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Published: May 10, 2020

COVID-19 and Preparing for Secondary Health Effects

Health care providers responding to the COVID-19 public health emergency, both those directly treating patients with the coronavirus and those working to ensure continuity of care for other health conditions, understand that the health impacts of this public health emergency go beyond COVID-19 cases.

Many patients are experiencing disruptions in their access to medications and care or are even delaying needed care out of fear of COVID-19. What’s more is that the stress caused by the outbreak, the necessary physical distancing measures to slow the spread of the virus, and the resulting distress due to lost wages, unemployment, and school closures are taking a huge toll on our brains and bodies. These secondary impacts will acutely affect the health and well-being of Californians in weeks, months, and even years ahead.

Experience and research have demonstrated that crises, such as widespread communicable disease outbreaks (like COVID-19) and natural disasters, result in short- and long-term physical and mental health impacts, including increased cardiovascular, metabolic, immunologic, and neuropsychiatric risk. These result from disruption of access to care and the resources needed for health maintenance, as well as to over-activity of the biological stress response, also known as the toxic stress response.

If providers don’t act intentionally and inclusively, the disproportionate impact of COVID-19 on at-risk communities will worsen existing health, social, and economic disparities. For myriad and complex reasons, including increased exposure to cumulative adversity, communities of color have a higher rate of many underlying medical conditions that increase risk for serious COVID-19 infection. These include heart disease, high blood pressure, chronic lung diseases, diabetes, kidney disease, and some cancers.

Providers can help address and mitigate negative health outcomes associated with toxic stress by responding with disaster-responsive, trauma-informed care, and treatment plans that also include measures to help regulate the stress response system.

It is vital that providers learn the signs and assess for toxic stress-related morbidity, including elevated blood pressure, increased Hemoglobin A1c, exacerbations of chronic obstructive pulmonary disease and asthma, immune dysregulation, and mental and behavioral health deterioration, which may increase risk for infection, autoimmune disorders, heart attack, stroke, and other stress-related health conditions.

Providers can stay informed on the most current guidance and best practices and should support continuity and integration of medical and behavioral health services via telehealth and related adaptations in service delivery during the crisis. The Department of Health Care Services has specific guidance for Medi-Cal providers, including on Telehealth and Virtual/Telephonic Communications.

Launched earlier this year, the ACEs Aware initiative offers Medi-Cal providers training, clinical protocols, additional resources, and payment for screening children and adults for Adverse Childhood Experiences (ACEs) and responding with trauma-informed care. Individuals with a history of ACEs are especially vulnerable to negative health outcomes related to the COVID-19 emergency. As a result, ACEs Aware has created and curated evidence-based clinical tools and resources specifically to support providers in recognizing and responding to stress-related morbidity and specific guidance on the topic in COVID-19 response.

In the weeks and months to come, identifying patients at risk for toxic stress and supplementing usual care with strategies to regulate the stress response system can yield highly impactful, life-saving results.

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