By Liora Engel-Smith
Coronavirus has invariably changed life as we know it in some big ways. With thousands of cases, deaths and hospitalizations from the novel virus in North Carolina, some of these changes are obvious. Others are now a given in our socially distanced world: medical appointments take place via computer or phone, in-car testing, and even flu vaccinations have also become more commonplace.
The pandemic has also reshaped health behaviors in more subtle ways. People are delaying routine screenings and other well-care visits. Demand for contact lenses is up. Sales of elderberry syrup and gummies — a natural remedy marketed as an immune system booster — have risen sharply since March, even without conclusive evidence for effectiveness against coronavirus.
It’s hard to know the exact implications of this new reality, but we’ve gathered some of the most compelling shifts in people’s health behaviors in recent months.
Contact lenses are hugely popular
Masks don’t just stop the spread of coronavirus-laced droplets — they also fog up eyeglasses. This has prompted many people to consider contact lenses for the first time, said Rachael Wruble, president of the North Carolina Optometric Society.
“It was something I wasn’t expecting,” said Wruble, who also co-owns three eye clinics in the Charlotte area. “But it makes sense, especially [since] we’re wearing masks full time.”
Wruble said demand for contact lenses came in two waves. The first began in May, with essential workers, who had started wearing masks full time at their jobs. Wruble said that trend coincided with a higher-than-normal volume of routine eye exams that patients missed in March and April, since eye doctors closed their clinics to control the spread of the new virus.
As more people returned to the workplace, people in other professions, including teachers and office workers started looking to contacts. Demand has remained high, she added. Between the three clinics, which serve a collective 75 patients a day, the number of patients requesting contact lenses has doubled.
Those who already wore contact lenses are also changing their behavior, Wruble said. The same phenomenon that causes glasses to fog – air that flows up the face from behind an ill-fitting mask – can also dry the eyes of mask wearers. Many of them are shifting from monthly lenses to disposable ones, which are generally thinner and help reduce eye dryness. The widespread use of masks has even prompted a new diagnosis: Mask-associated dry eye.
Elderberry and other remedies are in high demand
Elderberry is a cold and flu remedy with some scientific backing, though the evidence for its effectiveness is limited and insufficient at best, said William Schaffner, infectious disease doctor at Vanderbilt University in Tennessee. It’s even less clear if the popular folk medicine can stave off coronavirus, he added.
“About once a week, I get a question about a natural substance or food or something like that and if it has been shown to have any effect against coronavirus,” he said. “And the short answer is ‘no.’”
Yet elderberry syrup and supplements such as zinc, vitamin C and even probiotics are selling like hotcakes, said Joe Moose, owner of Moose Pharmacy, a chain with seven stores in Cabarrus, Union, Stanley and Rowan Counties.
“COVID made folks really interested in immune-boosting supplements,” he said. “New supplements are coming to the market and you see people asking for supplements … that have a loose association with boosting immunity.”
The elderberry business appears to be booming, as a result. Kristen Sewell, co-owner of the Cary-based Elderberry Lady, said business typically peaks during the winter months and falls off when cold and flu season ends. This year, however, demand for syrup and gummies has only increased since March.
Sewell said most of her customers before the pandemic were from the Triangle, but the pandemic has created an increased market for elderberry products all over the country.
“People are concerned about staying healthy,” she said about the surge. “They’re more concerned about preventive [measures] rather than taking the risk and getting sick.”
The trend is playing out nationwide, said Devon Bennett, president of Norm’s Farms, an elderberry syrup producer that works with growers all over the country, including in North Carolina. Bennett said the demand for elderberry was high even before the coronavirus pandemic, as people began showing interest in remedies for immune health.
The pandemic, however, brought on massive and rapid growth in demand for the product.
Though Bennett said Norm’s Farms stopped advertising elderberry as an immune booster because it is not proven to prevent or cure coronavirus, business has doubled since March, he said, and sales have remained brisk.
Norm’s Farms was already working to expand its production and placement of elderberry syrup in more stores, but coronavirus fast-tracked that growth.
“People have come to the realization that we have to pay attention to our health and wellness,” he said. “Because if you look at COVID, it’s a whole-body experience. You need to be well so you can fight it off.”
Schaffner, for his part, said that concerns over coronavirus have led to people seeking any kind of advantage they can to avoid the virus. To date, however, no natural supplement or remedy has been proven to prevent or treat coronavirus infections.
Schaffner said elderberry syrup likely won’t help prevent coronavirus, but it won’t harm people either. However, he warned, taking a supplement should not replace proven methods to curb the spread of the new virus, including hand-washing, wearing masks and practicing social distancing.
Demand for the flu shot up
The pandemic has also spurred some renewed interest in more conventional preventative measures as well, with more people getting vaccinated for the flu this year, experts said.
“It seems like everyone who has ever in the past has been OK with getting the flu shot, they’re all coming this year to do that,” said Lisa Reed, family physician at the Asheville-based Mountain Area Health and Education Center.
Though some people remain vehemently opposed to vaccines, she added, demand for the flu shot has exploded, particularly because of concerns of getting coronavirus and the flu together. During an average flu season, clinic staff would generally administer three to four flu vaccines a day, Reed said.
“This year, we can have 40 people coming to get the flu shot in an afternoon,” she added.
Moose, the pharmacist, said that people’s desire for the vaccine is so high that his chain has struggled to keep up with supplies. Each of the seven pharmacies he owns, he said, has a waiting list of 50 to 100 people who wanted to get the flu shot last week, but couldn’t because they ran out.
Demand for the vaccine, he said, is likely to remain high throughout the season.
“[People] understand that this is not the year they want to get sick,” he said. “This is not the year they want to spend time in the hospital or the doctor’s office.”
Alongside that demand, clinics across the state, including the one at MAHEC, have tried to make it easier to actually get the shot this year. MAHEC, for instance, is holding Saturday flu shot clinics. Drive-through flu vaccination programs are also popping up in eastern North Carolina and on the coast have created new opportunities to get vaccinated.
Cancer screenings are still down in parts of the state
The early stages of the pandemic prompted health care providers to suspend routine procedures, including cancer screenings. Though some patients have gotten caught up on routine tests since the closures in early spring, patients have been slow to come back in some parts of the state.
In eastern North Carolina, an area with pockets of high cancer morbidity and mortality and higher rates of poverty, fewer patients than average are scheduling routine mammograms and colonoscopies, said Vidant Medical Center oncologist Mahvish Muzaffar.
Muzaffar worries that the coronavirus-fueled reluctance to get routine screenings will widen the disparity between poorer communities of color, who already experience higher rates of cancer mortality, and more affluent white communities in the state.
“Cancer doesn’t wait,” she said. “We already, among the black community, see a disadvantage and screening rates are so low. We cannot let that get out of hand.”
Reed, who works in Asheville, said the same is true for her patients, many of whom have not yet caught up on routine Pap smears and other preventative services, mainly because of fears of coronavirus.
“I’m very worried that in a year and a half, we’re going to be diagnosing more breast cancer that could have been diagnosed earlier.”
That trend doesn’t hold true in the Triangle, said Jay Baker, chief of the breast imaging division at Durham-based Duke Health. The division usually accommodates roughly 30,000 procedures and imaging studies a year, he added, and at the height of the pandemic in early spring, only about a third of patients — those with urgent needs — were being seen.
As restrictions eased, patients who missed screening appointments came back almost entirely.
Baker said there’s no way to know how many women planned on scheduling a mammogram this spring and decided not to because of the pandemic. And while it may be safe to delay a screening for a couple of months, the same isn’t true for longer periods, particularly with aggressive cancers.
“The important message is that COVID is obviously a health emergency,” he said. “But it’s clearly gone on longer than people anticipated. Certainly health systems adapted. Everyone in the hospital is wearing masks.”
He urged patients who haven’t done so to schedule their routine screenings or at least discuss the decision to delay with their medical provider.