Preeti Malani is Chief Health Officer and a professor of medicine at the University of Michigan. She is also the director of the National Poll on Healthy Aging based at the Institute for Healthcare Policy and Innovation. 

Throughout the COVID-19 pandemic, the main focus has been decreasing viral transmission through strategies like social distancing and stay-at-home orders. Yet infection is not the only risk to health and well-being during this time. Public health mitigation measures (and resulting social isolation), general fear about COVID-19 along with economic worries can all increase psychological distress and loneliness. 

A new study published in JAMA Psychiatry by Kristin M. Holland and colleagues examined changes in U.S. emergency department (ED) visits during the pandemic. Using data from the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program, the authors looked at nearly 190 million ED visits from the start of 2019 through October 2020.  They found that mean visit rates (per 100,000 ED visits) for mental health conditions, suicide attempts, drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher in mid-March through October 2020 compared with the same period in 2019. For example, there was a 15% jump in visit rates for mental health conditions, 21% for suicide attempts and 45% for opioid overdoses.

There are limitations to the data used in this study. They are not representative of all EDs nationwide, and ED visits were down across the board during the pandemic, which likely affected the observed rates for these types of visits. However, the findings underscore the need to further integrate mental health care, substance use treatment, violence screening and other prevention services into the overall response to public health crises. The results also highlight the opportunity to better connect patients with services prior to discharge.  

This study is a stark illustration that the true cost of the pandemic goes beyond COVID-19 related hospitalizations and deaths. And while violence, overdoses, and suicides have been exacerbated by COVID-19, they won’t simply go away when the pandemic ends. These are complex problems that require complex solutions, including strengthening economic supports to lessen financial stressors and changing payment and regulatory policies to expand telehealth, behavioral health and addiction treatment services. Much like the public health infrastructure was mobilized to contain the spread of COVID-19 infection, the same type of approach is needed to overcome the consequences of social isolation and loneliness.