In 2020, the Covid-19 pandemic prompted New Zealand and much of the world to undertake something few of us had ever contemplated: a near-total lockdown of society. In this Lockdown legacies series, James Dann explores the impacts of those extraordinary measures, intended and otherwise. Today: From traffic accidents and seasonal flu to heart disease, the indirect health effects of the Covid lockdown were many and varied.

This project was made possible thanks to support from the Aotearoa New Zealand Science Journalism Fund.

With most of the world deep in first or second waves of Covid-19, it doesn’t need to be said that the disease has had devastating effects on people’s health. While the lockdown was designed to break the chain, and minimise the spread of the disease, there were also other health effects from this period of forced isolation. In this article, I’ll be looking at some of the indirect health benefits of the Covid lockdown, from fewer traffic and workplace accidents, to a near eradication of the seasonal flu, and fewer presentations of heart disease. There may also be negative health impacts from the lockdown, with people not being able to see their GP in person, having to delay surgeries, and the impact of increased alcohol and drug consumption.

Accidents

Much of the reduction in the number of deaths and injuries was a result of us staying home and not doing a hell of a lot. The road toll was just nine in April, a record low (over the last decade, there have been about 30 deaths a month; there were 45 in April of 2019). While many people were working from home, in some jobs this just isn’t possible, and many of these – construction, logging, heavy industry – have a high rate of workplace injury and death. Accordingly, the number of workplace injuries and fatalities fell substantially. Over the previous three years, the average number of deaths for April and May was seven and six, respectively. In 2020, there were four deaths  in April, and two in May. The number of injuries at work dropped from 247 in February to 184 in March then 74 in April, climbing back to 174 in May. Though this was a large reduction, it still shows that people were continuing to get injured at work, even while the workforce had shrunk.

A study of trauma admissions at Waikato hospital shows changes in the places and ways people were being hurt. The paper compared admissions from a 14-day period prior to lockdown with a 14-day period under level four. It found a 43% fall in the number of admissions. There were decreases in the number of admissions caused by traffic accidents, falls, and assaults. Some categories, such as cycling, equestrian, and pedestrian didn’t change. There were also changes to the places where people suffered injuries, with fewer incidents on the road, in water, in public places, and at sports fields. Farming, which was an essential service and therefore continued to operate as normal, saw a slight increase in the number of injuries.

The demographic which saw the biggest decrease was males, who tend to be over-represented in many of the high-risk workforces.

The flu curve flattened

As well as breaking the chain of transmission of Covid-19, the lockdown also stopped the spread of other diseases that usually require human-to-human transmission. One of these is the flu, which is estimated to kill around 400 to 500 people in New Zealand each year. The Flu Tracking site records the number of people reporting flu-like symptoms. The number of people reporting flu-like symptoms this year was much lower than in previous years. Circulation was broken by the lockdown, and while the numbers have ticked up slightly since then, the amount of flu circulating remains low.

Another factor that could have contributed to the drop in deaths was a reduction in cardiovascular disease (CVD), including heart attacks and strokes. The WHO lists CVDs as the number one cause of death globally; in New Zealand, they account for 5% of all hospital admissions. A study from the Waitemata DHB compared the number of admissions for CVDs during lockdown to the same period in 2018 and 2019. It found that there was a reduction in the number of admissions during level four. The reasons for this, however, aren’t clear. It could be that there were fewer instances of CVD during the lockdown; alternatively, there could have been the same number of instances, but fewer of them were either reported, or diagnosed, due to the lockdown.

Air pollution elevates the risk of heart disease, and as we saw in the previous article, air quality was significantly improved due to the decrease in traffic volumes. Stress is also a contributing factor to heart disease, and for some people, the lockdown was a less stressful time.

Conversely, a sedentary lifestyle raises the risk of CVD, so if people weren’t getting as active as they had been pre-lockdown, this could have had a negative effect. The strict stay at home messaging, especially for people over 70 who are the highest risk for CVD, may have led to some people being overly cautious when they were feeling unwell. Another possibility is that the lack of in-person consultations meant that many symptoms were missed by physicians.

The lockdown backlogs

With the health system focusing on Covid, many people had to wait until the lockdown lifted before they could be seen in person by their doctor. This may have meant a delay in diagnosis, or people on a waiting list having to wait even longer, such as for women with endometriosis. The NZ Association of Orthopaedic Surgeons said more than 10,000 elective surgeries were delayed. While elective surgery is generally not regarded as urgent, it would have resulted in many people living in pain and discomfort for much longer than they would have liked to.

Another example is specialist cancer treatment. This April, there were 1031 fewer cancer registrations than in April 2019 – a 47% decrease. However, the sector has been working hard since lockdown lifted, and the number of cases diagnosed is almost back to that of a normal year. Professor Diana Sarfati from Te Aho o Te Kahu, the Cancer Control Agency, said that ”since lockdown lifted we have seen a major ramping up of cancer services, with many in the sector doing weekend and evening work, as well as outsourcing, to catch up on the Covid created backlog.” By the end of July, the number of cases reported was just 2.5% below that of 2019.

Booze and other social drugs

Another indirect effect on people’s health could have come from changes in the amount and frequency alcohol was consumed. There were stories in the days before lockdown of (socially distanced) queues forming outside liquor stores, and most people could continue to buy beer and wine from their local supermarket during lockdown. The Global Drug Survey ran a study with more than 40,000 respondents across the world, including more than 3,000 from New Zealand. Of the Kiwi respondents, 20.7% reported drinking a lot more, and a further 30.2% reported drinking a little bit more than usual. This was the biggest increase of all the countries surveyed, with the global average of people drinking a lot more being 13.5%. We also recorded very high numbers of people increasing instances of binge drinking, well above the global average. Across the whole survey (data for this question wasn’t split by country) the top two reasons for drinking more were “I have more time to drink” and “I am more bored.”

While around half of Kiwis in the survey reported drinking a little or a lot more, there were also about a quarter of us who said they were drinking less, and about 30% who reported fewer instances of binge drinking. The top reasons for drinking less were having “less contact with the people I usually drink with”, and “I can’t go to the place I usually drink.” The Global Drug Survey also asked about other drug use; while New Zealand had the second lowest use of cannabis in the 12 countries participating, above only Ireland, 41% of people used more use during lockdown, while for 42% it stayed about the same. Only 16% reported a decrease in usage.

As a result of our lockdown, fewer New Zealanders will die this year. There are a number of reasons for this. There were fewer of us involved in car accidents, or incidents at work. The lockdown broke the chain of transmission for a number of other diseases, not just Covid, and this meant that fewer of us got sick.

But with the health system focussing on coronavirus, many people had their appointments cancelled or delayed, from their regular visits to the doctor, through to more serious interventions, such as elective surgeries and cancer treatment. This will place further strain on the health system, as well as the physical and mental health of those having to wait longer for treatment. Finally, the lockdown changed the way that we consume alcohol and drugs, with some of us using more, while others went the other way, removed from the places and social situations we were so used to.

In tomorrow’s concluding article in this series, we’ll look at some other impacts the lockdown had on the way we behave, and our lifestyles and wellbeing more generally.

LSD was criminalised across the world in the late 1960s, following a moral panic about the effect recreational use was having on young people. After a 40 year hiatus on medical use, LSD is being studied once more. Helen Glenny explains.

Mel Elwin, 36, swallowed five large pills and washed them down with water. She put on headphones, dark eye shades, and lay back in a bed. After a while, she started to relax. “I just felt really peaceful,” Mel says. “And that’s probably when I left my body.”

She had been referred to Imperial College London in 2015 by her GP after eight years with severe depression, spanning a relationship breakdown, a job loss, and the birth of her son. She’d tried three different types of antidepressants; two made her worse, the other made her numb. The pills she took contained psilocybin, the active ingredient in magic mushrooms.

Mel’s trial was the first in 40 years where psychedelic drugs were given to patients with severe, treatment-resistant depression, and it was remarkably effective. Psychedelics studies are now underway across Europe and North America, and the University of Auckland is about to start an LSD microdosing trial, bringing the psychedelic revolution here.

The acid test

In the 1950s and 60s, more than 40,000 patients were treated with LSD for depression and alcoholism. LSD was criminalised around the world in the late 1960s at the height of beat poetry, counterculture and America’s war on drugs, and as a result, psychedelics vanished from the psychiatrist’s toolbox. But over the last 10 years, a resurgence has begun.

Professor David Nutt, who heads the Imperial College lab where Mel’s trial took place, campaigns for the reclassification of drugs based on an objective ranking at how harmful they are. Psychedelics, he points out, are neither addictive nor harmful, especially when administered by doctors. For Mel’s trial, he’d wangled permission to treat 12 volunteers all suffering from treatment-resistant depression with psilocybin.

(This modern wave of psychedelics trials all use either LSD or psilocybin. They have similar, but not identical, effects. The choice often comes down to which drug is easier to get permission to use. If both are available, psilocybin is preferable because the trip only lasts six hours, allowing everyone to get home for dinner.)

Trial trips are very different to taking LSD recreationally. Mel spent hours getting to know her two “guides”; and on her dosing days she lay under blankets in a dimly-lit room, with soft table runners and ornaments giving the lab a yoga-studio vibe. She took 25mg of psilocybin, and the experience, she says, was “soul-bending”.

“I just became a ball of light, and I was literally everywhere at once,” she says. “I was the sun, I was the stars, I was the moon, I was everything. There were lots of other lights around me. They were all souls, and I was a soul.”

During the trip, her guides would check in with her every 15 minutes. If she encountered something scary, her guides would reassure her she was safe.

As part of the trial, Mel had psychotherapy sessions that helped her make sense of her experience, and she started feeling better straight away. “I booked myself into the gym and started working again,” she says. It was the first break from an eight-year depressive period. She still has hard times, but four years later, she no longer considers herself depressed.

This was just a small-scale feasibility study, but the results were fascinating. Every participant in the trial was less depressed a week after their trip. Mel was one of seven (out of 12) who was considered depression-free. After three months, five were still free from depression; a mammoth result for people for whom nothing else had worked.

Your brain on psychedelics

A team at Imperial College went one step further; giving healthy patients LSD and sliding them into an MRI scanner to image their brain activity as they trip.

They expected to see fireworks, but in most areas of the brain, activity actually decreased under LSD. Instead, a low level of activity hummed all over the brain. One region that went particularly quiet was a hub of brain structures called the “default mode network”. This is the network responsible for self-reflection, self-criticism, and thinking about the future or the past. It’s thought to be the seat of our ego, and in depressed people, it’s often in overdrive.

“Overactivity of the default mode locks people into negative, internalising thinking,” says Professor David Nutt. “Psychedelics disrupt the default mode and allow people to think differently. You’ve got this double whammy: you’ve escaped through the trip, and afterwards, your brain is more receptive to new ways of thinking.”

Mel’s experience, feeling at one with nature, and physically part of every bit of the universe, is a classic example of ego-dissolution, the result of a default mode network gone quiet.

In fact, every condition that’s been treated successfully with psychedelics involves a component of critical self-thought: I can’t get through the day without a drink, in alcoholism; I’m responsible for something that happened to me as a child, in trauma. Depression, OCD, anorexia, smoking; all involve inescapable negative loops of thought that gradually shade out reality, and psychedelics ease these loops open.

A tab a day keeps the doctor away

Most psychedelics studies use “macrodoses” – a high enough dose to induce a trip. But a team at the University of Auckland, led by associate professor Suresh Muthukumaraswamy, is investigating LSD microdosing: taking just a little, not enough to elicit any kind of psychedelic experience, frequently.

Volunteers will take a small dose every fourth morning at home; a quirk in our drug laws allows Class A drugs to be prescribed for a month or less, with “mountains of paperwork,” according to Dr Rachael Sumner, a postdoc working on the trial. “The crux of the trial is the ability for people to go home and live their normal lives.”

Microdosing on LSD isn’t expected to open up ego-dissolving experiences. Instead it may boost plasticity; the ability of the brain to change.

A lack of brain plasticity is a hallmark of depression. A less plastic brain is subject to getting stuck in rigid loops of negative thinking, the kind that goes on in the default mode network. Traditional antidepressants are believed to increase brain plasticity, but it can take six to eight weeks. “Drugs like LSD, psilocybin and ketamine all increase plasticity within hours,” says Sumner.

At this early stage, the trial is looking at microdosing in healthy male volunteers with no added therapy, but in the future, it could be combined with psychotherapy or CBT to help create enduring change. Six-hour guided explorations of an ego-free universe aren’t for everyone, so microdosing could be a solution for those who aren’t keen on a trip.

In the UK, Professor David Nutt continues to campaign for psychedelics to be legalised, at least for medical use. Attitudes are slowly changing; in the past year, Denver, Oakland and Santa Cruz, all in the USA, voted to decriminalise magic mushrooms. Johns Hopkins is running a new trial for psilocybin use in those suffering from Alzheimer’s. Mel hasn’t taken psychedelics again, saying that what she learned from her one experience is enough to keep her well. “It hasn’t all been easy, life happens. But this trial reset my brain.”