This year, out of nowhere, my left heel has started hurting. Is it the onset of some degenerative condition, a normal byproduct of ageing, or simply pandemic life, I wonder. After all, living through this period has had surprising health consequences – even for people who have not caught coronavirus. It has recently emerged, for instance, that the Covid era has been a global hair-loss event – a clear manifestation of the stress everyone has been under. What else have these unprecedented times written on our bodies?
When the UK’s Institute of Trichologists (IoT) – a professional association for those who treat hair and scalp disorders – surveyed its members this summer, 79% said they had seen cases of “post-Covid hair loss” in their clinics. Eva Proudman, consultant trichologist and chair of the IoT, puts it down to the high temperatures and loss of appetite that are common with having the virus. “Both of these factors reflect in the hair, usually between four to six weeks after the virus has started to resolve, and the hair will start to shed excessively.”
But mental stress alone can also lead to hair shedding. Richard Spencer, a trichologist working in central London, says other reasons for hair falling out can be “the anxiety of having the virus and not knowing how badly one might suffer from it, as well as the stress of lockdowns”. While Proudman has seen cases in men and women, it can be more obvious in women, “as they tend to wear their hair longer than men, and you see a higher volume of hair coming out in the shower, brush and generally shedding”.
Pandemic-induced hair loss is most likely a condition known as telogen effluvium, “a disruption to the hair’s normal growing and shedding cycle,” says Proudman, “causing there to be less hair in the growing phase, and more in the resting and shedding phases”. The good news, says Spencer, is that whether the loss is due to physical or emotional stress, “most or all of the hair is recoverable”. In some cases, adds Proudman, “the body will recover from this disruption on its own. In other cases, we may need to help with dietary changes, specific hair supplements or treatments.”
Pandemic eyes are dry and, frankly, shattered from so much screen time. This makes them scratchy, sore and blurry, and it’s hard not to blame this on some perceived malignant force in the screens, such as blue light. Ditto for the boom in childhood myopia that was shown in a Chinese study to coincide massively with increased screen use (and time indoors, without distant vistas) during lockdowns. This study is now held up around the world as a warning, triggering universal parental guilt and worry, while in practical terms being extremely hard to heed.
But blue-light-blocking glasses are unlikely to be the solution. There is no evidence that screens themselves are damaging eyes. Myopia is caused by focusing continuously on something close to the face (it’s just that children tend to do this more with screens than books). And it is not screen glare that is drying out our eyes. It is our natural tendency to blink around five times less frequently when doing screen work (or, again, when reading books), and to blink incompletely during screen work (less so with books, so books win).
Having had all routine dental checkups cancelled during the Covid crisis, my family didn’t see a dentist for almost two years. According to the British Dental Association (BDA), safety measures have meant that more than 35m appointments have been lost across England since Covid struck. Tooth decay was already the most common cause of hospitalisation in children (because many are too young to cooperate with treatment without a general anaesthetic).
Mick Armstrong is chair of the BDA’s health and science committee, and has come out of retirement to help with the backlog in West Yorkshire. “I treated a tooth the other day,” he says, “that required root canal therapy.” If he had seen it six months earlier, it would have been salvageable, he says, but: “When I did see it, it was too far gone.” He says there was already a crisis in access to NHS dental care, and this is one of the many areas in which existing health inequalities have been exacerbated by Covid.
But those whose teeth haven’t quietly rotted beyond repair may have inadvertently ground them to smithereens instead. When the American Dental Association surveyed its members in February, it found that 71% of almost 2,300 dentists around the country reported seeing an increase of bruxism – teeth grinding and clenching – among their patients during the pandemic. This can also lead to temporomandibular disorder, which more than 60% of the dentists also saw rise, with symptoms including jaw clicking and pain, and headaches around the temples. There was a similar rise in cracked and chipped teeth, which can result from tooth grinding.
Cardiologists have seen a rise in chronic heart conditions during the pandemic, says Sonya Babu-Narayan, associate medical director at the British Heart Foundation. For some, diet and exercise have suffered (more on which later), while it has become harder to access medical help. “Each delay adds to a snowball effect,” she says, “which ultimately puts lives at risk. Cancelled procedures, missed appointments and growing waiting lists have likely already contributed to thousands more deaths from heart attacks and strokes during the pandemic than we would expect to see otherwise.”
Philip Smith, consultant gastroenterologist at Royal Liverpool hospital and trustee of the charity Guts UK, has noticed that irritable bowel syndrome (IBS) flareups have grown more common. “We have seen an increase in disorders which can be linked to stress and anxiety, such as IBS,” he says. “The brain and the gut interact very closely.”
“My entire job is ‘embarrassing bodies’,” he says. “People don’t want to talk about breaking wind and diarrhoea and there’s a lot of stigma with the conditions that I look after.” Lockdowns have made seeking help more off-putting, for conditions such as Crohn’s disease, ulcerative colitis and inflammatory bowel disease, “and by the time that people are actually diagnosed, and have their treatment, their disease is flaring a lot more severely than it would have done in ordinary circumstances. We might have caught it when it was moderate rather than severe.”
Alcohol-related hospital admissions dropped in the years preceding the pandemic, says Smith, but, since Covid, cases “have massively skyrocketed. They may present with alcoholic hepatitis and jaundice. They can present with weight loss, or withdrawal symptoms such as shakes, tremors, sweating and agitation. They can present with gastrointestinal bleeding, because when you’ve got cirrhosis of the liver, your blood vessels swell up in your gut.” It’s not that everyone is drinking more – in fact, one-third of those surveyed by the charity Alcohol Change UK in 2020 said they had stopped or reduced their drinking. However, one in five – an estimated 8.6 million adults – have been drinking more.
As you would expect, says Emma Craythorne, consultant dermatologist at Guy’s and St Thomas’ hospital in London, inflammatory skin conditions such as rosacea, eczema and psoriasis have been worsening over this stressful time, because stress equals flareups. And frequent handwashing can take its toll on anyone’s skin. In fact, Craythorne’s department had to set up a clinic for staff at the hospital because, as she says, doctors have to wash their hands about 100 times a day. “When you cleanse your hands, immediately, the outer layer starts to lose water because you’ve disrupted its bricks-and-mortar protection.” If you don’t moisturise afterwards, or use a hand sanitiser with added moisturiser such as glycerin, the constant drying, “starts to cause cracks in the skin. And then the pathogenic bacteria can get in and cause inflammation.”
The term “maskne” has been jovially mooted during the pandemic – referring to skin problems due to mask-wearing – but Craythorne doesn’t see this as a big problem. Some people might develop perioral dermatitis, she says, “a condition where the barrier of the skin isn’t working quite so well, and you develop these tiny bumps around the mouth that can be itchy – and people often confuse it with acne, but it’s not”. While wearing masks does change the environment in that area, which could trigger the condition, Craythorne suspects that blame might more lie with the specialist skincare acids.
According to Emma McConnachie, spokeswoman for the Royal College of Podiatry, who practises in Stirling, my dodgy heel may well be pandemic-related. “We have been seeing more tendon strains and types of heel pain such as plantar fasciitis,” she says. One hypothetical cause could be that while we are working from home, feet are deprived of their usual supportive footwear. “Not all foot types cope well with walking barefoot or in flimsy footwear,” she says. “Some are also reporting that their feet have ‘spread’ and that their shoes no longer fit. Although, it could be argued that their shoes may not have fit properly before and that they are more aware after the time out of them. Like when you first put on your jeans after spending lockdown in jogging bottoms.”
She says podiatrists are also seeing increases in painful arch areas, ankles and the achilles area at the back of the ankle. The assumption, she says, is that many of these injuries have resulted from “changes in activity type, or taking up new activities, such as running”. If you have had pain in your feet for longer than two weeks without improvement, she advises, “you are best to seek professional assessment, diagnosis and treatment”.
Diet and fitness
Tim Spector at King’s College London, whose Zoe Covid Symptom Study app has been a mine of epidemiological data throughout the pandemic, says that the app’s survey on diet and exercise showed, overall, little change in the nation’s weight and fitness. But, behind these averages, he says, “quite a lot of people shifted their behaviour. They either got healthier, or they got much less healthy, but on average, they sort of balanced out.” This data was published this year in the journal Nature Food.
While the survey found that overall, weight gain averaged at just 0.8kg (1lb 12oz), an NHS study this year showed that people seeking help with weight loss were on average 2.3kg heavier than those in the previous three years.
Meanwhile, the Zoe survey showed that, while just over a quarter of people did less exercise over the pandemic, a small amount became more active. And, when it came to diet, Spector says, about one-third rediscovered cooking and ate more healthily, while another third did the opposite, and the final third made no changes. “What will they revert back to?” asks Spector. “Will they miss the KFC – or the quinoa salad?”
guardian.co.uk © Guardian News & Media Limited 2010