A neglected issue in this round of epidemics: the "secondary" injury caused by the new crown

We all hope that the epidemic will end as soon as possible, and we also hope that the secondary damage caused by the epidemic will be minimized

Guided reading

Guided reading

As of April 9, there were more than 150,000 positive infections in this round of the epidemic in Shanghai, including 1 case of severe cases, and the severe case rate was 1 in 100,000 (calculated based on the disclosed data).

Under the epidemic, in addition to the health risks brought about by infection with the new crown virus, a series of secondary injuries caused by the new crown virus and various prevention and control measures are quietly emerging

When we put the new crown in the center of the stage, the other diseases with high fatality rate are relatively downplayed, but these diseases are often complicated with the new crown, and some even 1+1>2

The secondary injuries caused by various prevention and control measures are very complex, involving difficulties in seeing a doctor, eating, and living alone for the elderly, and even have a negative impact on the psychology of children (the same is true for adults)

Lifting the veil of the death rate of the new crown virus, how can we reduce the secondary damage of the new crown virus in the face of the increasing number of asymptomatic infections?

01 Taking the Wuhan epidemic as the starting point, what does the survey of 300 million people tell us?

01 Taking the Wuhan epidemic as the starting point, what does the survey of 300 million people tell us?

The secondary injury of the new crown is no longer a new word.

In 2021, the Chinese CDC Zhou Maigeng team published in the British Medical Journal (BMJ) the title Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries .

Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries

Title translated: Excess mortality in Wuhan and other parts of China within three months of the Covid-19 outbreak - findings from the National Mortality Registry

Why use this article as an example? Because the data behind this article is very hardcore

The study included more than 300 million participants across a wide range of ages, and monitoring sites were selected from 605 urban areas and rural counties set up in a nationally representative Disease Surveillance Point (DSP) system

Let us first clarify, what is excess mortality?

Let us first clarify, what is excess mortality?

For diseases caused by the new coronavirus, the definition of excess deaths or additional deaths refers to the number of deaths that are not directly caused by the new coronavirus during a certain period of time during the new crown virus pandemic.

To put it simply, it is to compare the number of deaths in a certain time period this year and the same time period in previous years (excluding direct deaths from the new crown), and get the death rate that exceeds the previous death limit

Trends of weekly observed (orange dotted lines) and predicted (blue solid lines) mortality rates for selected major diseases in different disease surveillance sites in China from January 1 to March 31, 2020

Taking Wuhan, the starting point of the entire Covid-19 pandemic as an example, in the Wuhan disease surveillance site area, the overall mortality rate was 56% higher than the predicted rate (1147 vs 735 per 100,000 people) (1.

Deaths from other diseases, which we cannot ignore, include cardiovascular disease (n = 2347 deaths; 29% higher than predicted) and diabetes (n = 262; 83% higher than predicted)

83%! If we follow this increase, let us imagine the current situation in Shanghai, and readers can calculate it by themselves (note that the population structure of each city is different, here is only a reference ratio, no actual guiding value)

02Double pressure of medical runs and long-term covid-19 complications

02Double pressure of medical runs and long-term covid-19 complications

After the current round of the epidemic in Shanghai, the run on medical resources was quite serious (the same happened in several megacities such as London, New York, and New Delhi before), similar to the situation in Wuhan in early 2020

So, based on the 25 million resident population, what is the total number of additional deaths due to diabetes in this more than one month?

According to the Shanghai Municipal Health Commission, in 2021, the prevalence of diabetes among people aged 35 and above in Shanghai will be 21.
6%, and the number of people aged 35 and above is roughly estimated to be 14 million (the seventh census 15-59 years old).
The population is 16.
6191 million, accounting for 66.
8%; the population aged 60 and above is 5.
8155 million, accounting for 23.
4%)
.

Then according to the data of the paper, the mortality rate of diabetes in Wuhan is 25/100000 people in three months, and the "normal" number of deaths from diabetes in Shanghai in one month is 14000000×25/100000÷3=1170 (person), then because of After the new crown epidemic is fully closed and controlled, the additional death toll of only diabetic patients may be: 1170 × 83% + 1170 = 2141 (person)
.
(Note: This data is only an estimate, for reference only, and there may be discrepancies with the final actual situation)

In China, many primary health care activities related to the long-term management of chronic diseases, such as diabetes, hypertension, and ischemic heart disease, tend to be primarily conducted through hospitals
.

During the pandemic, the ability to access essential life-saving drugs such as insulin and acute procedures such as stenting, or to monitor and manage major illnesses and associated risk factors (such as blood pressure, blood sugar levels) through hospital visits, has been severely compromised, resulting in confirmed disease exacerbation and increased risk of death (eg, diabetic crisis)
.

Adhering to dynamic clearing can control the epidemic, but the cost is not small, and we should reduce the secondary damage caused by this

Adhering to dynamic clearing can control the epidemic, but the cost is not small, and we should reduce the secondary damage caused by this

Recently, similar tragic incidents have occurred quite a few times
.

These are the misfortunes caused by the run on medical resources
.

The graph shows weekly in-hospital and non-hospital mortality trends for all causes, pneumonia, and other diseases in different regions of Wuhan between January 1 and March 31, 2020, compared to 2019
.
The orange dotted line represents the observed mortality rate in 2020, and the blue solid line represents the observed mortality rate in 2019.
Plot taken from the BMJ

The graph shows weekly in-hospital and non-hospital mortality trends for all causes, pneumonia, and other diseases in different regions of Wuhan between January 1 and March 31, 2020, compared to 2019
.
The orange dotted line represents the observed mortality rate in 2020, and the blue solid line represents the observed mortality rate in 2019.
Plot taken from the BMJ

Aside from the medical run factor, the evidence mentioned in the paper also shows that the new crown may cause tiny cells to appear in the body's circulatory system and become embedded in the heart, leading to myocarditis
.

In addition to making people sick, the new coronavirus also increases the risk of cardiovascular disease, such as myocardial infarction and ischemic stroke
.
Similarly, the new coronavirus also affects the pancreas, thereby increasing the risk of new-onset diabetes and exacerbating existing diabetes, leading to an increased risk of death
.

In fact, 13% of all deaths attributable to hypertensive heart disease in 2020 in Wuhan (i.
e.
coded as the underlying cause of death on the death certificate) were also found to have had myocardial infarction, coronary heart disease or cardiac origin Sudden death is the cause of death
.
But long-term adverse effects of the COVID-19 outbreak on cancer survival (and other major diseases) cannot be ruled out because of delayed diagnosis
.

Therefore, in addition to the various secondary disease risks caused by medical runs, and the many adverse effects of the new crown virus itself, this long-term new crown impact we have discussed in detail in other articles
.

03Under the epidemic, mental health problems cannot be ignored

03Under the epidemic, mental health problems cannot be ignored

In addition to the various secondary injuries suffered by the body, the mental health crisis is also a red light
.

In the case of Wuhan, another JAMA paper on statistics related to the new crown virus and mental health symptoms pointed out that between 2019 and 2020, Hubei experienced a high number of suicide deaths, which may be due to the outbreak of the new crown epidemic.
of poor mental health
.

Prevalence and risk factors associated with mental health symptoms in the general Chinese population during the 2019 novel coronavirus pandemic

Prevalence and risk factors associated with mental health symptoms in the general Chinese population during the 2019 novel coronavirus pandemic

The overall excess suicide risk ratio in Hubei Province is similar to that in Wuhan (both about 60%), but the absolute increase in suicide mortality in other areas of Hubei is much higher than that in Wuhan
.
This also reflects the higher mental burden of the people in the outskirts of Wuhan, those rural areas with poor resources
.

Consistent with the paper's findings, a recent study in China also showed that mental health symptoms were common during the COVID-19 outbreak, especially among residents of Hubei and those with confirmed or suspected infection or with COVID-19 patients.
among those who have been in contact
.

A recent study in China also showed that mental health symptoms are common during the Covid-19 outbreak, especially among residents of Hubei and among those with confirmed or suspected infection or contact with Covid-19 patients
.

Coincidentally, recently, a new report from the US CDC pointed out that epidemic control measures have affected the mental health of high school students/teens
.

In the first half of last year, a study of 7,700 samples found that 1/4 of the girls had suicidal tendencies, and 1/10 of the children were corporally punished/abused during school suspension
.

Therefore, many Americans are reflecting: Should schools be closed during the epidemic, and is social isolation necessary?

They believe that teenagers are originally a low-risk group of the new crown, and cannot be bound by society/adults because of the epidemic.
For children and teenagers: mental problems are more terrifying than the virus itself
.

Going back to the current epidemic situation in our country, during the outbreak of Omicron, mental health symptoms may also be prevalent among the general population across our country
.
(We've also seen an increase in many counseling sessions lately)

In particular, those who are infected, suspected to be infected, and those who may have been in contact with positive individuals are at greater risk for their mental health
.

How to deal with the long-term negative physical and mental effects of the new coronavirus while dealing with the epidemic, and avoid secondary damage, are issues that we must consider in the follow-up process of epidemic prevention
.

leave a message here