The other victims of the pandemic
The covid has become a medical priority, which means other diseases are relegated, as explained by some patients with whom the ARA has spoken
BARCELONA Covid-19 patients are not the only ones affected by the pandemic. Last spring, patients with other diseases found they did not have access to their usual professionals; and saw how their tests, visits, or operations were postponed, since the first wave of the coronavirus forced primary healthcare units and hospitals to dedicate themselves exclusively to covid patients. This scenario threatens to repeat itself in the coming weeks and health workers warn of the consequences that patients with other diseases may have on the health of the population once again being excluded from the health system.
This week some large hospitals in Barcelona such as Hospital Clínic, Sant Pau or Hospital del Mar have already had to postpone non-urgent surgeries, or not schedule new ones to free up critical beds. At the moment, all of them are still maintaining urgent and oncological operations, and are looking closely at the interventions that can be postponed while also promoting major outpatient surgery, which does not require admission. Knee replacement interventions or hernia removals, for example, have been suspended. "Programming and deprogramming has been done carefully, because the goal is to maintain as much activity as possible. Nobody wants the covid pathology to relegate the rest because in the end it is about health control”, Mireia Puig, head of emergencies at the Hospital de Sant Pau, explains, and admits that this generates "frustration" among professionals.
The impact that the covid has had on the care of patients with other diseases can already be seen. For example, 21% fewer new cases of cancer have been diagnosed, according to a study by the Spanish Association against Cancer (AECC). The first wave of the pandemic has led to a decrease in both the number of new diagnoses and the initiation of new treatments. This is attributed both to the suspension of face-to-face medical activity during the lockdown months, and to the fear of patients to go to hospitals and primary healthcare centres for fear of catching coronavirus.
That this will take its toll on the health of the population is evident. "What remains to be determined is the magnitude this will have: whether or not cancers in more advanced stages are detected and what implications it has", Josep Alfons Espinàs, coordinator of the Health Department's cancer screening office, says. In the Sant Pau Hospital, for example, a rebound in cancer diagnoses was detected in summer because there were patients who had not been to the doctor before. The breast and colon cancer screening programs, which were stopped during lockdown, now work "but at a slower rate than what would be desirable", Espinàs admits. As the goal of screening is, however, early detection of tumors, screening "a month or two late has little impact". "Obviously, if delays accumulate, it will have more impact”, he adds.
More severe strokes
Despite the pandemic, the rest of the diseases continue to exist. It is estimated that 35 strokes occur every day in Catalonia but activations of the stroke code were reduced by 20% last spring and patients arrived later and in more serious conditions to hospitals. Additionally, survivors have had less access to rehabilitation. It does not happen only in Catalonia. The situation is generalized. "Patients with cancer and cardiovascular diseases do not attend to doctors’ appointments as they did before. We must make an effort for them to come”, the cardiologist Valentí Fuster acknowledged a few days ago, who also admits that the mortality of these patients has increased. "We cannot say where things have gone wrong: if it is the patient who does not want to go to the hospital or if the hospitals have been negligent with non-covid patients". Health workers are making efforts to maintain non-covid activity but they warn that if the curve continues to grow, "the deprogramming will be total and that would be dramatic”, Puig admits.
All healthcare activity has suffered from the onslaught of the covid. There has also been a 40% decrease in the first visits of people with mental illness. "We are concerned because patients do not reach out to us although there is more mental illness as a consequence of the covid”, Víctor Pérez, head of the psychiatry service at Hospital del Mar, warns. He attributes it to primary healthcare, which previously screened these patients and referred them to mental health services, "now they cannot do it because they are busy with the covid”. But that patients do not arrive does not mean that they do not exist, he adds. He mostly refers to patients with depressive disorder, anxiety or severe mental disorders. "And as with cancers and strokes, when they come to our consultations, they will be more serious", Pérez concludes, and explains that they are working to implement a way for primary healthcare to be able to refer these patients to their correct medical specialists without having to visit them.
We have collected the testimony of several patients who explain how the pandemic has delayed their treatments, visits or surgeries.
- Breast reconstruction, 41 years old March 13, 2020 had to be a day of celebration. That day Leo Anglès finished chemotherapy after the summer before she was diagnosed with breast cancer. They found 11 tumors and she underwent a complete mastectomy: she went through six operating rooms in thirty days. And when she finished the last chemo session, the state of alarm was declared. "I had already passed my private lockdown, my pandemic: cancer. And it had to be a wonderful day but I couldn't see anyone and I locked myself at home”, she recalls. In April they had to do a reconstruction of her breasts but the pandemic has forced the last step of the recovery to be delayed up to three times. Now they have given her September 2021 as the probable date to enter the operating room. Medical check-ups, she says, have also been scarce. "Many visits have been canceled and have become telephone calls, when what you need is presence", she explains. During the first wave, the majority of centers substituted face-to-face visits for online ones, and only in those cases in which there was an emergency, a risk-benefit balance was made. She has, however, been to the hospital to receive immunological treatment, although she admits that the first days she was "scared" to go. "As an immunosuppressed patient, I could have catched covid very easily". She went alone, like all the other patients since the pandemic was declared. "Also to the CT scan, where they have to tell you whether the cancer has reproduced or not”. Still, she has no regrets. "Public health is still admirable, I do not blame the hospitals. If they have had to decide whether to give a respirator to a 50-year-old or an 80-year-old, what I have is just yet another illness". Although she recalls that people keep getting sick, pandemic or not, and many patients feel lost. The collateral effects have also been psychological: lockdown, her partner in ERTE, suffering because of the income... "I didn't have time to take a breath, I've had a bad time”, she says. Still in treatment, Leo returned to work early due to financial need. "I had half a year off to recover from the physical consequences but I had to force it, and the body, luckily, has responded well”.
- A herniated disc treated by private healthcare Pol is one of the readers who have responded to the call we have made asking for testimonials from patients affected by the postponement of tests or surgeries due to covid, especially during the first wave. Pol explains that he had a herniated disc with a pinched nerve in his leg. "They prescribed me treatments based on going to the emergency room when the pain was unbearable. From the beginning the same doctors who saw me recommended me to resort to private healthcare", he explains. Finally, he decided to make appointments, MRI scans and infiltrations via private doctors, waiting to be operated on through public healthcare. When finally called, the waiting time to operate is a year and a half, so he also decided to have surgery in a private center, since the hernia prevents him from carrying out daily tasks such as holding his son, who less than a year old. Readers have also written explaining successful experiences when ordinary activity in primary healthcare centres and hospitals resumed in June.
- Mother of a baby with hip dysplasia Ania explains that no one detected her 16-month-old baby’s hip dysplasia because when he was six months old, last spring, he did not have "the relevant follow-up ultrasounds" because ordinary activity was stopped by the pandemic. "Now we find that something that would have been solved in a very simple way when he was six months old, will have to undergo treatment or surgery. The child does not walk well and may have sequels. On top of that, getting the ultrasound almost ten months later has been very complicated, and to this day we still don't have an appointment to see the pediatric orthopedist”.