The mental burden of the pandemic and does telehealth work? Get well soon, Episode 1

Tanya Lewis: Hello. I’m Tanya Lewis.

Josh Fishman: And I’m Josh Fishman. we are Scientific American’s senior health editors.

Lewis: Welcome to the show officially known as COVID, Quickly.

Fischmann: Now it’s the first episode of a new show about COVID and more.

Lewis: We are entering the third year of our podcast. Wow. And the fourth year of COVID. The disease is still here and it’s still serious, but life for everyone is a little different now. So instead of just pandemic news, we want to highlight other health news and demystify medical research in a way you can use to stay healthy.

Fischmann: We call the show Your Health, Quickly.

Lewis: We will continue to cover important updates on COVID. But now we’ll also bring you the latest research on other infectious diseases like the flu.

Fischmann: And non-infectious ones like cancer and heart disease, reproductive health and mental health.

Lewis: We’ll also discuss the latest science in preventative health, nutrition and more. We hope you enjoy the show.

Fischmann: We should probably tell people what we’re talking about today.

Lewis: Okay. So our first topic is still somewhat related to COVID, but it’s something we haven’t talked about as much. The effects of the pandemic on mental health.

Fischmann: And we’ll discuss ways that across medicine, telehealth is changing the way care is delivered, even for things like cancer and diabetes.

Lewis: When the pandemic was at its worst, it made sense to focus on the dangers of death from the virus itself. But thanks to effective vaccines and treatments, we’re in a different place now. So now we can begin to address some of the effects the last few years have had on our well-being.

Fischmann: This is a good point. All the lockdowns and isolation have definitely taken a toll on us mentally.

Lewis: They really have. I know I had a hard time avoiding seeing friends and family during the worst outbreaks of COVID, on top of the constant fear of getting sick. And it’s not just anecdotal. There is growing evidence that these mental strains are widespread.

Fischmann: Tell me about it. What does this data show?

Lewis: Well, a nonprofit called the Kaiser Family Foundation is tracking mental health throughout the pandemic with an ongoing poll. In early 2021, data showed that four in ten adults had symptoms of anxiety or depression, compared to just one in ten adults before the pandemic. That fraction is now closer to three in ten, but that’s still a lot of depressed, anxious people.

Fischmann: This means that every third person I pass on the street has some of these problems. What are some of the ways this has been done?

Lewis: People have reported problems sleeping and eating, and started drinking and using drugs more, and existing chronic health problems worsened. To learn more, I spoke with the lead author of this mental health report.

Nirmita Panchal: My name is Nirmata Panchal and I am a senior policy analyst at the Kaiser Family Foundation.

Lewis: Can you just tell me a little bit about what some of the major findings were?

Panchal: So, as we know, during the pandemic, people have experienced a number of different changes and disruptions. For some this may be increased isolation. For others, it can be job loss and experiences such as housing and food insecurity.

Lewis: Can you talk a little more specifically about the impact on children and young adults in particular?

Panchal: When we looked at the young adult population and during the pandemic, they have experienced a series of interruptions during a time already filled with great transition. Going to college and then experiencing college closings in light of the pandemic. Perhaps they are facing a job loss or a reduction in their working hours. And what we knew before the pandemic is that a large percentage of young adults were not receiving mental health care.

Fischmann: This is very difficult in this age group.

Lewis: Many of these children had to miss important milestones such as graduations and birthday parties.

Fischmann: Yes. Well, you know, when you’re 16, that could be a big valley in your life.

Lewis: When you’re that age, when you’re a teenager, it’s so important and you just want to share it with all your friends. As you’ve probably seen, there was a recent CDC report that found high levels of depression and suicidal thoughts among teenage girls. Can you talk about that and why girls might be particularly at risk?

Panchal: Some of the data we’ve seen during the pandemic has found that adverse experiences at home for many teenagers tend to be higher among young women compared to their male peers. At the same time, we have also found that rates of self-harm are rising faster among young women.

Lewis: I wonder if you think these mental health effects are likely to persist in the long term?

Panchal: Yes, this is a big question. I think, you know, while we don’t have those answers yet, we do know that a lot of mental health conditions develop during adolescence. And if left untreated, they can persist into adulthood and can limit quality of life.

Lewis: One of the points Nirmita made was that you really have to deal with it in schools. So schools are like a natural place to connect children with mental health services.

Fischmann: Which of course will require local school districts and states to raise money for the schools.

Lewis: You can’t just expect kids to be so isolated and dealing with all these stresses and not have some sort of long-term consequences.

Fischmann: There’s one change we’ve all made during the pandemic that looks set to stick and that’s telehealth. Use a video or audio connection to check with your doctor.

Lewis: Before COVID hit, telehealth was pretty rare. Insurance companies did not reimburse health care workers who did so, and various regulations required what they called a personal relationship.

Fischmann: But after 2020, suddenly we had to keep our distance to avoid infecting others. So those regulations were relaxed and telehealth took off. The boom spread throughout medicine, including cancer care, endocrinology and many other specialties.

Lewis: How big of an explosion are you talking about?

Fischmann: Too big, Tanya. At Stanford Health Care in California, telehealth increased from about 3 percent of visits before the pandemic to about 70 percent during it. Now, many health care networks say it’s installed in about 10 to 30 percent of all their patient visits.

Lewis: But how do you take care of cancer through video? Shouldn’t you be showing up in person for chemotherapy and x-rays?

Fischmann: Well, that’s a great question. And you’re not the only one curious about it. Our colleague reporter Lydia Denworth wanted to know about that too. So I asked her to come over and explain. Maybe you should start by telling everyone who you are, Lydia.

Lydia Denworth: I’m Lydia Denworth. I’m a science journalist and I’m the editor of Scientific American for the magazine. And now I’m the new columnist for the Science of Health column.

Fischmann: I’m glad you’re here. Now, you’ve done some telehealth yourself, haven’t you?

Denworth: I did it. And like many other people in this country during the pandemic, I had some sessions with my psychiatrist, but I had to be via telehealth video instead of in person. That made me curious. As you know, the pandemic is starting to recede from people’s lives about how telehealth is actually being used.

Fischmann: I can imagine that talking, psychotherapy lends itself to telehealth. But you found some surprises in other medical specialties, didn’t you?

Denworth: I did it. But it turns out that things like cancer care also make pretty substantial use of telehealth in places.

Fischmann: How can you care for a cancer patient through a video link?

Denworth: You usually have to go to the doctor quite a bit and it turns out you can cut out like a big chunk of those appointments, the ones that don’t require things like an infusion for immunotherapy. So when you talk to your doctor and check in with your doctor, you can make those appointments virtual and save everyone time.

Fischmann: Does it work as well as getting in your car and driving to the doctor’s office or a hospital?

Denworth: It absolutely does. There are many drugs that are still a discussion between a patient and a doctor. There are some specialties that find there are real advantages to talking to people in their homes, or endocrinologists who treat diabetes can also see people at home and get more clues about what life is like in their home, how they might it’s their diet at home and how things are going.

Lewis: Lydia makes some good points. But I wonder how these virtual visits compare to in-person visits for quality care.

Fischmann: Turns out they actually stack up pretty well., Tanya. There have been a few studies that control care. Nearly 90 percent of the time a virtual diagnosis agreed with a later diagnosis made in person, researchers reported in the journal JAMA Network Open last year, and another study of more than 500,000 patients found equal or better results for telehealth in 13 of the 16 primary care measures such as diabetes management and registration for flu shots.

Lewis: This is very good. I guess another advantage is in rural areas where your doctor may be hours away, but basically you can save all that time and money in commuting and you don’t have to take a whole day off work.

Fischmann: Lydia goes into this in much more detail there in her article on Telehealth for SciAm, which you can read online from mid-March and in the April print issue.

Your Health Quickly is produced and edited by Jeff DelViscio, Tulika Bose and Kelso Harper.

Lewis: The show is one of Scientific American’s Science, Quickly podcasts. Subscribe to Science, fast wherever you get your podcasts.

Fischmann: And don’t forget to go to for up-to-date and in-depth health news.

Lewis: We will be back in two weeks. Talk to you then.

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