The Pandemic’s Mental Toll, and Does Telehealth Work? Your Health Quickly, Episode 1

Tanya Lewis: Hi. I’m Tanya Lewis.

Josh Fischman: And I’m Josh Fishman. We’re Scientific American’s senior health editors.

Lewis: Welcome to the show formally known as COVID, Quickly.

Fischman: Now it’s the first episode of a new show that’s about COVID, but also a lot more.

Lewis: We’re entering the third year of our podcast. Wow. And the fourth year of COVID. The disease is still here and it’s still serious, but life for everyone is a little bit different now. So instead of just pandemic news, we want to highlight other health news, too, and demystify medical research in a way you can use to stay healthy.

Fischman: We’re calling the show Your Health, Quickly.

Lewis: We’ll keep covering important updates on COVID. But now we’re also going to bring you the latest research on other infectious diseases like the flu.

Fischman: And noninfectious ones like cancer and heart disease, reproductive health and mental health.

Lewis: We’ll also discuss the latest science on preventive health, nutrition and much more. We hope you enjoy the show.

Fischman: We should probably tell people what we’re talking about today.

Lewis: Okay. So our first topic is still somewhat COVID related, but it’s something we haven’t really talked about that much. The pandemic’s impact on mental health.

Fischman: And we’ll discuss ways that all across medicine, telehealth is changing how care is being delivered, even for things like cancer and diabetes.

Lewis: When the pandemic was at its worst, it made sense for us to focus on the risks of dying from the virus itself. But thanks to effective vaccines and treatments, we’re in a different place now. So now we can start to address some of the impacts the past few years have had on our well-being.

Fischman: That’s a good point. All of the lockdowns and the isolation have certainly taken a toll on us mentally.

Lewis: They really have. I know I found it hard to avoid seeing friends and family during the worst COVID surges on top of the constant fear of getting sick. And it’s not just anecdotal. There’s mounting evidence that these mental strains are widespread.

Fischman: Tell me about it. What do these data show?

Lewis: Well, a nonprofit called the Kaiser Family Foundation has been tracking mental health throughout the pandemic with an ongoing poll. In early 2021, the data showed that as many as four in ten adults had symptoms of anxiety or depression, compared with only one in ten adults before the pandemic. That fraction is now closer to three in ten, but that’s still a lot of depressed, anxious people.

Fischman: That means every third person I walk by on the street has some of these issues. What are some of the ways that this has played out?

Lewis: People have reported problems with sleeping and eating, and they started drinking and using drugs more and existing chronic health problems got worse. To find out more, I talked to the lead author of that report on mental health.

Nirmita Panchal: My name is Nirmata Panchal, and I’m a senior policy analyst at the Kaiser Family Foundation.

Lewis: Can you just tell me a little bit about what some of the major findings were?

Panchal: So as we know, during the pandemic, people have experienced a number of different changes and disruptions. For some that may be increased isolation. For others, it may be job loss and experiences such as housing and food insecurity.

Lewis: Can you talk a little bit more specifically about the impact on children and young adults in particular?

Panchal: When we looked at the young adult population and during the pandemic, they have experienced a number of disruptions during a time that’s already filled with a great deal of transition. Transitioning to college and then experiencing college closures in light of the pandemic. Perhaps they may be experiencing job loss or a reduction in their work hours. And what we knew leading up to the pandemic is that a large share of young adults were not receiving mental health care.

Fischman: That’s really tough on that age group.

Lewis: A lot of these kids had to miss out on major milestones like graduations and birthday parties.

Fischman: Yeah. So, you know, like, when you’re 16, that could be a big valley in your life.

Lewis: When you’re that age, when you’re a teenager, it’s so important and you just want to share in that with all your friends. As you probably saw, there was a recent CDC report that found record high levels of sadness and suicidal thoughts among teenage girls. Can you talk about that and why girls may be particularly at risk?

Panchal: Some of the data we’ve seen during the pandemic has found that adverse experiences at home for a lot of adolescents, they tend to be more elevated among young females compared to their male peers. At the same time, we’ve also found rates of self-harm are increasing more quickly among young females.

Lewis: I’m wondering whether you think that these mental health impacts are likely to persist long term?

Panchal: Yeah, that’s a great question. I think, you know, while we don’t have those answers yet, we do know that many mental health conditions develop during adolescence. And if they go untreated, they can persist into adulthood and they can limit quality of life.

Lewis: One of the points that Nirmita made was that you really need to address this in schools. So schools are like a natural place for connecting kids with mental health services.

Fischman: Which of course is going to require local school districts and states to pony up money for schools.

Lewis: You can’t just expect kids to be so isolated and deal with all of these stresses and not have there be some kind of long term fallout.

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Fischman: There’s one change that we all made during the pandemic that looks like it’s going to stick around, and that’s telehealth. Using a video or audio connection for a checkup with your doctor.

Lewis: Before COVID hit, telehealth was pretty rare. Insurance companies didn’t reimburse health care workers for doing it, and various regulations required what they called an in-person relationship.

Fischman: But then in 2020, we suddenly had to keep our distance to avoid infecting others. So those regulations were relaxed and telehealth boomed. The boom spread throughout medicine, including cancer care, endocrinology and a bunch of other specialties.

Lewis: How big a boom are you talking about?

Fischman: A pretty big one, Tanya. At Stanford Health Care in California, telehealth shot up from about 3 percent of visits before the pandemic to about 70 percent during it. Now, a lot of health care networks are saying that it’s settled in at about 10 to 30 percent of all their patient visits.

Lewis: But how do you do cancer care over video? Don’t you have to show up in person for chemo and x-rays?

Fischman: Well, that’s an excellent question. And you’re not the only one curious about that. Our colleague, reporter Lydia Denworth, wanted to know about this, too. So I asked her to stop by and explain. Maybe you should start by telling everyone who you are, Lydia.

Lydia Denworth: I’m Lydia Denworth. I’m a science journalist and I’m a contributing editor for Scientific American for the magazine. And I am also now the new columnist for the Science of Health column.

Fischman: Good to have you here. Now, you yourself have done some telehealth, haven’t you?

Denworth: I did. And like many other people in this country during the pandemic, I had some sessions with my psychiatrist, but had to be by video through telehealth instead of in-person. That made me curious. As you know, the pandemic is beginning to abate in from people’s lives about how telehealth is actually being used.

Fischman: I can imagine that talk therapy, psychotherapy lends itself to telehealth. But you found some surprises in other medical specialties, didn’t you?

Denworth: I did. But it turns out that things like cancer care also are making quite substantial use of telehealth in places.

Fischman: How can you care for a cancer patient through a video link?

Denworth: You usually have to go to the doctor quite a lot and it turns out that you can cut out like a big chunk of those appointments, the ones that don’t require things like an infusion for immunotherapy. So when you’re talking to your doctor and checking in with your doctor, you can do those appointments virtually and save everybody some time.

Fischman: Does that work as well as getting in your car and driving to your doctor’s office or to a hospital?

Denworth: It absolutely does. There are a lot of medicine that is still a conversation between a patient and a doctor. There are some some specialties that are finding there are real advantages to talking to people in their homes or endocrinologists who treat diabetes can also see people at home and get more kind of clues to what their home life is like, what their diet might be like at home, and how things are going.

Lewis: Lydia does make some good points. But I do wonder how these virtual visits compare to in-person visits for quality of care.

Fischman: It turns out that they actually stack up pretty well., Tanya. There have been a few studies checking up on care. Nearly 90 percent of the time a virtual diagnosis agreed with a later diagnosis made in person, researchers reported in the journal JAMA Network Open last year, and another study of more than 500,000 patients found equal or better outcomes for telehealth across 13 of 16 primary care measures such as management of diabetes and getting signed up for flu shots.

Lewis: That’s pretty good. I guess another advantage is in rural areas where your doctor can be hours away, but virtually you can save all that time and money commuting, and you don’t have to take a whole day off work.

Fischman: Lydia goes into this in a lot more detail there in her article on Telehealth for SciAm, which you can read online starting in the middle of March and in the April print issue.

Your Health Quickly is produced and edited by Jeff DelViscio, Tulika Bose and Kelso Harper.

Lewis: The show is one of Scientific American’s Science, Quickly podcasts. Subscribe to Science, Quickly wherever you get your podcasts.

Fischman: And don’t forget to go to SciAm.com for updated and in-depth health news.

Lewis: We’ll be back in two weeks. Talk to you then.