Mitigating health impacts: Secondary Stress due to the COVID-19 pandemic

Print Friendly, PDF & Email

Date: April 13, 2018
To: HPSJ Providers (HPSJ) Providers, Practices, and Facilities
From: HPSJ Provider Services Department
Subject: Mitigating health impacts: Secondary Stress due to the COVID-19 pandemic)
Business: Medi-Cal

“First and foremost, HPSJ appreciates you – providers, practitioners, and facilities – for your tremendous commitment to take care of patients with the COVID 19 illness and others during this pandemic.” – HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD

While Californians have come together to practice social distancing to slow spread of COVID19; public anxiety due to the virus –  the economic distress related to lost wages and financial assets, school closures and the necessary physical distancing measures – can result in an increase in physical and emotional stress-related morbidity and mortality. Disasters of this nature are well known to result in short-term and long-term mental health and physical health impacts, including increased cardiovascular, metabolic, immunologic and neuropsychiatric risk.

We all worry about the whole range of negative health outcomes which can include:

  • Increased rates of heart attack and stroke
  • Increased blood pressure
  • Exacerbations of chronic obstructive pulmonary disease and asthma
  • Increased hemoglobin A1c levels among diabetic patients
  • Immune dysregulation – with increased risk for infection, autoimmune disorders, and poorer oral health
  • Poorer perinatal and birth outcomes, including preterm birth and low birth weight
  • Increased intimate partner violence
  • New or recurring mental and behavioral health conditions including depression, anxiety, suicidality, post-traumatic stress disorder, obsessive-compulsive disorder, and substance use disorder (inclusive of alcohol and drugs)

As providers, you play an essential role in helping to address where possible and mitigate some of the negative health outcomes identified above with appropriate adaptations to provide disaster-responsive, trauma-informed care to your patients. 

To mitigate negative secondary health outcomes, we are sure you agree it is crucial to provide high quality health care to HPSJ enrollees. HPSJ is confident that you will identify the signs of and assess for stress-related morbidity, and create responsive treatment plans –  including supplementing usual care with measures that help regulate the stress response system, such as: 

  • Supportive relationships
  • Age-appropriate, healthy nutrition
  • Sufficient, high-quality sleep 
  • Mindfulness and meditation
  • Adequate Physical activity
  • Mental health care

MITIGATING THE HEALTH IMPACTS OF SECONDARY STRESS DUE TO THE COVID 19 PANDEMIC  Health Plan of San Joaquin – April 13, 2020                                                                                                                                

HPSJ is eager to work with you and to assist you in providing supportive care for our members. To refer HPSJ members for the following services, please call (209) 942-6340:          

  • Case Management
  • Social Work
  • Behavioral Health

To Bookmark – HPSJ’s COVID-19 Provider Updates page includes Mental Health Supports.

Find it at 

Resources helpful in taking care of your patients

APLs related to trauma-informed care can be found at the following link: htt ps:// ov/formsandpubs/Pages/AllPlanLetters.aspx

For Telehealth:  

DMHC APL 20-13 for Telehealth Services:


Additional resources on how to mitigate the stress-related health outcomes anticipated with the COVID-19 emergency can be found on www.A CEsAwa re.o rg.

ACEs resources and information for Medi-Cal can be found on the DHCS webpage at

DHCS COVID-19 guidance on Telehealth – the ACES Aware and other helpful sites are also included here; please review:

Also see the Supplement to APL 19-009, Emergency Telehealth Guidance – COVID-19 Pandemic, which can be found at: es/AllPlanLetters.aspx

  • The Principles of Trauma Informed Care can be found at:

htt ps:// rmedcare/

Another resource: Burke Harris N. The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. Houghton Mifflin Harcourt, 2018

Posted on April 13th, 2020 and last modified on April 14th, 2020.