God knows when the Corona-pandemic is going to end. Most of us are waiting for the vaccine but we are hearing that there are numerous strains of the virus. As the virus is mutating, I am not very hopeful that an effective vaccine would be available in a short time.

Similarly, doctors worldwide are trying different strategies to fight the virus. The antimalarials, chloroquine & hydroxychloroquine, are going out of vogue. Antimalarials are now thought to be more harmful and increase the mortality rate [Ref]. The administration of convalescent plasma seems a logical approach. However, like a vaccine, the plasma may not be effective if it does not contain neutralizing antibodies.

A person who has anti-COVID-19 antibodies (that are not neutralizing) may not be immune. He may be immune to a single strand of the virus but not to all.

Most governments have imposed a lockdown and the strategy of social distancing, hand hygiene, and using a face mask is thought to be the only way to reduce the spread of the virus. Although this strategy may be effective, it has got its own drawbacks. We should prepare for the pandemic of post-COVID-19 issues.

The Pandemic of Medical Issues after the Lockdown:

Here is a list of medical issues that may be most affected by the lockdown and the corona-pandemic.

• Mental illnesses
• Metabolic problems
• Vaccination issues
• Chronic diseases
• Re-emergence of COVID-19

Mental illnesses associated with COVID-19:

Mental illnesses are probably the number one on my list of medical issues that have affected (and will affect) people. People have started visiting hospitals with symptoms of anxiety thinking that they have got COVID-19 infection. The COVID-19 infection and worldwide lockdown are going to cause more psychiatric problems. 

Coronavirus Anxiety:

Anxiety is a state of excessive worrying that is associated with significant distress. Patients may notice a change in their behavior.

Most patients develop irritability, fatigue, lethargy, restlessness, aches and pains, pins, and needles.

A majority of the patients also develop palpitations and visit cardiologists for investigations of heart disease.

In severe cases, patients develop panic attacks and may develop severe apprehension, become angry, or develop altered mentation and start talking insensibly.

Phobias:

Phobias mean the fear that causes an impairment of daily activities. Fears and phobias have a few distinguishing features. These features are highlighted in the table below:

Phobias are classified as an anxiety disorders. Phobias can be a simple phobia, social phobia, or agoraphobia.

Simple phobias are fear of a specific object or situation. Social phobia, as the name suggests, is fear of being humiliated or embarrassed and fear of being negatively evaluated by others.

Agoraphobia is fear of situations or environments where help may not be available as in crowded or open spaces such as moving in an elevator.

OCD (Obsessive Compulsive Disorder):

OCD or obsessive-compulsive disorder is a type of anxiety disorder that may be disabling in severe cases. Patients perform repetitive tasks in a stereotypical manner to relieve their anxiety.

These tasks may include repetitive touching, handwashing, repeating the same words, and repeatedly arranging things. Patients may develop severe disabling symptoms of OCD. Repeated hand washing may cause dermatitis and skin sloughing.

Depression:

Depression may manifest as a low mood, loss of interest in daily life activities, poor concentration and energy, and changes in sleep, appetite, and weight.

Patients more prone to depression include those who are themselves affected by COVID-19  or one of their close relatives is affected, individuals with a past history of depression and anxiety, individuals with chronic illnesses, and individuals who are affected financially such as those who lose their jobs.

How to Cope with the COVID-19-associated anxiety and other mental illnesses?

Different people have different reactions when they hear the News Channels or watch videos related to COVID-19. Take this time as a break from work.

Eat healthily, get plenty of sleep, continue with your regular exercise schedule, and connect with your friends and loved ones (via emails, social media, phone, etc). Make new hobbies like painting, drawing, gardening, and cooking, etc.

Watch entertaining movies and avoid listening to NEWS Channels. Support and take care of your friends and family members especially those who have chronic illnesses. Participate in healthy discussions and share the facts about COVID-19. Seek telephonic advice from your healthcare provider.

Other medical problems:

Vaccination and infections:

Missing routine vaccination may result in a dramatic rise in the incidence of vaccine-preventable diseases. Common diseases like diarrhea, pneumonia, hepatitis, measles and influenza that have been controlled with routine immunizations may become major public health problems.

Metabolic problems:

Metabolic problems include changes in glucose and cholesterol metabolism, weight gain, and obesity-related problems. Lack of exercise may result in hyperglycemia. Patients may develop excessive sleepiness or insomnia that can alter the metabolic rate.

Patients with chronic diseases may even miss doses of their essential medicines like statins, blood pressure, and diabetes medicines. All these factors can result in a pandemic of metabolic problems during and after the COVID-19 pandemic times.

Chronic diseases:

Patients may have an exacerbation of underlying diseases like COPD, asthma, and heart failure. Others might have missed doses of essential medicines because of unavailability.

Because of the fears of COVID-19 infection, patients may start taking unproven medicines to keep themselves protected from the infection. These medicines (especially chloroquine and hydroxychloroquine) are not totally safe and without any adverse effects.

And finally the re-emergence of COVID-19 infection:

People may start social gatherings after the termination of lockdown. Unidentified and asymptomatic cases may cause the spread of the infection resulting in the re-emergence of the COVID-19 infection. This is also concerning as WHO has stated recently [Ref]:

There is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.”

In summary,

After the pandemic is over, the world may be hit by another wave of pandemic of medical issues. Most of these issues could be related to mental health. However, there could be a surge in other diseases as well.