As the COVID pandemic rages on, most of the attention has been on its immediate effect on the health of the American people. We are provided with daily updates on the number of new cases, the current number of hospitalized patients, and, sadly, the daily tally of COVID-related deaths. These figures are once again rising, and most epidemiologists feel that, if anything, they understate the extent of the problem.

Considering the Long-Term Impact

As important as these statistics are, they are limited to those directly affected by the pandemic and do not consider the collateral damage. We may never know the extent to which the pandemic has caused an increase in unrelated health problems or complications from untreated conditions and deferred surgeries. Widespread apprehension over visiting a hospital emergency department or even a doctor's office has also had a health impact. There is already ample anecdotal evidence of unanticipated health consequences as a result of the pandemic. It has deadly consequences for many who are not directly affected by the virus. For 2020, the coronavirus represented the third leading cause of death for the U.S. If deaths that have resulted from the indirect effects of the pandemic are considered, the number of COVID-related deaths could surpass those for heart disease and cancer.

As the number of survivors of COVID episodes has grown, some health professionals are turning their attention to the long-term health effects of the pandemic. The coronavirus can impact virtually any bodily organ, and early research on survivors indicates permanent lung and/or heart damage in many cases. Recent data on COVID "long-haulers" has found over 200 symptoms affecting those previously affected by the virus. These reports of permanent damage are even more noteworthy given that many of these long-haulers never suffered an acute episode.

The Importance of Indirect Effects

While the lingering effects of the pandemic are likely to involve dire consequences for those affected and for the healthcare system, there are several indirect effects that may be more consequential in the long run. The isolation required to avoid contact with infected individuals has had a documented psychological effect on much of the population. Isolation has been associated with a number of negative consequences for both mental and physical health. One can only speculate on the number of deaths that occurred because quarantine conditions prevented regular monitoring of isolated shut-ins.

The Impact of Isolation

The negative consequences for families experiencing long-term isolation has clear implications for children. The stress induced by potential or real job loss or eviction increases the risk of domestic violence. The impact of adverse childhood experiences (ACEs) such as child abuse has no doubt been significant with many of the "buffers" protecting children eliminated. Our mental health "system" has been overwhelmed by people (including children) desperate for psychological care. The long-term mental health effects from isolation and from dealing with the consequences of COVID for family members and loved ones are significant. There is evidence of symptoms associated with "survivor syndrome" along with a growing epidemic of post-traumatic stress disorder (PTSD).

The Impact of Evictions

There are other indirect effects of the pandemic that bode ill for Americans and the healthcare system. Despite the eviction moratoria that have been put into place, many families and individuals lost their homes early in the pandemic as jobs were eliminated and incomes reduced. While most evictions have been postponed due to the mandate issued by the Centers for Disease Control and Prevention (CDC), the recent ruling by the Supreme Court striking down this ban may result in widespread home loss. In reality, the eviction ban is of little solace for many in that the threat of eviction is just as impactful on health as eviction itself. Multiple studies have found that eviction is associated with poor health, an increased risk of death, and adverse birth outcomes.

The Impact of Job Loss

Another consequence for health is the impact of job loss and unemployment. The impact of job insecurity on disease and death is well documented, and the negative effects are found to persist long after the job-loss experience. The longer the period of unemployment the greater the health consequences. As with evictions, the threat of job loss has almost the same effect as job loss itself.

It goes without saying that job loss involves a decline in income. Perhaps of all of the indirect effects this is the most impactful. The link between poverty and poor health is well documented, with a clear connection between decreasing income and increasing health problems. This is particularly relevant when--as is often the case--job loss also involves loss of health insurance coverage. The impact on health is often the most acute for those who are used to reasonably comfortable circumstances but now find themselves in dire straits.

The View Beyond the Pandemic

Even prior to the pandemic there was evidence that Americans were getting sicker. We were already experiencing an increasing death rate and declining life expectancy. The COVID pandemic has added an exclamation point to that trend, serving to exacerbate many of the existing negative developments. While few Americans have been unaffected by the pandemic, much of the health impact has been felt by the most vulnerable among us. We can expect an inordinate, and long-term, impact on the health and life chances of members of various minority groups--groups that were already struggling before the pandemic.

One can only speculate on the long-term implications of these developments for our healthcare system and our society. It is safe, however, to assume that the world as we knew it no longer exists. Only time will reveal the health characteristics of the American population at the conclusion of what is promising to be a disaster with long-term consequences. We were clearly unprepared to deal with the direct effects of the pandemic. Hopefully, lessons have been learned, and we can proactively address the aftermath of this unprecedented health emergency.

Richard K. Thomas is a medical sociologist and health demographer with 50 years healthcare experience. He has written over 20 books and been on various university and medical school faculties. Thomas works as a healthcare consultant and is a faculty member at the University of Tennessee Health Science Center. He is also a research affiliate at the Social Science Research Center at Mississippi State University.