By Brianna Abbott

The ripple effects of the Covid-19 pandemic’s influence on nearly every aspect of health in America are becoming clear.

Covid-19 has killed more than one million people in the U.S., a toll mounting by some 350 people a day. A range of other chronic diseases and acute threats to health also worsened during the pandemic, data show, as people missed screenings, abandoned routines and experienced loss and isolation.

“In addition to just the terrible burden of a million Americans dying, there are other repercussions from the pandemic that we need to address,” said Chrissie Juliano, executive director of Big Cities Health Coalition, an organization of city health officials.

Some setbacks could be reversed relatively quickly, health experts said, while it might take years to recognize the full effects of others. Here are some of the public-health challenges that grew in the pandemic’s shadow:

Overall deaths and the death rates from heart disease and stroke rose sharply during the pandemic, setting back progress against two of the nation’s leading killers, according to a report published in March. Many people missed visits to doctors or avoided hospitals early in the pandemic. Some later died at home, or reached the hospital too late. Covid-19 infection also increases the risk for stroke and heart attack, studies suggest.

People also have been under more stress in the past few years or haven’t been as active as before. Some gained weight or struggled to manage chronic conditions, said Donald Lloyd-Jones, a former president of the American Heart Association.

“We can’t immediately snap our fingers to get diabetes or blood pressure under control,” said Dr. Lloyd-Jones, chair of preventive medicine at the Northwestern University Feinberg School of Medicine.

Drug-overdose deaths, rising before the pandemic, jumped to a record of more than 107,000 in 2021, according to preliminary data from the Centers for Disease Control and Prevention. The potent synthetic opioid fentanyl is driving the crisis, officials have said.

The age-adjusted rate of overdoses in the U.S. also increased from about 22 deaths per 100,000 people in 2019 to 28 per 100,000 in 2020, the agency said. Disparities in access to treatment are driving up overdose rates among Black and Native American people, data show, as the pandemic has exacerbated inequities in healthcare outcomes.

Alcohol consumption and excessive drinking also increased during the early months of the pandemic, surveys have shown. A March report estimated that alcohol-related deaths increased about 25% from 2019 to 2020, a more rapid rise than in years before the pandemic.

More people globally experienced symptoms of anxiety and depression in the first year of the pandemic, according to the World Health Organization. In the U.S., clinicians and public-health experts have raised alarms about the state of mental health, particularly among children and adolescents. More than one-third of some 7,000 U.S. high-school students who responded to a recent CDC questionnaire in the first six months of 2021 reported poor mental health during the pandemic.

In 2020, about 5.6% of adults had a serious mental illness within the past year, or a mental, behavior or emotional disorder that interfered with or limited a major life activity, according to estimates from the Substance Abuse and Mental Health Services Administration. About 21% of U.S. adults had any mental illness, SAMHSA estimated.

The U.S. gun-homicide rate increased nearly 35% from 2019 to 2020 to the highest level since 1994, according to a May CDC report. Agency officials cited economic stress, disruption of services and social isolation during the pandemic as potential factors. The firearm-suicide rate increased slightly as well. In a separate CDC report, researchers found that the suicide rate overall declined by 3% in 2020 from the year prior.

The U.S. also lost ground on antimicrobial resistance—bacteria, fungi and viruses evolving to withstand medications, making infections harder to treat. Resistant infections that started in the hospital increased at least 15% in 2020 from 2019 among seven pathogens, the CDC said. Related deaths rose as well.

Antibiotics were overused early on in 2020 to attempt to treat Covid-19 patients, said Helen Boucher, interim dean of Tufts University School of Medicine. Prevention efforts also likely slipped at overstretched hospitals and healthcare settings, she said, with resources focused on fighting the pandemic.

After dropping early in the pandemic, reported U.S. cases of gonorrhea and syphilis increased by the end of 2020 and were greater than 2019 levels, according to a CDC report.

Some people likely limited their sexual activity at the onset of the pandemic, according to the agency. But reduced screening efforts and less access to care could have led to longer, untreated sexually transmitted infections and more disease spread, the CDC said.

In 2020, screening prevalence for breast cancer and cervical cancer decreased by 6% and 11%, respectively, compared with 2018, according to data from the American Cancer Society. Colonoscopies for men and women dropped 16% but were offset by increases in stool testing that can be done at home.

Most of the drop occurred in the first few months of the pandemic. Cancer screening has since rebounded but has yet to fully make up for that initial gap, cancer doctors and researchers said. Researchers are tracking whether the gap in screenings will lead to worse outcomes.

Routine vaccination rates for three childhood shots among kindergartners was about 1 percentage point lower during the 2020-2021 school year compared with a year earlier, according to the CDC, to about 94% coverage. Some states saw bigger drops.

That 94% rate for the MMR, or measles, mumps and rubella, is now also below the target of 95% coverage, after being roughly at the target the year before. Health authorities use kindergarten inoculation as a benchmark, since vaccination against a series of diseases is often required for school.

Pandemic disruptions likely caused some children to miss scheduled shots, public-health experts said, and schools had less bandwidth to follow up with families and collect data. Some clinicians said hesitancy toward Covid-19 vaccination might spill over into other vaccines. Thirty percent of kids ages 5 through 11 in the U.S. are fully vaccinated against Covid-19, CDC data show.

Lower vaccination rates can give highly contagious viruses such as measles an opportunity to spread. Global childhood-vaccination rates during the pandemic recorded their largest sustained decline in about three decades, according to the WHO, following almost a decade of stalled progress.