As a family physician witnessing the direct and indirect effects of COVID-19 lockdown measures on my patients, I have become increasingly disturbed by the continued use of policies without careful consideration of their effects on people’s health. If we were to weigh all health outcomes, not only deaths due to COVID-19 – be it years lost due to delayed cancer diagnosis, opioid overdoses, trauma from child abuse, domestic violence or suicides – would we continue blunt, sweeping lockdowns as our main public health strategy?
Despite mounting evidence that the lockdowns are having negative effects on our health, this is not being substantively reflected in the current discourse. This is not to deny the terrible health outcomes of COVID-19 infections; they are real and have been amply documented in both the press and the scientific literature over the past year.
Among my patients, however, the acute challenges created by lockdowns are much more apparent than the effects of COVID-19. I see patients with severe mental health problems experiencing worse symptoms and people with little or no history of mental health diagnoses suffering symptoms for the first time. These patients come to me often disconnected from family and friends and meet a health-care system with fewer resources for support. I suspect, as do many of my peers and patients, that contributing to these outcomes are isolation, the incessant media narratives promoting fear instead of rational caution, and the inability to access mental health protective activities, including exercise facilities, religious services, support groups, gatherings with friends and escape from stressful home environments.
I hear parents describe crippling anxiety in their children, some from fear of contracting COVID-19 and others from depression due to lockdown rules. With school closures, these problems are compounded, especially for my patients who experience marginalization due to poverty. They cannot afford childcare and most do not have paid sick leave or the luxury of working remotely. With fewer resources and therefore less support for remote learning, their children suffer. I am concerned about a widening gap in the performance of children from low- and high-income households, undermining a primary objective of an equitable public education system. The lack of consideration of these outcomes is in stark contrast to our society’s supposed growing awareness of the effects of poverty, the importance of access to education and the effects of trauma and its ability to transcend generations. It is surprising that public health officers have largely ignored these facts.
The health-care system as a whole is affected. For example, cancer screening, including mammograms, colon cancer tests and pap smears, were put on hold for months. And now, even after positive screening results, there are delays in obtaining specialist appointments for potentially curative surgeries or procedures. For decades, we have championed the importance of cancer prevention through early detection and treatment. This too is being undone and will undoubtedly have a human cost. The question is how much.
Through a forced sedentary lifestyle and isolation, the lockdowns are also having a toll on chronic diseases such as diabetes and hypertension. For example, key components of the prevention and control of diabetes include specific dietary measures and adequate exercise. I have seen years of prevention and control undone in months through reduced physical activity coupled with poor mental health that results in poor food choices. Importantly, chronic diseases are known to have a transformational effect on patients’ lives, both physical and psychological. For many of these diseases, this regression can lead to irreversible outcomes.
As we enter the second year of the pandemic, I am experiencing a deep dissonance between ethical family medicine practice and the continued promotion of sweeping lockdowns by health professionals leading the COVID-19 response. I suspect this is a question of training. Emergency situations require a unique skill set: immediate action with singular focus. This is in direct contrast to family physicians who are skilled at weighing the long-term benefits and trade-offs of proposed treatments with both scientifically based evidence and the subjective experiences of patients. The patient decides, with the help of a physician, which costs they are willing to bear. Inherent in this is the capacity to hold ambiguity and uncertainty.
Family doctors are trained to consider not just mortality and morbidity but quality-of-life measures. To see a life as something more than to just sustain and “keep alive” has become a pivotal value of family medicine. It is for this reason that any conversation regarding substantive public health measures must include the voices of those trained in making holistic considerations on equal footing as those providing emergency responses.
For this reason, I invite my colleagues to voice their clinical experiences, whether they are similar to mine or not, as these may be the only evidence we have at this juncture. In addition, I ask policy-makers to include the known long- and short-term effects of lockdowns on people’s health and well-being when planning for the future of this pandemic.
If not, I fear that the negative effects we are witnessing will be considered the unfortunate side effects of an appropriate COVID-19 response when in fact the response is one with poor consideration of preventable measures. Above all, I fear that the toll of the lockdowns may be worse than COVID-19 itself.
The author would like to thank Cristian Rangel, PhD, assistant professor at the University of Ottawa, Faculty of Medicine, for his guidance and contributions to this article.