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Public Health

The Epidemic No One Is Talking About

We are "going in the wrong direction" and only seeing "the tip of the iceberg."

The COVID-19 pandemic has caused a number of downstream impacts, but the increase in hepatitis C cases is not one that gets as much attention as mental or heart health. But the isolation wrought by the pandemic has increased drug use and hepatitis C transmission while reducing testing and treatment.

Hepatitis C causes liver inflammation that can lead to severe liver damage and possibly death. The infection usually goes undetected for years, as the symptoms are subtle until the liver is damaged enough to have an impact on health. If left untreated, it can cause liver cancer or failure. The Department of Health and Human Services says that 2.4 million people have hepatitis C in the United States, but that number could be much greater due to the silent nature of the infection.

The increase in hepatitis C cases is also tied to the opioid epidemic, as it is a bloodborne virus that can be transmitted through sharing needles. With more people isolated during the pandemic, mental health problems increased, leading to more drug use and needle sharing. At the same time, fewer people were getting tested because of avoided care.

A study from Science Direct found that there was a 59 percent decrease in hepatitis C testing in April 2020 compared to April in 2018 and 2019. The number of positive tests fell by 62 percent in March 2020 and remained 39 percent below normal through July 2020. Treatment for the disease also fell during that time.

While testing and treatment went down, it is likely that cases actually went up, meaning there are more undiagnosed and untreated individuals who may spread the disease to others or become severely affected themselves.

Because hepatitis C patients are often asymptomatic, they are less likely to seek treatment or get tested, and are more likely to spread the disease to someone else. Meanwhile, liver cirrhosis and potential liver cancer are developing inside them. “Millions of people who have hepatitis C don’t even know that they have the infection, and they don’t consider themselves at risk,” said Dr. Mamta Jain, an infectious disease specialist at Parkland Hospital and a professor of internal medicine at UT Southwestern.

The lack of detection is frustrating for medical professionals treating hepatitis C patients because disease is now easily treatable. By taking just one pill once a day for eight to 12 weeks, nine out of ten patients can be cured. “We know that if we treat them early, we can cure them,”. “You reduce mortality, as people with hepatitis C die 20 years earlier than those without hepatitis C,” Jain said.

Jain used to rarely see new acute hepatitis C cases each year, but she has seen several in the past six months, she said. Only 5–10 percent of cases are symptomatic. “That’s just the tip of the iceberg,” Jain said. “We’re just seeing those with symptoms, and that tells me that there’s more going on.”

Parkland and JPS were leading the charge in North Texas on hepatitis C testing prior to the pandemic, with mobile outreach units looking to test vulnerable populations. Much of that was paused during COVID, but Jain says they are looking to ramp up operations again—especially given the increase in cases and drops in testing. For a disease that is now so easily treatable, it pains providers to see it spread.

“I am sad to see that we’re kind of going in the wrong direction with hepatitis C,” Jain said. “I’m worried that if we continue to see increases in hep C, we’re going to see increasing death down the line.”

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