Survival of the fittest: The health of the nation post-COVID19 could be bleak

Dr Breanne Kunstler (BBiomedSci, BHealthSci, MPhysio, PhD). 

Physiotherapist, behaviour change scientist and run coach.

My last post involved talking about the potential positives of being isolated during the COVID-19 pandemic. Now it's time to talk about some of the negatives. But, I'm not going to talk about the immediate negatives like poor health and economic outcomes. Instead, I'm going to focus specifically on the future negatives. What could go wrong when we encourage the entire Australian population to stay indoors?

Image 1: Will you look circle-like after self-isolation? (credit: Bored Panda)

For those who don't know, I am a researcher and do a lot of work in changing health behaviours (e.g. supporting people to exercise more). So this pandemic has made me not only fear for our current health, but also our future health as a result of the lifestyle changes we'll make as we transition to increasing the amount of time spent indoors trying to dodge this nasty virus.

Although I mentioned in my previous post that I think, as of March 2020 and early in this pandemic, that people are probably exercising more due to the fear of having the great outdoors taken away from them as the restrictions progress, I don't expect this increase to last. Self-isolation, either due to being sick or avoiding becoming sick, will likely lead to a reduction in the amount of time people spend active overall. This isn't just because people are encouraged to stay indoors, but because opportunities to exercise are being gradually taken away. Indoor gyms are closed, outdoor gyms are closed, we currently can't go out with more than one person in Victoria so group fitness sessions in the park are cancelled. Many parks and beaches are also closed because people can't behave themselves and avoid large gatherings or maintain 1.5m between them, making Australians look like idiots internationally. Exercise is hard to do when you take opportunities to exercise away from people, such as the opportunity to actively commute (I discuss this later), despite the huge increase in free online exercise classes and recreational cycling. This leads to a slippery slope where those who have developed good exercise habits risk losing them, and those who need to adopt good exercise habits can't.

So, what could go wrong when we encourage people to stay indoors for an extended period of time?

You put that population at risk of developing the "worried well" persona when you tell an entire population to isolate themselves. People who are encouraged to act like a sick person (e.g. self-isolating to prevent viral spread) might imagine what it would really be like to be sick and be stuck inside their house for at least two weeks or until they recover. This might create a sense of panic where the person might act to conserve their resources (e.g. avoid excessive activity and eat high calorie meals) and accumulate other resources "just in case", like toilet paper and stocking the freezer with bulk-cooked meals. The conservation of resources has the potential to lead to excessive sedentary time as we sit on the couch, which will see less energy expended each day, and with the consumption of high calorie 'comfort food' type meals, we will consume more energy each day. Overall, I expect a gain in weight and poor habits alongside a loss of fitness and general health.

Working from home takes away the opportunity to accumulate incidental activity performed during commutes. This can see a huge loss of activity for some, like the cyclists who spend 2 hours on the bike 5 days a week, or a smaller loss for people who walk 30 minutes commuting to and from train stations each day (like my husband!). This loss of activity, without replacing it with regular desk breaks to walk around the block, can see a significant loss of energy expenditure (2.5hrs a week even for those just walking to and from the station). Reduced activity can also result in loss of muscle mass, leading to lower basal metabolic rate and, again, less energy expenditure that can lead to weight gain.

What about our diets? Suddenly we need to eat all meals at home, which might be very different for people who work full time outside the home and enjoy eating out. These people probably eat most meals outside the house and have several restaurants or cafes that they like to frequent. They might become concerned that their favourite places might close down with the loss of business associated with social distancing and forced shut downs or conversion to 'take away only' menus. This might see them order more take away from these places than they usually would to support the business but also to account for their lack of cooking skills or desire to use them. As a result, diets can become very "take away" quality, potentially leading to weight gain and a development of a habit around ordering in. This habit development is facilitated by companies making it easier to order people's favourite treats to be delivered, like delicious cakes and dumplings, and excessive advertising of "comfort food" (e.g. the KFC "comfort food" radio and TV ads).

Image 2: At least the crane industry will benefit (credit: Facebook)

And what about substance abuse? I'm not just talking about the use of illicit and prescription drugs like prescription opioids, but also the increased use of alcohol in a way we otherwise wouldn't. People have been buying and drinking more alcohol during the pandemic compared to other times. Why does isolation encourage us to drink more? Is it boredom? Is it just 'because we can' or 'because it's there'? Australians have said that it's to cope with anxiety and stress during the pandemic. But what about the effect of targeted advertising? I have lost count of the number of times First Choice Liquor have used a short ad on some of my favourite apps to show how to make a cocktail at home. I'm also seeing ads on social media advertising alcohol as an isolation survival necessity. Regardless of the cause, this is a concerning new habit to adopt and it's not one we want to continue because maintaining an increased alcohol intake can play havoc on our physical and social health over time.

Could the cancellation of elective surgeries, and not just the nature of self-isolating, increase people's desire to comfort eat and abuse alcohol and drugs? If people are stuck at home and in pain, dealing with the disappointment of not getting the surgery that they have probably waited for over a year for might be unbearable, resulting in them turning elsewhere for relief (e.g. prescription, over-the-counter and illicit drugs, alcohol or comfort food). Elective surgeries are gradually resuming in Victoria as of April 27, with joint replacements being on the priority list. It will be interesting to talk to the people who have been on the roller-coaster ride of having surgery delayed and then rescheduled sooner than expected to see how their desire to abuse prescription medicines or use other treatments changed over the weeks.

An increase in alcohol consumption might also correlate with an increase in domestic (intimate partner or family) violence cases. Police in Victoria had, sadly, anticipated an increase in domestic violence reports as people have been forced to isolate in homes with people who might be violent towards them and others. This led to the development of Operation Ribbon. Furthermore, isolation was identified as a contributing factor to many marriage breakdowns and domestic violence incidences during isolation in China. The increased amount of time spent with one or two certain people in a small area might be nice for some, but it can clearly put a strain on some relationships and be downright dangerous for some of our most vulnerable (e.g. people in abusive relationships and the children caught up in it).

Image 3: The Shadow Pandemic: Violence Against Women and Girls and COVID19 (credit: UNWomen)

How is our treatment of the innocent person walking past us in the street going to change? We have been encouraged to keep a distance of 1.5m from people walking past, and even more from people running or exercising vigorously. Many people simply don't give others the space and freedom to do this (either intentionally or unintentionally). Australians have started to relax the practising of social distancing (and have been punished for it) since the numbers of new cases in Australia has reduced so dramatically, despite calls from the government and medical professionals to maintain social distancing as the fight against COVID-19 is far from over.

Image 4: The grocery store has become a battleground (credit: wearethemighty.com)

I was at the grocer and people were leaning over me to reach vegetables, making me feel uncomfortable and disappointed enough to tell the person that they should be maintaining their distance. I was angry and disgusted by this person. I wonder if my attitude towards people getting closer than 1.5m to me will change after isolation? Will I be more accepting of people in my personal space or will I continue to feel uncomfortable? What affect will this have on my happiness in public and my desire to be around others? Will I continue to treat the people around me like walking petri dishes? Some think that those who have always valued their personal space will just continue to do so to the same extent, rather than it be permanently changed by the COVID-19 pandemic experience. I think this will be me. Please give me my space!

Image 5: Please breathe somewhere else! (credit: Twitter)

So, how will we change as we come out of this hibernation? Will we be overweight, angry, abusive, introverted and avoidant alcoholics? I'm exaggerating, but who knows what behaviours we will adopt and keep, and which ones will just be temporary. I'm still going to be introverted that's for sure, and I am CERTAINLY going to miss isolation.

Image 6: Quarantine rocks (credit: Twitter) 

Stay healthy, my fellow humans.