The effects of COVID-19 on healthcare go well beyond the daily count of infected individuals and the deaths due to the virus. While the world’s attention is understandably focused on the direct impact of COVID-19, the challenges of keeping essential medical services alive and running are immense.
Many health experts feel that the invisible toll of the pandemic will be those with other medical conditions that go unchecked, either due to fear of contracting the virus or the reduced availability of health care services for “routine” problems.
A study published earlier this month in American journal JAMA Cardiology showed the risks of neglecting signs of other disease and what consequences they eventually have on people’s health.
The researchers focused on heart attacks during the pandemic and looked at data from six US states and compared it to the same time period in 2018 and 2019.
They found that the people who suffered from a heart attack in 2020 during the COVID-19 months were more than twice as likely to die from it when compared with the previous years.
They suggested several reasons for this. Reluctance to seek medical attention in case they got infected, early discharge to free up beds and less effective follow-up care, as well as the stress and various lifestyle changes associated with the COVID-19 pandemic.
Another study published last week showed that rates of cancer diagnoses in the US substantially declined during the early months of the pandemic. This certainly does not mean that there is less cancer around, as one of the study authors remarked “while people have taken to social distancing, cancer does not pause.”
These researchers have warned that the inevitable delays in diagnosis are likely to lead to patients presenting at more advanced stages and eventually worse outcomes. They even predicted more than 10,000 excess cancer deaths in America during the next decade because of missed screening tests, diagnostic delays, and the overall reduction in oncology care.
This is very disheartening. As if we didn’t have enough worry about with the possibility of contracting a potentially life-threatening illness, now we have to find a way to keep other services going while minimising risk to all involved.
While getting the pandemic under control is clearly a priority for everyone, it is certainly not an option for us to drop our regular medical services and focus solely on COVID-19. Essential services need to continue.
This is particularly challenging in settings where the health services struggle to cope with their usual workload even before COVID-19.
These systems are now at risk of becoming overwhelmed both directly due to the outbreak, but eventually indirectly from not adequately managing other potentially treatable conditions.
All countries therefore are required to make difficult decisions to balance the demands of COVID-19 while at the same time coordinating the delivery of essential health care services.
Both the WHO and the CDC offer various recommendations and guidance to deal with this. This includes public health advice as well as the importance of a steady supply of protective equipment for health workers.
The WHO emphasises that countries must identify essential services that should be prioritised to ensure continuity of health care delivery.
Some examples of these services that must continue include cancer management, routine vaccination, reproductive health care including pregnancy and childbirth, care of young infants and older people, as well as those with mental health illness. Non-communicable diseases such as heart disease, diabetes and high blood pressure still require regular input, and auxiliary services like imaging, laboratory and blood bank services must carry on.
All of this obviously requires a robust and coordinated action between governments and health facilities. It is one thing to cancel non-essential care but even that cannot be done indefinitely.
In many countries around the world, including our own, non-essential care and elective surgical cases and outpatient clinics were cancelled initially in response to COVID-19. When the first surge of cases waned, many of these services resumed in response to patient needs.
However, the recent resurgence of the virus in many areas around the world means that these services are again under threat.
The pressure on health care providers is unprecedented, and collaboration with all involved is needed, even the private health sector should be utilised to facilitate much needed continuity of care. More robust digital technology to strengthen clinical telemedicine and other patient-doctor interactions would also help.
After all, leaving the “other “medical problems unattended for too long is an untenable option that has the potential to turn one public health crisis into another.”