The Covid-19 pandemic has had an unprecedented effect on the world; there is no human being who has not been affected. Though the priority of most governments across the world has been to reduce the transmission of the virus and search for an effective vaccine, there are also important side-effects of Covid lockdowns which should not be forgotten.
One of these side-effects is the devastating impact which Covid-19 has had on the provision and delivery of medical treatment for heart and cancer patients. A group of patients who have consistently been referred to as an “overlooked” sector of the population during this pandemic.
The Disruption of Covid-19 on the Provision and Supply of Heart and Cancer Care
A considerable body of research has shown that the priority of National Health Service (NHS) resources to deal with the increase in infected patients has meant the healthcare system has been restructured. This restructuring has included minimising patient contact with healthcare professionals; the rescheduling and postponing of routine hospital visits and healthcare checks; the postponement of non-essential procedures, and an increase in telephone and video assisted consultations and check-ups.
The official governmental advice of “Stay Home, Protect the NHS, Save Lives” has also increased fears of contracting the virus, which has meant that heart and cancer patients are avoiding hospitals, or attending screenings too late to benefit from life-saving treatment. The European Society of Cardiology (ESC), conducted a survey with 3,101 healthcare professionals in 141 countries, including the UK in Mid-April 2020 and found some deeply alarming results. The number of heart attack patients seeking hospital care “dropped by more than 50% during the Covid-19 outbreak”. Most respondents have said that out of the patients who did attend hospital, 48% arrived later than usual for effective treatment. ESC President, Professor Barbara Casadei has stressed it is the fears of catching the coronavirus which has meant people who are even in the middle of suffering a heart attack are now too afraid to attend hospital for treatment.
The real fears and anxieties of heart patients need to be recognised to a stronger degree by governments and healthcare practices. As these fears affect whether or not heart patients seek treatment and in turn, affect their health status, local GP surgeries and hospitals should provide more public reassurance to patients about what Covid-secure measures there are in place. In addition, the government should dedicate more time in Covid briefings, to reassure non-Covid patients that they still remain a priority of this newly restructured healthcare system.
The Forgotten “C”?
In October 2020, Macmillan Cancer Support Charity have estimated that across the UK, there are approximately 50,000 “missing diagnoses”. This means that for a similar time frame in 2019, there are 50,000 fewer people who have been diagnosed with cancer. Kimberly Eccles, a 23 year-old woman has learnt that she has a 1% chance of survival, after missing three crucial appointments at the beginning of the first lockdown; many other patients will sadly face the same fate. The situation cannot carry on as it is.
In addition, Macmillan has found that more than 22% of people living with cancer in the UK, have experienced disruptions to their cancer treatment and care because of Covid. For approximately 150,000 patients, this disruption took many forms including postponements in follow-up care following earlier cancer diagnoses and delayed, rescheduled or cancelled treatments. Rosie Loftus, Chief Medical Officer of Macmillan has rightfully pointed out that in navigating all the chaos of the pandemic, there is one issue which remains clear: cancer patients’ needs do not stop during the pandemic.
There needs to be greater transparency provided to patients by healthcare practitioners and governments about what changes they can expect to their cancer treatment plans, what changes these might involve and a full commitment to rescheduling any postponed appointments or consultations as soon as possible. The effects of the pandemic on mental health have been well-documented. The government should recognise these adverse mental health effects, and invest more funding plan into mental health and pastoral support schemes. These schemes could include counselling and support groups, which could help people who have been diagnosed with cancer to feel more connected during this isolating period of lockdown.
Virtual Clinic Models and the Redefining of “Essential” Healthcare
There has been an increase in the use of virtual clinical models and redefinitions of “non-essential” procedures. Research has found that the deviation from face-to-face to online consultations can have emotional and psychological implications for patients. The barriers created via a screen can lead patients to feel more distanced from the process, may undermine rapport building between them and their doctor and hinder confidentiality. The government should recognise that though more convenient during lockdowns, online consultations will not work effectively for everyone. There should be an increase in in-person consultations, with greater acknowledgement by practitioners and governments that the transition from face-to-face appointments to the virtual realm is not an easy one, with many complications involved.
It is very concerning that a large sector of the non-COVID patient population are suffering as a result of the restructuring of the healthcare system. It must be recognised that heart and cancer patients’ needs do not disappear during the pandemic, but are likely to worsen. The political will to reassure non-COVID patients is questionable, given that the majority of efforts are directed towards reducing the transmission of COVID and ensuring an effective vaccine roll-out. However, closer partnerships can be exercised between the NHS and the Government to provide greater public reassurance and secure more funding into more mental well-being and pastoral services for patients during this overwhelming time.
Rohini Anand is a recent MSc graduate in International Social and Public Policy from the London School of Economics.
The featured image (top) is by Francisco Àvia Hospital Clinic on Flickr