New health concerns emerge post-pandemic

As the spread of COVID-19 slows in Iowa, health professionals are voicing concerns about post-pandemic health issues. 

The main concerns in the state are still related to the pandemic, both physically — with post-COVID syndrome and inflammation issues — and mentally.

With hospitals, medical centers, and health clinics returning to full volumes, they are still receiving COVID positive patients. They are also seeing more patients with “Long COVID” or post-COVID syndrome, said Dr. Nicole Gilg Gachiani, the chief physician quality officer at Broadlawns Medical Center in Des Moines.

“We continue to diagnose patients with COVID, but now we see more patients with post-COVID syndrome, which is tricky because the symptoms can be quite vague,” she said. “It’s difficult to tell if it’s actually related to a previous COVID infection.”

There are several long-term effects for people who tested positive for COVID-19, according to the U.S. Centers for Disease Control and Prevention. Whether it’s “Long COVID,” a range of symptoms that can last months after first being infected, or health effects after treatment or hospitalization, long-term health issues are a reality for some previously COVID-positive people.

Long COVID presents similar symptoms to those endured when first infected, including fatigue, dizziness, fever, and difficulty breathing. There is no clear link between risk factors and long-term COVID symptoms, according to Johns Hopkins Medicine. 

One of the most difficult parts of Long COVID is the unknown, Glig Gachiani said. She tries to make evidence-based decisions for patients, but she said she runs into issues due to the lack of research on the syndrome.

Dr. Barbara Hodne, chief quality officer for The Iowa Clinic’s Ankeny location, agreed. She said there are a variety of symptoms and there aren’t guidelines to suggest how long they’ll stick around.

Potential inflammation and blood clot issues

However, extended novel coronavirus symptoms is not Hodne’s biggest concern. Neurological damage and inflammatory issues are also present in previously COVID-positive patients, she said, and these can be more dangerous.

“We know a lot about the body’s inflammatory response to COVID, which might be things like blood clots in legs or ones that travel to their [patients’] lungs,” she said. “Sometimes there’s heart damage. There’s a whole variety of potential long-term consequences that linger.”

There are also concerns of neurological damage for people who tested positive, she said. When patients cannot smell or taste for a long period of time, there is nerve irritation and inflammation that hinders the body’s ability to use all of its senses, she said. 

These issues have a variety of potential long term effects, Hodne said, but there isn’t enough research on the topic to know them all or who is likely to have them. 

Anxiety and depression rates continue to rise

While the physical health of patients has been monitored closely this pandemic, so has the mental health of Iowans. Whether they tested positive for the virus or not, anxiety, depression, stress, and substance abuse rates went up drastically, said Broadlawns Outpatient Mental Health Services Director Dr. Kindra Perry. 

Visits at the hospital’s outpatient behavioral health clinic are up by 15%, she said in an email to Iowa Capital Dispatch.

“Now that we’re beginning to emerge from the last year, it’s important to take a step back and acknowledge the difficulties that we faced,” she said. “It’s normal to have struggled and to have felt more anxious, stressed, or depressed.”

The diversity of symptoms isn’t strictly in physical health. Perry said quarantine fatigue — the exhaustion experienced because of a restricted lifestyle — and re-traumatization are big concerns for mental health professionals. Isolation and grief are also causing more stress, anxiety, and depression in the short and long term, she said. 

Iowa’s trends are concurrent with the rest of the country, National Alliance on Mental Illness Iowa Executive Director Peggy Huppert said. The national hotline for NAMI saw a 93% increase in calls while 42% of Iowa adults reported dealing with issues of anxiety and depression, nearly doubling before-COVID numbers, she said. 

“As life changing as the pandemic has been, we’ve been through a lot more than that,” she said. “In the last 15 months, Iowa’s been through a drought, racial unrest, the derecho, and a contentious presidential election … That’s a lot of collective trauma and people are still dealing with it and they will be for some time.”

Perry and Huppert said 15- to 25-year-olds were the age group most affected by the pandemic. Perry said minorities, essential workers, and COVID “long haulers” are also at increased risk of mental health issues. Huppert said the deprivation of contact for young people’s developing brains  caused a significant amount of struggling that is still present. 

Hospital functions change in another stage of the pandemic

With hospitals returning to normal operations, medical professionals are recuperating and learning from the pandemic, CEO of the University of Iowa Hospitals and Clinics Suresh Gunasekaran said. 

“There are some lessons we’re taking post-pandemic, and probably the most important one is that health care is mostly delivered by people to other people,” he said. “It’s been a long pandemic for frontline health care workers. And we’re really committed to supporting caregivers as they come through this period of significant exhaustion.”

The University of Iowa Hospitals and Clinics are also continuing telehealth services, Gunasekaran said. The medical centers see people from all over Iowa, he said, and most check-ins can be done from the comfort of patients’ homes now. 

NAMI Iowa is also planning to utilize hybrid options moving forward, Huppert said, after seeing strong participation online. Hodne said The Iowa Clinic will continue to use telehealth options when it is “appropriate for care.”

Gilg Gachiani said the increased variety of uses for telehealth is the “silver lining” of the pandemic. Now that the infrastructure exists, she said Broadlawns will utilize online options to increase accessibility.

“It’s been really beneficial for patients and staff in being able to make health care more accessible and more efficient,” she said. “Telehealth is more beneficial for some patients, and I’m excited to see it continue in the future.” 

Moving forward into a ‘new normal’

Cases of COVID-19 are steadily decreasing in the United States, but Hodne said people must remember complacency is a problem. She said people need to stay vigilant about new information regarding vaccine booster shots and CDC guidelines because conditions can change at any time.

“It’s critical for our population to receive the vaccine so we have lower numbers of people transmitting the virus and decreasing the risk of mutations,” she said. “Once they have the vaccine, they need to stay tuned for new recommendations.”

Gilg Gachiani said patience is still necessary with medical professionals as guidance continually changes with new research and evidence that improves decision making. 

Alongside vigilance, Huppert said everyone needs to keep an eye out and be aware of the people around them. The pandemic has impacted everyone differently, and returning to normalcy will be difficult, she said. 

“The return to normalcy is very welcome, but that doesn’t mean that people aren’t still suffering,” she said. “We need to be on the lookout for those close to us who aren’t bouncing back. It’s OK to not be OK, to recognize that, and ask for help, especially now.”