In the first few months of the COVID-19 pandemic, governors around the United States urged everyone (with the exception of essential workers) to stay home if at all possible. Most states, along with the Centers for Medicare and Medicaid Services (CMS), banned nonessential medical, surgical, and dental procedures until the outbreak was contained. Unfortunately, those orders had unintended consequences. Emergency department visits from March through May dropped 23 percent for heart attacks, 20 percent for strokes, and 10 percent for uncontrolled blood sugar, according to an analysis from the Centers for Disease Control and Prevention (CDC). In late April and early May, most states allowed non-urgent and elective procedures to resume, but many people continue to stay away. This is causing what one expert calls a “tsunami” of illness that has yet to make its full extent known. For instance, the drop-off in cancer screenings due to the pandemic could result in an estimated 10,000 additional deaths from breast and colorectal cancers over the next decade, said Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases, at the American Association for Cancer Research virtual meeting on July 20. RELATED: Fear of COVID-19 Linked to People Delaying Care for Heart Attack
Patients Are Missing Out on Critical Treatments
“There are truly heartbreaking stories of people in life-threatening situations who are afraid to seek care,” says Thomas Marron, MD, PhD, an oncologist at Mount Sinai Hospital, an assistant professor at Icahn School of Medicine at Mount Sinai in New York City, and a medical reviewer for Everyday Health. “I had a patient who had a mass found in his lung back in March, but he was too scared to come back for a biopsy,” says Dr. Marron. The man was finally diagnosed with cancer in July. During the intervening months, the patient had lost the ability to move his left leg normally, which could have been the result of a stroke or a sign that the cancer had spread. “It turned out that both those things had occurred,” Marron says. “The patient told me that he knew it was likely that he had a suffered a stroke, but he was too afraid to come to the emergency room.” In the end, Marron says, “We had to admit him directly to hospice because the cancer in his brain was so advanced that nothing was really going to help him.” Marron is seeing fewer patients in his cancer clinics, which concerns him. “I’m worried we’re going to see a deluge of patients come fall or winter, once people get to the point where they can’t ignore their symptoms anymore or something else brings them to the doctor, and they find out they have very advanced cancer,” he says. RELATED: Should You Delay Cancer Treatments During the COVID-19 Pandemic?
Screenings and Preventive Care Are Taking a Back Seat
Patients are also shying away from routine medical screenings, which can detect diseases in their earliest stages, when they are generally most treatable. “Certainly, we’ve always said that any symptoms of cancer should be checked immediately — we always have our doors open for that,” says Larry Norton, MD, the chair in clinical oncology at Memorial Sloan Kettering Cancer Center in New York City and a member of the Castle Connolly medical advisory board. “But when the first wave of COVID-19 hit we were very cautious and told patients that it’s okay to delay screenings such as mammograms for a month or two.” That short period where delays in screenings were warranted is now over, says Dr. Norton. “People who were due for a screening in April and haven’t had it yet are starting to stretch the envelope of what’s safe,” he says. “We know how many people we should be seeing on a week-by-week basis, and we’re just not seeing them.” “Cancer is not taking a vacation or following the stay-at-home order," he adds. “Cancer is growing, and this is a great concern to us.” Doctors who treat cardiovascular disease are also alarmed that patients are putting off preventive care. “There are definitely fewer people coming into our clinic, which focuses on hypertension, says Suzanne Oparil, MD, a researcher and cardiologist at the University of Alabama at Birmingham and a member of the Castle Connolly medical advisory board. During the pandemic, she says, preventive care for anyone with hypertension, atherosclerotic disease, or heart failure is more important than ever. “These people are among those most likely to be severely afflicted by the coronavirus and more likely to die,” she says. Patients who are working with their doctors to carefully manage their medical conditions, she explains, are in a better position to survive COVID-19 than those who are going it alone. RELATED: What People With Heart Disease Need to Know About COVID-19 Telehealth can take the place of in-person visits for some people. “If the patient is not able to physically come, we are offering video visits so that we may continue to manage these patients as we always would,” says Bhargavi Patham, MD, PhD, an endocrinologist and internal medicine doctor who practices academic medicine at Houston Methodist Hospital in Texas, and a medical reviewer for Everyday Health. But certain patients can’t make telemedicine work. “The technology can be complicated for them, though we can do these visits over the phone as well,” Dr. Patham says. RELATED: 10 Diabetes Care Tips During the Coronavirus Pandemic
Misconceptions That Are Keeping People Away
In addition to anxiety about contracting the coronavirus, there are a variety of reasons that people aren’t seeking healthcare right now. “If they’re losing their jobs or health insurance or have other personal issues, health concerns might not be top of mind,” says Sanjai Sinha, MD, an internal medicine doctor at Weill Cornell Medicine in New York City and a medical reviewer for Everyday Health. Misconceptions about what can happen at a hospital or doctors’ office may also be keeping people away. Here are three widespread myths.
Myth 1: Going to the Doctor Increases Your Chance of Catching COVID-19
Doctors’ offices and hospitals take multiple precautions to keep patients safe. “We have very few appointments scheduled, people are taken right to the [examining] room, and we do any labs or testing in that room rather than have the patient travel from area to area in the clinic,” Dr. Sinha says. “Right now, I think going to the hospital is safer than shopping at the grocery store,” Marron adds.
Myth 2: It’s Okay to Put Off Screenings and Procedures Indefinitely During the Pandemic
Because doctors put elective surgeries and routine screenings and office visits on hold early in the pandemic, patients may not see the harm in waiting a few more months, says Kara Leigh Smythe, MD, an obstetrician-gynecologist in Bangor, Maine and a medical reviewer for Everyday Health. This may be fine for certain patients, says Dr. Smythe, but it’s not safe for everyone. “There are some people where it may be okay to put off care that long, but for other patients with different underlying problems or health histories, a delay could have serious risks. It’s not always apparent to the patient where they may fall in that spectrum.” She says, “It’s important that the doctor and patient communicate during this time so it’s clear whether waiting for a screening or procedure is appropriate, or if the patient needs to come in, rather than the patient being left to decide on her own.” RELATED: Why You Shouldn’t Miss Your Ob-Gyn Wellness Visit Because of the Pandemic
Myth 3: Your Doctor Is Busy Taking Care of COVID-19 Patients and Doesn’t Have Time to See You
“I’ve had patients tell me quite apologetically and sheepishly, I’m so sorry to bother you, I’m sure you’re really busy, but should I come in about this?” says Sinha. “I tell them immediately, it’s not a bother, and yes, I want to see you.” “I think it comes from a good place of people not wanting to use valuable healthcare resources,” he explains. “Yes, I was busy when COVID-19 was at its peak here in New York City, but even then I was still able to do video visits with patients who didn’t have the virus and see people in person for urgent issues.”
Easing Stress, Preventing Regrets
Patients who stay away from their doctors’ office may find it takes a toll not just on their physical health but also their mental well-being. Delaying medical care can be stressful. Norton recalls a patient with a lump in her breast who was terrified to come to the hospital to get it checked because of COVID-19. When she finally had it tested, it turned out not to be cancer after all. “If she hadn’t come in, she would have had increasing anxiety that she had a breast cancer that was growing and could kill her,” says Norton. Then there are the patients who do end up getting a cancer diagnosis. “When they finally come in, they often realize, appropriately, that they’ve significantly hurt their chances of being cured by the delay, or they require additional therapy,” says Norton. “I call that ’the regret factor,’” he adds, “and often people carry that for the rest of their lives.” RELATED: How to Build Your Resilience During the COVID-19 Pandemic
