The Limited Times

Now you can see non-English news...

OPINION | Coronavirus: The unexpected side effect of covid-19

2020-05-28T19:51:18.298Z


The concern was that covid-19 would overwhelm the patient care system. Although this has happened in some critical areas, the larger image shows just the opposite: the covi…


  • Click to share on Facebook (Opens in a new window)
  • Click to share on Twitter (Opens in a new window)
  • Click to share on LinkedIn (Opens in a new window)
  • Click to email a friend (Opens in a new window)

Editor's Note: H. Gilbert Welch is a General Internist at the Brigham and Women's Hospital Center for Surgery and Public Health and author of "Less Medicine, More Health." Vinay Prasad is an oncologist, associate professor of medicine at Oregon Health and Science University, and author of "Malignant: How Bad Policy and Bad Medicine Harm People With Cancer." The opinions expressed in this comment are those of the authors; See more opinion pieces at CNNe.com/opinion.

(CNN) - The concern was that covid-19 would overwhelm the healthcare system with patients. While that has happened in some critical areas, the larger image shows just the opposite: the covid-19 has deprived the patient system.

Surely some of these potential patients have been harmed: by having avoided or by being told not to undergo interventions that would have helped them live longer and / or live better. For others, the delay may not affect; they will be equally fine with the intervention at a later date. But it is important to consider another possible outcome: some improve with less medical attention.

No one has national data yet, but the turn of events is remarkable.

In mid-March, hospitals began canceling elective surgeries both to protect patients and to have capacity in the event of an increase, following instructions from the American College of Surgeons. This not only stopped hernia surgeries and joint replacements, but also surgeries for low-risk cancers, specifically, early-stage breast and prostate cancer.

Then, emergency care unexpectedly plummeted. Emergency rooms in Boston, Detroit, and Minneapolis / St. Paul saw a substantial drop in volume, and emergency physicians are experiencing cuts in both their hours and wages. The decrease in volume does not appear to be limited to fewer minor injuries and self-limiting diseases, it also includes fewer heart attacks and strokes.

But the impact of the covid-19 goes far beyond the hospital and includes all doctor-patient encounters. Despite the advent of telehealth, primary care practices are seeing fewer patients and laying off staff. The American Academy of Family Physicians estimates that about 40% of family medicine clinics are at risk of closing in late June, more than double the number of counties in the United States. with a significant deficit in healthcare providers in late March.

With fewer outpatient visits, a later effect is expected: fewer lab tests and x-rays. This limits efforts to find the disease early in asymptomatic individuals. In particular, cancer screening has been effectively closed.

What can we learn from this cataclysmic interruption in medical intervention?

Previous research on the global effects of medical strikes suggests that overall mortality remains stable or indeed declines. Clearly, it will be important to carefully study mortality trends in 2020 and separate covid-related deaths from other causes of death. It will be equally important to distinguish the rich from the poor: we can find that interruption of medical care decreases mortality among the rich, but increases mortality among the poor.

While analysis of overall mortality is important, more detailed topics are also discussed. Interruption of elective surgeries should lead us to reevaluate the need for these surgeries and their associated risks. There are opportunities to look at even finer details: In our hospitals (Brigham and OHSU), for example, women with early-stage breast cancer are delayed from surgery, and instead are taking hormone therapy. We may learn that some women do not need surgery.

Stopping cancer screening is another important area to study. There is little doubt, for example, that the decrease in mammography will lead to fewer diagnosed breast cancers. But is that a bad or a good thing?

One opportunity is to study what happens to US cancer statistics. when detection resumes. One of two observations are possible. Breast cancer rates could catch up: which means that the deficit of cancers during the pandemic would be equated with an excess of cancers in the following years. In other words, all cancers that were not detected in patients during the pandemic would eventually be detected. The alternative would be for breast cancer diagnoses to never catch up.

A few years ago, researchers observed this phenomenon in Norway. Women, ages 50 to 64, who had three mammograms for six years had more invasive breast cancers found compared to similar women who had a single mammogram at the end of six years. Delayed mammography led to fewer diagnoses of breast cancer, and the deficit never recovered, despite a mammogram at the end of six years. These findings suggest that some small cancers come back on their own. Could this be happening now during the covid-19 pandemic?

The decrease in heart attack and stroke raises equally important questions in cardiovascular disease. Some patients may have been reluctant to go to the hospital and suffered, perhaps even died, at home. However, what “counts” as a heart attack or stroke has expanded over the years. An alternative explanation may be that doctors no longer diagnose patients with very mild cardiac or neurologic abnormalities. Perhaps what you are missing are minor, painless events for which no treatment is needed, or even harmful.

It's also possible that there are actually fewer heart attacks and strokes right now. Smog is disappearing in Los Angeles and in India, people can see the Himalayas from miles away for the first time in 30 years. Air pollution has been consistently linked to heart attacks. And "taking refuge" has meant slowing down for many. Has a better air and lifestyle helped our hearts?

After covid-19, if we dare imagine the day, it will be important to ask who was harmed by delayed and lost medical care. But severe financial strains on people and public budgets make it equally essential to ask who benefited by avoiding interventions without a curative effect.

But we won't find the benefits unless we look for them. We need medical researchers willing to ask difficult questions about the services they provide, questions that may threaten their own professional or financial interests.

Covid-19 offers a once-in-a-lifetime opportunity to study what happens when the well-oiled healthcare machine shifts from high to low volume to target patients with severe illness. It will be comfortable for medical researchers to study what was lost. It will be brave for them to study what they have earned.

coronavirus

Source: cnnespanol

All news articles on 2020-05-28

You may like

Trends 24h

Latest

© Communities 2019 - Privacy

The information on this site is from external sources that are not under our control.
The inclusion of any links does not necessarily imply a recommendation or endorse the views expressed within them.