(CNN)The concern was that Covid-19 would overwhelm the medical care system with patients. While that has happened in some hot spots, the broader picture is just the opposite: Covid-19 has deprived the system of patients.
Some of these would-be patients have surely been hurt: having either shied away or been told to stay away from interventions that would have helped them live longer and/or live better. For others the delay may not matter; they will do equally well with intervention at a later date. But it is important to consider another possible outcome: some do better with less medical care.
No one has national data yet, but the turn of events is remarkable.
In mid-March hospitals began to cancel elective surgeries both to protect patients and to provide surge capacity, following guidance from the American College of Surgeons. This not only halted hernia repairs and joint replacements, but also surgeries for low-risk cancers — specifically, early stage breast and prostate cancer.
Next, emergency care unexpectedly plummeted. Emergency rooms in Boston, Detroit and Minneapolis/St. Paul saw substantial drops in volume, and ER doctors are experiencing cuts to both their hours and pay. The decline in volume doesn’t appear to be confined to fewer minor injuries and self-limited illnesses, it also includes fewer heart attacks and strokes.
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But the impact of Covid-19 goes well beyond the hospital to include all physician/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 by the end of June — more than doubling the number of US counties with a significant shortfall in health care providers at the end of March.
Given fewer outpatient visits, one downstream effect is wholly expected: fewer lab tests and X-rays. This limits efforts to find disease early in asymptomatic individuals. Most notably, cancer screening has been effectively shut down.
What can we learn from this cataclysmic disruption in medical intervention?
Previous research on the global effects of doctor strikes suggests that overall mortality either remains stable — or, in fact, declines. Clearly, it will be important to carefully study 2020 mortality trends and disentangle Covid-related deaths from other causes of death. It will be equally important to distinguish the well-off from the poor: we may find that medical care disruption decreases mortality among the well-off, yet increases mortality among the poor.
While analysis of overall mortality is important, so, too, is looking into more granular topics. The disruption in elective surgeries should lead us to reevaluate the necessity of those surgeries and their associated risks. There are opportunities to look at still finer detail: In our hospitals (Brigham and OHSU), for example, women with early-stage breast cancer are having their surgeries delayed and are instead being started on hormonal therapy. Maybe we will learn that some women don’t need surgery.
Suspending cancer screening is another important area to study. There is little doubt, for example, that the decline in mammography will lead to fewer breast cancers diagnosed. But is that a bad thing or good thing?
