The potential impact on heart and brain disease poses challenges to healthcare systems globally
When Dr David Strain encountered a 64-year-old patient on his ward round, the British geriatrician had a bleak epiphany.
Less than six months earlier he had treated the man for Covid-19. Now, his deterioration was painful to witness. “He came in with a stroke and really bad delirium, a precursor of dementia,” Strain says. “I saw the patient, recognised him [and] recognised the fact that his brain had dramatically aged.”
By unsettling coincidence, the same day Strain, who is based at the University of Exeter in England’s west country, had read a newly published study which identified significant brain shrinkage in a cohort of about 400 people aged between 51 and 81 who had recovered from coronavirus.
The encounter crystallised Strain’s belief that Covid generated a kind of epidemiological aftershock by leaving people susceptible to a huge range of other conditions, threatening global health systems already struggling with insufficient resources and ageing populations. “It made me realise that this is something that we’re going to be facing in a really big way in the near future,” he says.
As he started to see a rise in certain conditions in the first year of the pandemic, Strain assumed it was the result of people being unable or unwilling to access healthcare. Only as the pandemic entered its second year did he begin to suspect that Covid itself could be increasing vulnerability to other serious illnesses.
He now sees it as an inversion of the huge drop in respiratory illness doctors saw from the 1980s onwards, when millions either stopped or reduced smoking. “The level of damage that’s been done to population health [during Covid], it would be as if everybody suddenly decided to take up smoking in one go,” Strain says.
David Strain of Exeter University believes Covid generated a kind of epidemiological aftershock by leaving people susceptible to a huge range of other conditions © Tom PIlston/FT
While more data will accumulate in the coming years, there is already evidence to back up his concerns. A Financial Times analysis of data from the UK’s NHS, one of the world’s richest health data sets, showed significant rises in deaths from heart disease since the start of the pandemic in all but the very oldest age groups. In the 40-64 age group, heart attack deaths increased 15 per cent in 2021 compared with 2019.
In February, meanwhile, an analysis of more than 150,000 records from the national healthcare databases at the US Department of Veterans Affairs suggested that even some people who had not been seriously ill with Covid had an increased risk of cardiovascular problems for at least a year afterwards.
Researchers found that rates of many conditions, such as heart failure and stroke, were substantially higher in people who had recovered from Covid than in similar people who had not been infected. A separate analysis of VA data, published in March, suggested that in the “post-acute phase” of the disease, people with Covid “exhibit increased risk and burden of diabetes”.
“What’s particularly alarming is that these are really life-long conditions,” says Dr Ziyad Al-Aly, chief of research and development at the VA St Louis Health Care System and clinical epidemiologist at Washington University in St Louis, who led both pieces of research.
While just 4 per cent more people contracted heart failure following a Covid infection than those who had not been infected, “because the number of people infected with Sars-Cov-2 in the world is colossal, even small percentages will translate into huge absolute numbers.
“Will it be sufficient to elevate the burden of chronic disease and subsequently put an additional strain on healthcare systems? We think the answer is yes,” he adds.
Some researchers caution it is too early to draw broad conclusions from limited data. Dr Christopher Murray, director of the Seattle-based Institute for Health Metrics and Evaluation (IHME), says the increases might also reflect inconsistencies in reporting. In the first year of the pandemic, for example, many of the deaths in older people had been assigned to dementia when they may in fact have been due to undiagnosed Covid, which had a high death rate in the very elderly. “Disentangling that is quite tricky”, he says.
But although the evidence is still coming into focus, it is already becoming clearer to clinicians and health leaders in medical systems around the world that they are coping with a higher burden of disease in the population — whether from the increased susceptibility to serious illness after Covid, or from the lingering, little understood impact of long Covid, or a backlog of patients.
At the same time, over the past two years many workers have burnt out, or were lost fighting the pandemic on the front lines. “Our capacity may be shrinking at a time when the demand in the population is increasing,” warns Eric Schneider, an executive vice-president at the National Committee for Quality Assurance, a non-profit organisation that focuses on improving health care quality.
Jeremy Lim of Singapore’s NUS Saw Swee Hock School of Public Health acknowledges that structures must be kept in place for those people who are not able to take their health destinies into their own hands © Cyril Ng
This combination of rising disease levels and scarce resources is forcing medical professionals to re-evaluate the way they practise medicine and organise healthcare, putting a greater emphasis on preventive care, collaborative working, and telehealth to manage chronic disease and boost population health.
Given the many challenges healthcare professionals are facing “it’s impossible to square the circle unless we are prepared to very fundamentally rethink how we deliver healthcare,” says Jeremy Lim, director of the Leadership Institute for Global Health Transformation at Singapore’s NUS Saw Swee Hock School of Public Health.
When Dr David Strain encountered a 64-year-old patient on his ward round, the British geriatrician had a bleak epiphany.
Less than six months earlier he had treated the man for Covid-19. Now, his deterioration was painful to witness. “He came in with a stroke and really bad delirium, a precursor of dementia,” Strain says. “I saw the patient, recognised him [and] recognised the fact that his brain had dramatically aged.”
By unsettling coincidence, the same day Strain, who is based at the University of Exeter in England’s west country, had read a newly published study which identified significant brain shrinkage in a cohort of about 400 people aged between 51 and 81 who had recovered from coronavirus.
The encounter crystallised Strain’s belief that Covid generated a kind of epidemiological aftershock by leaving people susceptible to a huge range of other conditions, threatening global health systems already struggling with insufficient resources and ageing populations. “It made me realise that this is something that we’re going to be facing in a really big way in the near future,” he says.
As he started to see a rise in certain conditions in the first year of the pandemic, Strain assumed it was the result of people being unable or unwilling to access healthcare. Only as the pandemic entered its second year did he begin to suspect that Covid itself could be increasing vulnerability to other serious illnesses.
He now sees it as an inversion of the huge drop in respiratory illness doctors saw from the 1980s onwards, when millions either stopped or reduced smoking. “The level of damage that’s been done to population health [during Covid], it would be as if everybody suddenly decided to take up smoking in one go,” Strain says.
David Strain of Exeter University believes Covid generated a kind of epidemiological aftershock by leaving people susceptible to a huge range of other conditions © Tom PIlston/FT
While more data will accumulate in the coming years, there is already evidence to back up his concerns. A Financial Times analysis of data from the UK’s NHS, one of the world’s richest health data sets, showed significant rises in deaths from heart disease since the start of the pandemic in all but the very oldest age groups. In the 40-64 age group, heart attack deaths increased 15 per cent in 2021 compared with 2019.
In February, meanwhile, an analysis of more than 150,000 records from the national healthcare databases at the US Department of Veterans Affairs suggested that even some people who had not been seriously ill with Covid had an increased risk of cardiovascular problems for at least a year afterwards.
Researchers found that rates of many conditions, such as heart failure and stroke, were substantially higher in people who had recovered from Covid than in similar people who had not been infected. A separate analysis of VA data, published in March, suggested that in the “post-acute phase” of the disease, people with Covid “exhibit increased risk and burden of diabetes”.
“What’s particularly alarming is that these are really life-long conditions,” says Dr Ziyad Al-Aly, chief of research and development at the VA St Louis Health Care System and clinical epidemiologist at Washington University in St Louis, who led both pieces of research.
While just 4 per cent more people contracted heart failure following a Covid infection than those who had not been infected, “because the number of people infected with Sars-Cov-2 in the world is colossal, even small percentages will translate into huge absolute numbers.
“Will it be sufficient to elevate the burden of chronic disease and subsequently put an additional strain on healthcare systems? We think the answer is yes,” he adds.
Some researchers caution it is too early to draw broad conclusions from limited data. Dr Christopher Murray, director of the Seattle-based Institute for Health Metrics and Evaluation (IHME), says the increases might also reflect inconsistencies in reporting. In the first year of the pandemic, for example, many of the deaths in older people had been assigned to dementia when they may in fact have been due to undiagnosed Covid, which had a high death rate in the very elderly. “Disentangling that is quite tricky”, he says.
But although the evidence is still coming into focus, it is already becoming clearer to clinicians and health leaders in medical systems around the world that they are coping with a higher burden of disease in the population — whether from the increased susceptibility to serious illness after Covid, or from the lingering, little understood impact of long Covid, or a backlog of patients.
At the same time, over the past two years many workers have burnt out, or were lost fighting the pandemic on the front lines. “Our capacity may be shrinking at a time when the demand in the population is increasing,” warns Eric Schneider, an executive vice-president at the National Committee for Quality Assurance, a non-profit organisation that focuses on improving health care quality.
Jeremy Lim of Singapore’s NUS Saw Swee Hock School of Public Health acknowledges that structures must be kept in place for those people who are not able to take their health destinies into their own hands © Cyril Ng
This combination of rising disease levels and scarce resources is forcing medical professionals to re-evaluate the way they practise medicine and organise healthcare, putting a greater emphasis on preventive care, collaborative working, and telehealth to manage chronic disease and boost population health.
Given the many challenges healthcare professionals are facing “it’s impossible to square the circle unless we are prepared to very fundamentally rethink how we deliver healthcare,” says Jeremy Lim, director of the Leadership Institute for Global Health Transformation at Singapore’s NUS Saw Swee Hock School of Public Health.
