Dr. Kevin Sherin, MD, MPH, MBA, FACPM is the former Health Officer and Director of the Florida Department of Health in Orange County
There is a growing dialog about COVID-19 and its impacts on childhood adversity (ACEs), chronic stress, and mental health across the lifespan.
The fear and social isolation associated with COVID-19 commonly exacerbates existing chronic stresses. Reports are surfacing of increased mental health problems, anxiety, partner violence, depression, suicidality, child abuse, opioid use disorder, other substance abuse, drug overdose, and alcohol abuse. Children are forced to stay home from school or daycare and witness and experience this trauma in greater degrees. These all contribute to higher childhood adversity (ACE scores) which will add to chronic stress across the lifespan (toxic stress).
COVID-19 adds to the chronic stress from childhood adversity. Inner cities seem to be heavily impacted, e.g. New York City, Newark, Boston.
The chronic stress of childhood adversity from an early age can increase comorbidities and chronic diseases in adult life. A landmark study on early childhood adversity and its powerful effect on adult obesity and multiple other biomedical diseases was first published in AJPM in 1998 by Vincent Felitti and Robert Anda.
The CDC advises that ACEs are strongly and cumulatively associated with 5 of the top 10 causes of death. Dr. Felitti recently indicated that high ACE scores have now been correlated with the 10 top causes of death.
In New York City, approximately 88 percent of COVID-19 patients had comorbidities such as obesity, diabetes, hypertension, and pulmonary disease.
The ethnic disparities of COVD-19 cases are being linked to disparities in chronic diseases. Blacks and Latinos are showing higher COVID-19 test positive rates among symptomatic individuals.
Racial and ethnic disparities have also been identified with ACES. COVID-19 can create an additive impact on adversity in racial and ethnic minority populations. Adverse outcomes in populations with a greater burden of chronic disease are more frequent.
This raises the related question of whether an existing background of a high ACE Score with its associated toxic stress can modulate the outcome of COVID-19 infection. For instance, certain of the dose-related adult outcomes of ACEs, like various cancers and obstructive vascular disease, are now understood to be a result of toxic stress hyperstimulating certain areas of the brain leading to immune system suppression and thus inhibiting the normal destruction of our usual daily production of low levels of malignant cells by various organs. Similarly, hyperstimulation of other CNS areas is known to release high amounts of pro-inflammatory cytokines leading to vascular obstruction.
Documenting a possible relationship of background ACE Scores to COVID-19 outcomes years later might be verified by routinely assessing ACE Scores in several thousand randomly selected COVID cases and then following their outcomes over time. A similar approach might also be used to determine a possible impact of background toxic stress on whether this could affect the likelihood of infection or non-infection subsequent to exposure to COVID-19.
ACPM can advocate for greater attention to early COVID-19 antibody testing for all, and especially vulnerable populations with ACEs including racial and ethnic minorities.
ACPM can also promote more mental health support and youth resilience program, in addition, and to greater outreach to long-neglected minority populations.