CPD: The COVID kilos and the mystery of the disappearing strokes

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Whilst gym closures certainly disrupted routines for many, our interest in exercise skyrocketed.

Whilst it is too early – and perhaps even fanciful – to start talking about the legacy of COVID 19 just yet, there is little doubt that there will be significant, long lasting impacts on our financial, mental and physical health.

Aside from the virus itself, one of the most immediate – and perhaps visibly evident – health effects has been on our waistlines. The dreaded ‘COVID kilos’ are most definitely a ‘thing’. 40% of respondents to a recent CSIRO survey said they had gained weight during COVID[1]. One medical practice has sought to quantify that even further, reporting an average weight gain amongst its clients of 3 to 5 kilos[2].

So, what’s driving this?

Those tempted to blame a lack of exercise should probably think again. Whilst gym closures certainly disrupted routines for many, our interest in exercise skyrocketed, especially during the very first series of lockdowns in March and April. According to an analysis of Google Trends data led by researchers from the University of Sydney’s Charles Perkins Centre, online interest in exercise has been at an all-time high during the COVID-19 pandemic[3]. And whilst data from Garmin trackers from around the world[4] shows we are walking less in our normal day to day routines, the number of us walking as a workout has increased – up 40% compared to 2019. We are working-out more indoors too (see Figure 1 below), seeing sales of home fitness equipment surge, and if you were hoping to find a bicycle under the tree this Christmas, think again; Bike sales between April and June were up 200% year on year, and a slowdown in manufacturing means many retailers simply can’t get their hands on stock[5].

Sales in other categories have surged too, although two in particular are proving to be COVID culprits rather than heroes.

Wine o’clock is getting earlier

For a start, ‘wine o’clock’ is coming around more frequently, and earlier in the day.

Pre-COVID that first stress relieving beer or wine would be consumed when we got home from work, typically around 6pm. Working from home, however, has probably seen 6pm become 4pm for many of us, helping drive an overall increase in alcohol consumption[6] since March (despite pubs and clubs being subject to closures and capacity limits). On average, 35 to 40 percent of Australians over the age of 25 reported that they were drinking more (Figure 2).

At the same time, our diets have gone out the window. A CSIRO survey carried out in June found that 34 per cent of us reported raiding the pantry for snacks more frequently. And, perhaps because we needed the comfort of calories, the snacks weren’t always of the healthy variety: 32 per cent of us reported that we’re eating more junk food[7].

These bad habits are likely to accelerate our national journey towards obesity, which, within Australia’s adult population, is expected to rise to 70.3 per cent in 2020-21, up from 69 per cent in 2019-20.

The extent to which obesity and alcohol consumption contribute to a range of health issues – including diabetes, cancer, and cardiovascular diseases (including heart attack and stroke) – is well documented.

Combined with these indirect health effects of COVID is the as-yet-unknown direct impact on those who contract and recover from COVID itself. In Australia that’s currently around 25,000 people[8], a thankfully small number by world standards, but still a meaningful cohort who could already be at higher risk of cardiovascular problems in the future, according to two recent studies from Germany. These studies[9], of patients who recovered from COVID, found that two thirds had experienced structural changes to their hearts, with the presence of a biomarker usually indicating heart stress.

Given the bulging catalogue of adverse health consequences, short and long term, from the pandemic, one might expect that doctors, nurses and other healthcare professionals are all rushed off their feet. Paradoxically, that’s not the case.

People are afraid to visit medical centres and hospitals

In fact, the flow on effect from COVID 19 that many health professionals are the most worried about is that many of us have stopped going to GP clinics and hospitals altogether, leaving a raft of health conditions undiagnosed and untreated. You could call it a ticking time bomb.

Early data from the Medicare Benefits Schedule (MBS) revealed that tens of thousands of Australians with chronic diseases missed vital visits to their doctor in the early days of the pandemic, with March seeing a 10% year on year drop in GP visits for chronic conditions, equating to around 96,000 visits[10].

At the same time, people were also forgoing potentially life-saving cholesterol tests – vital in the prevention of heart attacks and strokes – with NSW pathology data revealing a 28% drop in cholesterol tests being processed in March compared with February 2020.

Nor is the drop-off limited to more ‘routine’ medical matters either. Driven as much by a fear of catching COVID at clinics and hospitals, as a civic minded decision to ease the burden on the health system, Australians are avoiding medical attention even for more serious conditions.

Data from Cancer Council Victoria showed pathology cancer notifications fell by up to 28 per cent during the first March to May national lockdown[11]. At the same time, presentations at emergency departments for heart attacks fell around 30%[12], mirroring international experience and leaving some to question ‘where have all the heart attacks gone?’.

Perhaps most concerning of all is the plunge in stroke patients attending hospital, leaving medical professionals fearful that many undiagnosed stroke victims will die prematurely or be permanently disabled.

Stroke occurs when blood cannot travel to the brain, a result of a blocked or burst artery. Limited blood to the brain causes brain cells to die due to a lack of oxygen and nutrients.

Stroke symptoms – including speech disturbance and limb weakness – can be notoriously difficult to identify if you don’t know what to look for. And whilst serious stroke sufferers are still presenting at hospital, it is those suffering ‘minor’ strokes or warning attacks and not attending hospital – or taking longer to attend than normal – that have experts particularly worried.

Where have all the strokes gone?

Across major hospitals in Melbourne, CT scans for strokes totalled 108 in August, up from an April low of 73, but well below the pre-COVID average of 160. Clot retrieval operations almost halved to 11 in August, from an average of 20 pre-COVID.  And, according to data collected from 45 hospitals across Australia, brain scans for strokes fell from a peak of 172 a week to as low as 105 per week between March and May[13].

Stroke has a significant and lasting impact on its sufferers, and the broader community.

In 2020 it is estimated there will be 27,428 strokes experienced by Australians, and almost 8,800 deaths from stroke[14]. One stroke occurs every 19 minutes. Women over the age of 55 have a one in five chance of suffering stroke, and men over 55 have a one in six chance[15].

Almost a quarter of all strokes are suffered by people age 54 and under, and 10% are suffered by those aged 44 and under[16].

Increasingly, the prognosis for stroke suffers is good, and there are 445,087 survivors of stroke living in our community. This is expected to exceed 800,00 people by 2050[17].

Unlike some conditions which can develop over time, stroke often comes ‘out of the blue’. In fact, approximately 46% of women and 62% of men affected will have no warning[18].

As mentioned above, the symptoms of stroke aren’t necessarily understood by sufferers or people around them at the time, which is why health authorities around the world promote the simple, memorable, FAST test (see strokefoundation.org.au) to identify potential strokes:

  • Face (facial drooping)
  • Arms (can the person lift both arms?
  • Speech (is speech slurred and do they understand you?)
  • Time is critical (call 000).

Stroke is a leading cause of disability in Australia[19]. The impact of stroke on survivors and carers (most likely a family member) can be significant, ranging from profound limitations relating to self-care, movement and communication to difficulty with balance, ongoing fatigue and loss of concentration.

A stroke will often impair one’s ability to earn income (as executive functioning in the brain in terms of decision making, regulating emotions and memory may be affected as well as use of limbs and thus mobility). Unsurprisingly, depression and anxiety are also common after stroke.

Treatment for stroke involves a variety of procedures to remove clots and blockages and restore blood supply to the brain.

The cost of stroke

Zurich’s Cost of Care report examined the cost of stroke to the individual, finding that, in addition to the lifetime out-of-pocket costs to the individual in excess of $30,000 (including treatment and medication), there are significant indirect costs borne by those who care for stroke sufferers:

  • 58% of primary carers of spend 40 hours or more per week in their caring role
  • 21% report a decrease in income due to their caring role
  • 24% incur extra expenses due to their caring role
  • 31% have difficulty meeting everyday living costs.

The economic impact a was put into perspective by the Stroke Foundation’s recently released report – ‘The economic impact of stroke in Australia, 2020’.

The report estimated the economic cost of stroke – in 2020 alone – will be $6.2 billion, driven mainly by $2.9 billion in lost productivity, and $1.3 billion in health care costs. The report estimated a further $26.0 billion in lost wellbeing due to long term disability and premature death.

The risk factors for stroke are controllable

Happily, more than 80% of strokes in Australia are preventable by managing the modifiable risk factors identified by the Australian Burden of Disease study[20]: 

  • High blood pressure
  • High cholesterol
  • Alcohol consumption
  • Dietary risk
  • Overweight and obesity
  • Tobacco use
  • Physical inactivity
  • High blood plasma glucose
  • Impaired kidney function
  • Air pollution

The role financial advisers play in the health of their clients

Financial advisers are well placed to assist their clients achieve positive health outcomes in a number of ways.

Firstly, clients expect to talk to their financial adviser about their physical mental health, and that of their partner. This makes sense given the extent to which health can be an enabler of, or barrier to, the achievement of the goals laid down in their financial plan.

Zurich research showed that physical health was the second most frequently discussed non-financial issue between advisers and their clients – both in Australia, where it was raised by 69% of clients, and in the USA (52%). See Figure 3, below.

These conversations are an opportunity for advisers to educate their clients about the risk factors (described above) and direct and indirect costs of various health conditions. They are also conversations where the adviser can encourage the client to be vigilant and diligent about visiting their doctor and having any issues checked and monitored.

In the case of stroke specifically, advisers can help promote the use of the FAST test described above. Channels through which these (and other) educational messages can be promoted include the practice website, client newsletters, and printed materials available from health associations such as the Stroke Foundation and the Heart Foundation.

Secondly, advisers can encourage the client to think of them as someone they can call at any time. This is not inconsistent with the nature of strong adviser-client relationships, where the adviser is seen as much as a counsellor and mentor as a financial expert. With more and more people forced to work from home, and on-again off-again border restrictions and lockdowns, isolation is becoming more prevalent. Advisers can play a supportive role by being there to simply listen, and by even monitoring clients they know may be struggling, or who lack support structures. UK research found that 98% of emergency calls for stroke were made by someone other than the sufferer, underscoring the importance of being able to understand symptoms, provide support and seek help.

Thirdly, by understanding the financial implications of stroke – in terms of treatment costs, lost income, and the costs borne by carers – advisers can tailor life insurance coverage to the client’s individual circumstance, ensuring they can afford the best medical treatment and care, without the burden of financial stress impeding their ability to recover and rehabilitate.

 

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References:
[1] Unbalanced: COVID-19 shifting Australian dietary habits, Press Release, IBIS World, July 27, 2020.
[2] ‘COVID-kilos: Perth dietitian Margaret Hayes reveals best weight loss tips and tricks for Christmas countdown’, Caitlyn Rintoul & Jenna Clarke, The West Australian, 29 October, 2020, accessed November 17, 2020.
[3] ‘Has COVID 19 boosted interest in physical activity?’, Sydney University, https://www.sydney.edu.au/news-opinion/news/2020/07/02/has-covid-19-boosted-interest-in-physical-activity-.html 2 July, 2020, accessed November 17, 2020.
[4] ‘Garmin data reveals how the world is working out during the lockdown’, James Stables, wareable.com, April 11, 2020, accessed November 17, 2020.
[5] Bicycles, dumbbells and Nintendo Switch among the COVID 19 must-have items of 2020, Rachel Pupazzoni, abc.net.au, 31 October 2020, accessed November 17, 2020.
[6] Alcohol purchasing and consumption curing COVID 19, Drug Policy Modelling Program Study, University of NSW, October 2020.
[7] ‘How the COVID 19 pandemic is impacting our diet’, Nicola Heath, https://www.sbs.com.au/food/article/2020/08/20/how-covid-19-pandemic-impacting-our-diet 20 August 2020, accessed November 17, 2020.
[8] Australian Government Department of Health data, accessed November 17, 2020.
[9] ‘Can COVID 19 affect your heart?’, providence.org, September 29, 2020, accessed November 17, 2020.
[10] ‘Concern for Australians missing vital GP visits’, https://www.hospitalhealth.com.au/content/clinical-services/article/concern-for-australians-missing-vital-gp-visits-681251311#axzz6du6jjckM 22 May, 2020, accessed November 17, 2020.
[11] ‘More cancer deaths from COVID 19 lockdown’, John Kehoe, afr.com, August 12, 2020, accessed November 17, 2020.
[12] Drastic drop in cancer and heart attack patients linked to COVID 19, Doug Hendrie, https://www1.racgp.org.au/newsgp/clinical/drastic-drops-in-cancer-and-heart-attack-patients 14 April 2020, accessed November 17, 2020.
[13] Stroke victims go missing during COVID-19 lockdowns, John Kehoe, afr.com. September 9. 2020, accessed November 17, 2020.
[14] The economic impact of stroke in Australia, 2020, Stroke Foundation, November 2020.
[15] The Cost of Care, whitepaper, Zurich Life & Investments, 2018.
[16] The economic impact of stroke in Australia, 2020, Stroke Foundation, November 2020.
[17] Ibid.
[18] The Cost of Care, whitepaper, Zurich Life & Investments, 2018.
[19] The economic impact of stroke in Australia, 2020, Stroke Foundation, November 2020.
[20] Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015, https://www.aihw.gov.au/reports/burden-of-disease/burden-disease-study-illness-death-2015/contents/table-of-contents 13th June 2019, accessed November 17, 2020.
[21] Zurich Survey of Australian Financial Advisers, August 2020.
[22] ‘The Changing Role of the Financial Planner Part 1: From Financial Analytics to Coaching and Life Planning’, Dubofsky, D., and Sussman, L., Journal of Financial Planning, August 2009.

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