The public health impact of Covid-19 beyond infection

In this article, Professor Maria Rosaria Galanti from Karolinska Institute provides her opinion on the adverse consequences of Covid-19. 

Everyone knows what a pandemic is, but few of us have been witnessing one like that caused by the SARS -COV-2 virus.

Unprecedented because of the virus: elusive, devastating, a multifaceted killer when it kills. With many “perhaps” in its natural history: “perhaps” eliciting humoral immunity; “perhaps” transmitted only through airways emissions; “perhaps” infecting only during the early symptomatic stage…

And because of the mitigation measures, the most prominent of which is the imperative to physical distancing (a term that I strongly prefer to the more common “social distancing”). Lock-down or not, the physical nearness that links people together in natural bounds must be broken. Such a simple thing, with so many unforeseen consequences in the long run.

Along with the undeniable benefits of limiting the transmission, here are some adverse consequences, documented in the extant literature:

  • Social disruption and isolation, with consequences on mental health1
  • Increase in health inequality- It has been recently observed2 that this pandemic has not only revealed the unequal burden of risk factors for contracting the Covid-19 (e.g. crowding), but also the unequal penetrance of the containment measures (who are the privileged who are allowed to work from home?)
  • Decay of population literacy (because of school closure)
  • “Health care debt” because of reallocation of health resources and because of the barriers imposed by the fear for contagion. A debt particularly heavy among the frail members of the community with more pronounced needs of health care: elderly, chronic ill, drug users, psychiatric patients3.
  • Lifestyle disruption, partly caused also by economic recession: lack of physical activity4, unhealthy eating5, excessive alcohol drinking6, defective ergonomics for those with remote working have all been described as logic and in the long term potentially harmful consequences of the mitigation measures). Again, the burden of these conditions is unlikely to be socially evenly distributed.
  • Finally, worry and “sanitization” of every day’s life. Who did not react to a person’s coughing, to one’s own mild and once “innocent” symptoms such as head- or muscle aching? And what about “hygienic thinking”? A friend of mine expressed it properly “To me, you are all infected, and I treat you all consequently”. Any member of a community has gained in the imaginary of the others the status of “vehicle”7, to the point that sometimes it is difficult to still see the person behind.

How will we cope with these consequences once the pandemic is over? To rebuild communities in the new scenario seems to be the next task for preventionists, starting from people and places, from safety and connection.

About the Author:

My name is Maria Rosaria Galanti and I am a Professor in Public Health Epidemiology at the Karolinska Institutet, Sweden. My research focuses on intervention evaluation, the epidemiology of tobacco use and the influence of school environments on mental health among adolescents. You can email me on: rosaria.galanti[at]ki.se

  1. Marroquin, B., et al. (2020). “Mental health during the COVID-19 pandemic: Effects of stay-at-home policies, social distancing behavior, and social resources.” Psychiatry Res 293: 113419 []
  2. Marmot, M. and J. Allen (2020). “COVID-19: exposing and amplifying inequalities.” J Epidemiol Community Health 74(9): 681-682. []
  3. Qiao, S., et al. (2020). “Disparity in HIV Service Interruption in the Outbreak of COVID-19 in South Carolina.” AIDS Behav. []
  4. FITBIT. The Impact Of Coronavirus On Global Activity. 2020 []
  5. Asgeirsdottir TL, Corman H, Noonan K, Reichman NE. Lifecycle effects of a recession on health behaviors: Boom, bust, and recovery in Iceland. Econ Hum Biol. 2016;20:90-107. []
  6. Keyes KM, Hatzenbuehler ML, Hasin DS. Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors. Psychopharmacology (Berl) 2011;218:1-17 []
  7. Lingis A. (2020). The New Fear of One Another. Bioethical Inquiry https://doi.org/10.1007/s11673-020-10035-6 []

1 thought on “The public health impact of Covid-19 beyond infection

  1. Thank you Rosaria fo your contribution and sharing your thoughts 🙂
    Beyond the consequences hereby cited, I believe that it will be as well challenging for the preventionist community to go through this pandemic. The trust of the population towards public health messages is getting harder and harder to get. Anti-vaccines groups are already communicating actively and their messages are shared extensively by a population whom does not understand why they have to change their habits, why it takes so long, and why they do not see any positive consequences of such change. Masks that people are asked to wear start to become as well a mixed up symbol: oppression from the governement, resistance towards illogic measures, solidarity towards vulnerable people, …
    In a world where it is easier to discover, travel, communicate and exchange with others, individuality is also enhanced. Certain health priorities are undermined in favour of privileged groups or individuals (e.g. global warming, deforestation, GMOs, etc.). Therefore, it seems difficult in this case to make people aware of a collective interest when it does not make sense: why now, what for, why me, what about them?
    Rebuilding communities and connection at large would be a whole new (?) area to develop…

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