Delaying Medical Treatments Because of COVID-19

Across the country, people have been putting off screenings, vaccinations and other care, because of their fears about COVID-19. Many are avoiding the emergency department, even with life-threatening symptoms.

“The issue is patients have felt the hospitals are not safe in general [from spreading COVID-19],” said George Adams, MD, MHS, FACC, director of Cardiovascular and Peripheral Vascular Research, at Rex Hospital, and associate professor of Cardiology at UNC School of Medicine in Raleigh, North Carolina, during a W.L. Gore & Associates webinar.

A study conducted in May 2020 for the Alliance of Community Health Plans and the Academy of Managed Care Pharmacy found 72 percent of U.S. consumers have delayed or plan to delay health procedures. 

Delaying treatments because of COVID

A Medical Economics survey of 500 U.S. physicians in May 2020, found 93.8 percent of them said they are concerned patients are foregoing routine or acute medical care because of fear of COVID-19.

“If there is an urgent need, they do need to come in,” said Darren Schneider. MD, at New York-Presbyterian and Weill Cornell Medicine in New York.

Early in the pandemic, many states required or requested delaying elective procedures. Organizations, such as Susan G Komen, suggested people postpone cancer screening. Hospitals have since opened up their surgery schedules, but often with more structure to thoroughly clean between cases. However, patients still are delaying treatments because of COVID-19.

“We are going to be faced with a lot of patients requesting to push their elective procedures to the late summer or beyond,” said Gareth Morgan, MD, a congenital interventional cardiologist at Children’s Hospital Colorado in Aurora. “The damage that can be done can be significant.

Of particular concern is cardiac patients avoiding the emergency department. A study, reported in Journal of the American College of Cardiology found activations of U.S. cardiac catheterization labs to treat ST-Elevation Myocardial Infarctions were down 38 percent during the pandemic. The American College of Cardiology encourages people to promptly call 911 and seek care if they have heart or stroke symptoms.

“There are a lot people not coming,” Adams said. “They are showing up too late. They die outside of the hospital or they lose their leg before we can try to save it.”

Adams reported an 800 percent increase globally in patients dying at home of cardiovascular disease. At Rex, such visits are down 40 percent, similar to the U.S. study. Cancer screenings also have dropped off, by as much as 94 percent in March 2020 as compared with volumes from January 2017 through January 2020, according to research by the Epic Health Resource Network. The report concludes that if cancer is not detected, it could be diagnosed at a later stage.

A study from Komodo Health in New York reported a 67 percent decline in cholesterol testing and a 65 percent drop in hemoglobin A1c tests following the first shelter-in-place orders. Declines are sharpest in COVID-19 hot spots, such as New York.

“We’ve seen a dramatic decline in primary care visits,” said Farzad Mostashari, MD, co-founder and CEO of Aledade in Bethesda, Maryland. “We should be worried about the untreated chronic diseases having bad outcomes.”

Ateev Mehrotra, MD, MPH, associate professor of Health Care Policy and Medicine at Harvard Medical School & Beth Israel Deaconess Medical Center, both in Boston, reported on a Commonwealth Fund study, conducted by Harvard and Phreesia, a technology company, which found primary care visits remain down by 30 percent from baseline, indicating a rebound from 60 percent but not back to normal.

Additionally, the Centers for Disease Control and Prevention reported in May 2020 a substantial reduction in orders for vaccines through the Vaccine for Children Program and warned that “as social distancing requirements are relaxed, children who are not protected by vaccines will be more vulnerable to diseases such as measles.”

Sally Goza, MD, FAAP, president of the American Academy of Pediatrics, said in a statement that the findings are “incredibly worrisome.” 

Returning to routine care 

What’s it going to take to bring people in for needed care? Each year, according to the Centers for Disease Control and Prevention, 883 million office visits take place. Those visits need to resume for patients and providers.

“Healthcare providers need to get back to the routine, for them and the patients,” said Greg Kefer with LifeLink of Oakland, California. “You have to do it in a safe way.”

Some practices, such as Jewett Orthopaedic Clinic in Winter Park, Florida, are checking incoming patients’ temperatures, requiring masks, providing hand sanitizer and promptly taking patients into an exam room.

The American Medical Association, American Academy of Pediatrics and professional medical societies have developed guidelines for providing care during the pandemic. Recommendations include wearing masks, performing rigorous cleaning, triaging outside and screening for COVID-19, and waiting outside until the provider is ready to see the patient.

Mehrotra recommended practices assure “patients they can operate with protections for everyone.”

Embracing technology  

Banner Health, a network of 1,500 physicians in 300 clinics based in Phoenix, has drawn on technology to enhance patients’ experience and keep them safe. The health system has created a virtual waiting room with mobile chatbots from LifeLink. The electronics communicate with patients in a natural, conversational style to complete digital intake forms, check in and wait outside until notified electronically that the doctor is ready to see the patient. Banner Health had the system up and running within two weeks.

“With COVID, the [traditional] processes are forced to be rethought,” Kefer said. “Everyone knew going to the waiting room was never fun, but with social distancing and hospitals needing to get back to business, this has forced Banner and others [to think] about how you virtualize going to the doctor.”

RELATED: Resuming Elective Surgeries: What to Expect

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