The Covid-19 crisis has washed across the United States like a tidal wave. And experts say it has set the stage for dangerous ripple effects, with Americans suffering from a decline in conditions they are failing to have treated because of the pandemic.
“There’s a huge, massive wave coming up behind us, because people have delayed vital care in terms of cancer, diabetes, and heart disease,” said Garth Graham, vice president of community health at CVS Health, speaking at a virtual Milken Institute conference this week. The same underlying health conditions, he added, can exacerbate the severity of Covid-19 — particularly if left unchecked.
Graham was joined on the panel by other health leaders who echoed his concerns — and emphasized the importance of people staying in close contact with their physicians.
“People are ignoring serious things like chest pain and appendicitis that can be treated early and safely,” said Susan Bailey, president of the American Medical Association. “It’s important to keep the lines of communication with health providers open — even in the Covid era.”
Telemedicine, in which patients can remotely communicate with their doctors, has expanded substantially during the pandemic. It’s helped many patients avoid office visits entirely, and policymakers are seeking to make permanent policies that have helped to facilitate telemedicine.
“The use of telemedicine has exploded: I’ve heard we’ve experienced 10 years of growth in 10 weeks’ time,” Bailey said.
But worrisome gaps in care are emerging, particularly among some minority groups and older Americans, who may have limited access to digital health tools. In some cases, Graham said, people are forgoing care entirely.
Overall, an estimated 42% fewer people visited emergency departments in April this year compared with April 2019. And nationwide, calls to emergency service providers have dropped 26% since the start of the pandemic.
Not all that news is bad news. Quartantines, for instance, mean fewer people on the roads — and thus fewer traffic accidents.
But the number of deaths that have occurred with EMS present has doubled, suggesting that people are only making these calls when circumstances are dire, according to a University of Buffalo study.
The outlook when it comes to cancer is particularly grim. A National Cancer Institute model that looked only at breast and colorectal cancer projects there could be an additional 10,000 deaths in the U.S. over the next decade — thanks to pandemic-related delays in diagnosing and treating these tumors. The model assumed cancer care is only depressed for just six months this year.
“It’s troubling — the rate at which people are not showing up at the ER for chest pain … this makes me realize that more people are dying at home,” Graham said. “The culture of fear has started to take over.”
Researchers are still trying to parse the causes of death during the pandemic. Some are linked, of course, to the novel coronavirus — but many others will likely be linked to simple delays in care, said Brooks Tingle, CEO of John Hancock Insurance, a Boston-based life insurance company.
“The longer people go without getting treatment for chronic diseases, the more these deaths are going to build up,” Tingle said.
His company is “getting tremendous insights into who is succumbing to the virus,” and the raw data have shown a disproportionate number of Covid-19 deaths among people who have chronic disease.
A John Hancock survey showed that, among people with diabetes, more than half believed they couldn’t qualify for life insurance — even though 88% were approved. The data suggests that the people who have chronic diseases often don’t reach out for support.
“This is going to sound crazy, but I was a bit saddened by how few death claims we’ve been seeing,” Tingle said. “So many of the people dying of Covid … don’t tend to have insurance.”
Access to care is segmented in the U.S., the experts all agreed, and patient education is a critical component in helping bridge those gaps. There have been major strides in health-related technologies that could help improve medical treatment for some pockets of society, but the challenge is to open the technology to underserved communities.
“We need to take care of ourselves, move beyond fear, and move to empowerment,” Graham said. “Self-care means social distancing, but it also means going to see the doctor.”