The most painful memory of the pandemic for Dr. Laura, who practices internal medicine in New York, is a patient who never had COVID. A middle-aged man who was diagnosed with stage 3 colon cancer in 2019, had surgery and a round of successful chemotherapy and was scheduled to have regular checkups to make sure the tumor hadn’t grown. Then the pandemic hit, and he decided that going to the hospital wasn’t worth the risks of contracting COVID. I postponed it…and postponed it. “The next time I saw him, in early 2022, he asked for hospice care,” Laura told me. He died shortly after. With the right care, Laura said, he “could have survived indefinitely.” (Atlantic Ocean She agreed to withhold Laura’s family name, as she is not authorized to speak publicly about her patients.)
Early in the pandemic, when much of the country was in lockdown, forsaking non-emergency health care as Laura’s patient did seemed to be the right thing to do. But health care delays didn’t just end when America began to reopen in the summer of 2020. Patients were delaying health care until the end of the first pandemic year, when vaccines were not yet widely available. And they were still doing a good job Until 2021at which point it appeared that a large part of the country was transitioning from COVID.
By this point, the coronavirus has killed more than a million Americans and weakened many more. One estimate shows that life expectancy in the United States decreased 2.41 years from 2019 to 2021. But delays in healthcare over the past two and a half years have allowed diseases to unnecessarily worsen, putting a strain on people with non-COVID medical problems as well. “My patients seem to be getting sicker,” Laura said. Compared to before the epidemic, it sees more people with AIDS, more people with irreversible heart failure, and more people with end-stage kidney failure. Mental health problems are more severe, and her patients with addictions were more likely to relapse.
Even as Americans treat the pandemic as an afterthought, there is still a disturbing possibility: Regardless of COVID, will the country simply be in worse health than it was before the pandemic? According to health care workers, departments, and researchers I spoke with from across the country, patients still face a range of problems from delaying care during the pandemic, problems they will face in some cases for the rest of their lives. . The scope of this damage is not yet clear – and it will likely not be focused on for several years – but there are worrying signs of a looming chronic health crisis for which the country has yet to reckon. At some point, the emergency phase of COVID will end, but the physical toll of the pandemic may remain in Americans’ bodies for decades to come.
During those dark ages before a vaccine, going to the doctor can feel like a disaster waiting. Many of the country’s hospitals were overwhelmed with COVID patients, and outpatient clinics closed. As a result, almost every week until July 2020 45 percent of American adults Over the previous month, they said, they had either postponed medical care or had not had it at all because of the pandemic. Once they arrived, they were much sicker – a trend observed for all kinds of illnesses, including Childhood diabeticAnd the AppendicitisAnd the cancer. a recent study They analyzed 8.4 million hospitalizations without COVID Medicare from April 2020 to September 2021 and found not only that hospital admissions fell precipitously, but also that those admitted to hospitals were up to 20 percent more likely to die — an astonishing effect. Continue throughout the study period.
In part, that finding came because only those who were sicker got to the hospital, James Goodwin, one of the study’s authors and a professor at the University of Texas Medical Branch, told me, at Galveston. This is also partly because overcrowded hospitals were providing worse care. But Goodwin estimates, “More than half of the reason was people delaying medical care earlier in their illness and therefore more likely to die. Instead of getting a urinary tract infection, they actually got poisoned. I mean, people were having heart attacks and not coming to the hospital. “.
In some cases, skipping one or two examinations may not be important in the long run. But for other cases, a visit to each doctor can count. Take the tens of millions of Americans who have problems with the blood vessels in their feet and legs due to diabetes or peripheral arterial disease. Their problems may, for example, lead to foot ulcers that can be treated with regular medical care, but a delay of even a few months can increase the risk of amputation. When patients came later in 2020, It was sometimes too late to save the party. Trauma Center in Ohio have found The odds of undergoing a diabetes-related amputation in 2020 were roughly 11 times higher Once the pandemic hit versus earlier in the year.
Although only a small percentage of Americans have lost a limb, a lack of care early in the pandemic has helped fuel a dangerous rise in substance use disorders. Within weeks or months, people’s support systems collapsed, and for some, years of work Overcoming addiction disintegrated. “My patients have taken a huge step back, perhaps more than many of us realize,” Artie Patel, MD, a physician assistant at Lower Manhattan Community Hospital, told me. One of her patients, a man in his late fifties who had been sober by five years, began drinking again during the pandemic and eventually landed in the hospital for withdrawal. Patients like this man, she said, “are going to be really in the hospital for long and difficult periods, because they are so at risk. DTsAlcohol bouts. Some of them even had to go to the intensive care unit because of [the withdrawal] It was severe.”
Later in the year, when doctors’ offices were ready to operate, “a lot of patients expressed that they didn’t want to go back for care right away,” says Kim Mullers, a graduate student at Pace University who studies the effects of COVID on medical care in the city of New York, North Carolina and Florida. In fact, during the spring of 2021, the main reason for receiving medical care Failed to seek care They don’t want to be in a medical facility. other people were Avoid the doctor Because they lost their job, their health insurance, and they couldn’t pay the bills.
The doctors told me the problem was that all those missed appointments started adding up. Patients with high blood pressure or blood sugar, for example, may now be less likely to get their condition under control — which after enough time can lead to all sorts of other illnesses. Losing a limb can present challenges for patients that will last for the rest of their lives. Relapses can put people at greater risk Lifelong medical complications. cancer screenings I retreatedand even a little weeks without treatment It can increase the chance of dying from the disease. In other words, even short-term delays can cause long-term chaos.
To make matters worse, the health care delays that are feeding a sicker America may not be completely gone yet, either. After so many backups, some healthcare systems have faltered Man power shortage, are struggling to meet pent-up demand for care that patients can no longer delay, according to officials and doctors from several major health systems, including the Cleveland Clinic, the Veterans Health Administration and the Mayo Clinic. Disruptions in the global supply chain force doctors to do so Basic supply rationsPlus, backlog. “All of these things only add to the ongoing delay, and I think we’ll see effects for years to come,” says Amy Oksentenko, a gastroenterologist at the Mayo Clinic in Arizona who helps oversee clinical practice across the entire Mayo system.
It’s still early days, not everything the providers tell me necessarily appear in the data. Oddly enough, the Centers for Disease Control and Prevention’s National Health Interview Survey found that most Americans were able to see a doctor at least once during the first year of the epidemic. And the same poll not revealed A slight increase in most health conditions, including asthma attacks, high blood pressure and chronic pain – which would be expected if America were to get worse.
It is even conceivable that the disturbing remarks of doctors are Statistical illusion. If, for whatever reason, the doctor now sees only the sickest—or is able to reach, it may be true that both providers See more seriously ill patients in medical facilities and that the total number of seriously ill people in the community remains the same. The scope of the damage isn’t clear yet: Perhaps fewer people will be worse off because of delayed cancer care or drug use relapses, or perhaps many more people—more than tens of millions of Americans—will deal with worsening problems for the rest of their lives.
None of this explains what COVID Itself You do for Americans, of course. The health care system has only begun to address the ways in which a previous episode with COVID poses a long-term public health risk, or the extent to which prolonged COVID can complicate other conditions. Many Americans may feel the pandemic is “over,” but many who have made it through the past two years or more may end up living sicker, and dying sooner.
This disturbing prospect is not only set for further destruction of societies; It’s also bad news for healthcare workers who are already exhausted from COVID. Laura, the internist in Manhattan who treated a colon cancer patient, told me that it’s frustrating to see so many people show up at irreversible points in their disease. “As clinicians, our overall hit rate is going down,” she said. Aarti Patel, Physician Assistant, put it in stricter terms:Burnt Maybe it’s a very simple term. We are in dire moral distress.”
Nothing about this bleak fate was inevitable. Laura told me “Going to the doctor in the middle of a pandemic Maybe he posed a small risk in terms of COVID, but not going was risky in terms of letting the disease pass unchecked. Looking back, it seems a lot of people didn’t quite understand that.” But there was no need for such a blatant trade-off between fighting the epidemic and maintaining healthcare for other medical conditions.
Some hospitals – at least those with better resources – have figured out how to avoid the worst kind of delay. Mayo Clinic, for example, is one of a number of systems with an advanced triage algorithm that prioritizes patients who need acute care. In the spring of 2021, the Cleveland Clinic launched a large-scale outreach campaign to schedule about 86,000 appointments, according to Lisa Yerian, chief improvement officer. The Department of Veterans Affairs is providing iPads to thousands of veterans who lack other means of Internet access in the spring of 2020, ensuring a smoother transition to virtual care, Joe Francis, who directs healthcare analytics, told me. Thanks in part to these efforts, Francis said, high-risk patients with VHA were seen at pre-epidemic levels just six months after the epidemic.
These healthcare systems also suggest a way forward. America may still be able to stave off the worst collateral damage by reaching patients who have fallen through the cracks — and indeed The data Suggest These patients tend to be disproportionately black, Hispanic, and low-income. Sadly, it’s too late for some Americans: people who died of cancer can’t come back to life; Amputated limbs cannot grow back. Others still have plenty of time. High blood pressure that is currently uncontrollable can be alleviated before causing an early heart attack; Drinking that has gotten out of control can be contained before it leads to liver failure within a decade; Undetected tumors can be detected in time for treatment. There could be a slight spike in premature death and disability, which is summed up in millions of Americans torsion health care system for years. But an acute public health crisis can still be prevented from creating a larger chronic one.