From the CBC:
“Studies reveal the unintended
consequences of delaying surgeries, drop in ER visits due to pandemic”
(Sean Perkins had a 'sizeable'
tumour cutting off 70 to 80 per cent of his airway. He faced delays getting
diagnosis and treatment because of the pandemic. Now, researchers are examining
the broader consequences of delays and and a drop in ER visits.)
"If it's a COVID death or a
COVID case, it's important. Otherwise it doesn't matter." That's how Sean
Perkins said his experience in the Ontario healthcare system during the
pandemic left him feeling. But non-COVID illnesses and deaths should
"matter too," he said. In
August 2019, during a softball league game, his friends noticed his breathing
sounded laboured. Eventually, after a circuitous journey to different
specialists, the Caledon, Ont., man was told he had an obstruction in his
airway and needed a CT scan. By that time it was the end of February 2020, the
cusp of the pandemic, and the Ontario government soon shut down all elective
surgeries and procedures. So Perkins had to wait. Perkins waited three months to get a CT scan
during the first wave of the pandemic — and then months more to get a biopsy.
It was a wait he's lucky didn't kill him, he says. (Submitted by Sean Perkins) As
the weather got warmer and the humidity rose, it became harder to breathe. "It
was like trying to breathe as though you were sucking in a thick
milkshake." Perkins finally got a CT scan at the end of May 2020 and it
showed a "sizeable" tumour cutting off 70 to 80 per cent of his
airway. He was designated a Priority 1
patient, which the province defines as "any condition in which failure to
diagnose and initiate treatment would result in serious
morbidity/mortality." Despite that, he still had to wait three more months
for a biopsy. Perkins is far from alone — Ontario's surgery backlog is
estimated at more than 257,000 cases and growing. As it did in the first wave,
the province told hospitals last month to suspend non-urgent procedures to free
up ICU beds as COVID cases spiked in the third wave. Only now are studies
starting to reveal what some of the consequences of those delays may be.
Excess deaths
(Dr. Peter Juni is the scientific
director of Ontario's COVID-19 Science Advisory Table, and the co-author of a
study that showed a 13 per cent increase in 'excess deaths' during the
pandemic.)
According to a study released
last week by the Ontario COVID-19 Science Advisory Table, these delays likely
contributed to excess deaths in the province. After analyzing cremation data in Ontario, the
study found a nearly 13 per cent increase in the number of deaths during the
pandemic compared to a baseline average from data taken between 2017 to 2019. Some of those deaths were almost certainly due
to COVID-19 but not counted as such, particularly in the first wave when
testing wasn't as widespread, said Dr. Peter Juni, the scientific director of
the advisory table and the study's co-author. While the study data did not include cause of
death, many of the excess deaths were likely not COVID-related because they
happened between pandemic peaks when deaths from the virus were low, he said. "In
an already strained health care system, what we start to see is that people are
struggling … to get appropriate care," Juni told Dr. Brian Goldman, host
of The Dose and White Coat, Black Art. The main causes of these extra deaths
are likely cancer and cardiovascular disease as they are the two leading causes
of death in western countries, said Juni, and with both "we know that if
you have delayed care, that this negatively impacts the prognosis." A drop
in trips to the ER during the pandemic over fears of contracting COVID-19 could
also be a factor in these excess deaths, depending on the condition, he said.
Some 'good news'
(Dr. David Gomez, an acute care
and trauma surgeon and a scientist at St. Michael's hospital in Toronto, says
people may have been overusing ERs before the pandemic, and some conditions can
be better treated virtually or managed at home.)
A new study published this week
in the Canadian Medical Association Journal showed that emergency department
visits for common conditions such as appendicitis, miscarriage, gallbladder
attacks and ectopic pregnancy decreased significantly in the first wave of the
pandemic. Researchers compared emergency department visits in Ontario from the
first half of 2020 to the first half of 2019, looking at those four conditions
— chosen because they are measurable, very common and managed in a standard
way. During the first wave of the pandemic they found a 20 to 39 per cent
reduction in visits for appendicitis and miscarriage. But the study also found something surprising
— patient outcomes for these conditions were not impacted. Despite fewer emergency
department visits, there was no increase in adverse patient outcomes, such as
sicker patients showing up later in the ER or increased rates of death. Study
co-author Dr. David Gomez, an acute care and trauma surgeon and a scientist at
St. Michael's hospital in Toronto, has a theory why that's the case: potential
over-usage of the emergency department before the pandemic. "It doesn't
mean that [people] are just suffering at home now," he said — instead they
are managing their care successfully at home or accessing healthcare elsewhere,
likely virtually. Mild appendicitis, for example, can be resolved at home or
managed with virtual healthcare visits, Gomez said. "A lot of the care that is provided in
emergency departments could be very efficiently, and probably in a more timely
manner, managed through a variety of other means, through urgent care centres,
virtual visits, [and] extended hours of primary care practitioners," he
said. Avoiding the ER could certainly
have negative consequences for some conditions, said Gomez, but he said these
study results are a reminder that the pandemic's impact on the healthcare
system "is not all bad news." As we emerge from the pandemic, Gomez
thinks we'll see more evidence of a healthcare system that, in certain cases,
like virtual care, adapted and transformed, and that these changes will
"hopefully persist over time." "This is a once in a generation
opportunity to really re-evaluate how care is delivered at all levels."
A big job ahead Perkins
finally underwent an open neck biopsy in August last year, a year after his
first symptoms appeared. The tumour was benign and in October, he had surgery
to remove it. But, Perkins said, he and his family had to live through months
of not knowing whether he had cancer. The target time for Priority 1
patients like Perkins to get a CT scan, according to Health Quality Ontario, is
within 24 hours of when the order is received, not the three months he waited.
(As of March 2021, the province's tracking website showed that 78 per cent of
patients are being scanned within that target time.) "It took me
seven plus months to get a biopsy, and nine months to have surgery to remove
the tumour, despite being a Priority 1 cancer patient with the inability to
breathe," he said. "This
was a situation where the tumour was benign…. Had it been malignant, the wait
alone might have been enough to kill me." The province has resumed
"non-urgent" surgeries and the Ontario government promised $300
million in its 2021 budget to help reduce the surgical backlog. But Juni
said there's "no way" the already stretched health care system can
catch up in time to save everyone on the "long, long, long
wait-lists." "These excess deaths in an already really
challenged health care system are most likely to continue beyond the
pandemic."
^ This article is right. A death
(whether by Covid or not) is still a death and is still something to try and
prevent. In the early days of the Pandemic Doctors, Officials and People
everywhere (Canada, the US, the rest of the world) had to deal with chaos and
confusion on a daily basis. People who were sick didn’t want to go to the
Doctor or Hospitals because of fear of getting Covid and Doctors and Hospitals
stopped most procedures and tests (not just “Elective” Ones) as they dealt with
the Covid Onslaught. Now everyone is paying the price of all of that. Doctors
and Hospitals are rushing to care for people with worsening conditions
requiring more care and people are dealing with those worsening conditions. Hopefully,
we can learn from all of this chaos and confusion and make sure it doesn’t
happen again. ^
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