 also increases in individuals afflicted with chronic disease, for example, hypertension, asthma or diabetes.
(Public Health Agency of Canada, 2020).
Chronic Disease
Chronic disease statistics in Canada are sobering. 60% of adult Canadians are afflicted with a chronic disease, and 75% are at risk of developing a chronic condition (Betancourt et al., 2014). Chronic diseases such as diabetes, cancer, arthritis, mental illness, cardiovascular and chronic respiratory diseases lead to poor quality of life and premature death in Canada (Betancourt et al., 2014). Of hospitalized COVID-19 patients, 74 % reported one or more chronic condition (Chronic Disease Prevention Alliance of Canada, 2020). Worsening of their chronic condition after having COVID-19 has been reported by 65% of COVID patients, both hospitalized and non-hospitalized (Viral Neuro Exploration, COVID Long-Haulers Support Group Canada & Neurological Health Charities Canada, 2021). Individuals experiencing low socioeconomic circumstances such as lower income and poor social support are disproportionately burdened with chronic disease (Betancourt et al., 2014).
The long-term effects of COVID-19 infections are now emerging, with many individuals reporting multiple symptoms that persists for weeks to months after the initial infection (Vanichkachorn et al., 2021). This post-COVID syndrome, also referred to as long haul COVID is concerning, as 25-35 % of recovered COVID-19 patients are experiencing these lingering effects that can lasts for months (Viral Neuro Exploration, COVID Long-Haulers Support Group Canada & Neurological Health Charities Canada, 2021). By early April 2022, an estimated 3,295,799 Canadians have been infected with COVID-19 and have recovered (Government of Canada, 2022b). Therefore, an estimated 825 000 or more will likely experience the long-term effects of COVID-19 infection. Of note, individuals with less severe symptoms of COVID-19, many of whom had not been hospitalized, seem to be disproportionately affected by these long-term symptoms (Viral Neuro Exploration, COVID Long-Haulers Support Group Canada & Neurological Health Charities Canada, 2021). The top reported symptoms are cognitive issues also described as brain fog as well as fatigue, headaches, and dizziness, anxiety, depression and shortness of breath (Viral Neuro Exploration, COVID Long-Haulers Support Group Canada & Neurological Health Charities Canada, 2021). Women in their middle years appear to be disproportionately impacted, almost two times more than men (Viral Neuro Exploration, COVID Long-Haulers Support Group Canada & Neurological Health Charities Canada, 2021). The impacts are profound. Many have been unable to return to their baseline with respect to their health and many are unable to return to work in any capacity (Viral Neuro Exploration, COVID Long-Haulers Support Group Canada & Neurological Health Charities Canada, 2021). While it is too soon to ascertain, experts are worried COVID-19 is becoming a chronic disease (Higgins et al., 2021).
Vulnerable Population
Marginalized and vulnerable populations such as Indigenous Peoples are also disproportionally affected by COVID-19, due to an increased risk of exposure and susceptibility as a result of existing health disparities (Abrams & Szefler, 2020). Poverty, lack of adequate housing, lack of nutrition, unemployment as well as a high rate of chronic disease have increased the risks for Indigenous Peoples (Public Health Agency of Canada, 2020). The public health measures put in place to contain the spread of the infection have further exposed the vulnerabilities of the Indigenous Peoples and have also underscored the importance of addressing the social determinants of health. Many Indigenous Peoples live in close proximity to their elders, in multi-generational homes, making it difficult to adhere to public health guidelines such as physical distancing and isolation (Public Health Agency of Canada, 2020). Tragically, First Nations Peoples living on a reserve experienced a COVID-19 case fatality rate of 67% early in the pandemic as compared to the rest of the population (Government of Canada, 2022a).
Public health measures such as isolation and closures of non-essential services and schools had a negative impact on the social determinants of health. Loss of employment, food insecurity, interruption in education, social isolation and disruption of family life has further impacted those already affected due to existing health inequities (Public Health Agency of Canada, 2020). Individuals most at risk of worsening mental health issues and at increased risk of suicide are predominantly from marginalized groups such as Indigenous Peoples and LGBTQ+. (Public Health Agency of Canada, 2020). A framework adapted by Public Health Agency of Canada (2020) further explores the impacts of those COIVD-19 pandemic as they relate to the determinants of health.
Multilevel Model of Health
Implemented early in the pandemic to reduce the risk of exposure, public health measures such as wearing face masks in public, have been the target of misinformation, which has contributed to increased confusion, insecurity, fear and has greatly influenced the public’s perception of risks related to COVID-19 (Tagliabue et al., 2020). The virulent nature of this misinformation has led to mistrust in experts and the medical community (Rosenberg et al., 2020).
As hesitancy and doubt related to mask wearing occurs at multiple levels, a multilevel model approach was used in uncovering barriers to mask wearing. At the individual level, compliance regarding mask wearing is identified as being affected by perceived feelings of invincibility and low susceptibility by younger adults (Casola et al., 2021). Other individual factors include public health illiteracy as described by the lack of understanding on how to wear the mask as well as understanding the importance of wearing a mask in the prevention of COVID-19 (Casola et al., 2021). Interpersonal and community influences include difficulty in obtaining masks due to financial challenges, further compounding difficult situations such as using public transportation where masks may be required, thereby creating barriers for individuals attempting to access health care services or essential items (Casola et al., 2021).
Misinformation from social media outlets and the inconsistencies from one government to another have contributed to increased confusion and has influenced individuals at the societal level (Casola et al., 2021). Racial stigmas and social inequities identified amongst Black and Hispanic who resist wearing face masks in public as covering their face could worsen an already dire situation with respect to racial profiling has also influenced mask wearing choices (Casola et al., 2021).
Future of Healthcare
As a result of public health measures, a shift towards virtual health and virtual social services was rapidly implemented to ensure the provision of care (Crawford & Serhal, 2020). Beyond the pandemic, virtual care enables continued and sustained access to care, and is estimated to be the leading approach to the delivery of future healthcare (Crawford & Serhal, 2020). As with the traditional delivery of health care, there are challenges to ensuring equitable access and it is important to ensure that digital health technologies do not exacerbate existing health disparities, particularly amongst individuals who experience digital illiteracy or experience barriers in accessing internet-enabled devices (Crawford & Serhal, 2020).
In summary, the Critical Foundations in Health Disciplines has contributed to my knowledge gaps and learning needs as it pertains the many challenges and benefits of the health care system in Canada. COVID-19 has certainly challenged the status quo. As we move to a more endemic approach in dealing with COVID-19, I can continue to apply the key learnings from this course to further explore and understand the challenges COVID-19 throws my way.
References
Abrams, E. M., & Szefler, S. J. (2020, July1). COVID-19 and the impact of social determinants of health. The Lancet Respiratory medicine, 8(7), 659–661. https://doi.org/10.1016/S2213-2600(20)30234-4
Betancourt, M. T., Roberts, K. C., Bennett, T-L., Driscoll, E. R., Jayaraman, G., & Pelletier, L. (2014). Monitoring Chronic Diseases in Canada: the Chronic Disease Indicator Framework. Chronic Diseases and Injuries in Canada, 34(1). https://doi.org/10.24095/hpcdp.34.S1.01
Burström, B., & Tao, W. (2020). Social determinants of health and inequalities in COVID-19. European journal of public health, 30(4), 617–618. https://doi.org/10.1093/eurpub/ckaa095
Casola, A. R., Kunes, B., Cunningham, A., & Motley, R. J. (2021). Mask Use During COVID-19: A Social-Ecological Analysis. Health Promotion Practice, 22(2), 152–155. https://doi.org/10.1177/1524839920983922
Chronic Disease Prevention Alliance of Canada. (2020). Chronic Disease and COVID-19. http://www.cdpac.ca/
Government of Canada. (2020, October 7). Social Determinants of Health and Health Inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Government of Canada. (2022a, April 4). Confirmed Cases of COVID-19. Retrieved from https://sac-isc.gc.ca/eng/1598625105013/1598625167707
Government of Canada. (2022b, April 4). COVID-19 Daily Epidemiology Update. Retrieved from
Higgins, V., Sohaei, D., Diamandis, E. P., & Prassas, I. (2021). COVID-19: from an acute to chronic disease? Potential long-term health consequences. Critical Reviews in Clinical Laboratory Sciences, 58(5), 297–310. https://doi.org/10.1080/10408363.2020.1860895
Public Health Agency of Canada. (2020, October). Chief Public Health Officer of Canada's Report on the State of Public Health in Canada 2020. https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19/cpho-covid-report-eng.pdf
Rosenberg, H., Syed, S., & Rezaie, S. (2020). The Twitter pandemic: The critical role of Twitter in the dissemination of medical information and misinformation during the COVID-19 pandemic. CJEM, 22(4), 418–421. https://doi.org/10.1017/cem.2020.361
Tagliabue, F., Galassi, L., & Mariani, P. (2020). The "Pandemic" of Disinformation in COVID-19. SN Comprehensive Clinical Medicine, 1–3. Advance online publication. https://doi.org/10.1007/s42399-020-00439-1
Vanichkachorn, G., Newcomb, R., Cowl, C. T., Murad, M. H., Breeher, L., Miller, S., Trenary, M., Neveau, D., & Higgins, S. (2021). Post-COVID-19 Syndrome (Long Haul Syndrome): Description of a Multidisciplinary Clinic at Mayo Clinic and Characteristics of the Initial Patient Cohort. Mayo Clinic Proceedings, 96(7), 1782–1791. https://doi.org/10.1016/j.mayocp.2021.04.024
Viral Neuro Exploration, COVID Long-Haulers Support Group Canada & Neurological Health Charities Canada. (2021, June 8). Report on Pan-Canadian Long Covid Impact Survey. Government of Canada. d8d3d3b0-c936-11eb-ba89-e7f98c8c358b-FINAL---Report-on-Long-Covid-Impact-Survey---June-8-2021.pdf (cosmicjs.com)
World Health Organization. (n.d.). Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
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