The phrase "a substantial toll" is correct and usable in written English.
It can be used to describe a significant impact or cost, often in terms of emotional, physical, or financial consequences.
Example: "The pandemic has taken a substantial toll on mental health across the population."
Alternatives: "a significant impact" or "a considerable cost".
So even if anxiety doesn't affect the progress of the disease, it takes a substantial toll on quality of life.
All in all, pessimism took a substantial toll; the most pessimistic individuals had a 42% higher rate of death than the most optimistic.
There had already been a substantial toll from that assault, he and others said, with some residents killed as their houses collapsed.
Spending more hours at work often leads to less time for sleep and insufficient sleep takes a substantial toll on performance.
Sanctions against Syria's oil industry are taking a substantial toll, draining $4 billion from the country's economy so far and causing widespread fuel shortages, a top official of the embattled government of President Bashar al-Assad said Wednesday.
The journey should be planned in such a way that the mountains are crossed or halted before they are reached, lest the herd is caught on the mountains and risks a substantial toll from heavy snow fall and extreme temperatures.
On the other hand, a highly active person who comes into sufficiently close contact with many individuals can cause a substantial death toll for any configuration we try.
Being especially vulnerable to disease to begin with and highly localized from the start, a substantial death toll of the elderly is almost guaranteed once a disease enters such a facility.
Infections generate a substantial economic toll.
Treatment and related complications exact a substantial economic toll [ 4].
These infections not only cause morbidity and further economic burden in predominantly low-income countries, but also result in a substantial death toll worldwide [ 1– 3].
