The COVID-19 pandemic has grabbed the world’s attention in recent weeks, and is likely to dominate the news, both generally and within the healthcare universe, for some time to come. COVID-19 is having broad and significant effects on health care, as well as on world economies and daily life in general, that is likely to have long-lasting ramifications, and we are exploring this in our blog as the situation evolves.
In this first of a planned series of commentaries on the evolving COVID-19 pandemic and its implications, we consider its impact on patient care.
Millions of patients have been or will be infected by the virus, with a significant proportion facing serious illness and death. The rapid spread of the infection is also having significant effects on patient care overall, including for illnesses and conditions unrelated to the virus. Limited resources — especially emergency rooms, hospital beds, intensive care units, and physicians and nursing staff — are being pushed to their limits to help fight the pandemic, and people are encouraged to stay home.
On a typical day, U.S. hospitals operate at or near capacity, and in recent years, the overall number of hospitals, hospital beds and emergency rooms has progressively decreased. In addition, there has been a shortage of health care workers overall, and emergency departments have been overcrowded. As a result, we have seen that as the number of moderate and severely affected coronavirus patients in an area increases, the effect on those facilities and their staffs is severe.
Hospitals have begun postponing elective procedures and taking other steps to reduce demands on doctors, nurses and other staff so that they can be available to handle the growing number of coronavirus patients. In some regions, where the number of hospitalizations has overwhelmed intensive care units, operating theaters have been converted to makeshift intensive care units, further limiting their availability for surgeries. According to some news reports, even some cancer surgeries are being postponed, putting the affected patients at risk of their disease worsening.
The strain on resources has also led to health care facilities asking oncology patients to postpone regular checkups, post-cancer screenings, preventive care, and adjuvant treatments meant to keep cancer from recurring. When it comes to primary cancer treatments, decisions are being made on a case-by-case basis, out of concerns that some patients may face a high risk of serious infections if their immune system becomes highly compromised as a result of treatment. Some of these delays are expected to persist for a time even once the outbreak ends, as hospitals struggle to deal with the backlog of appointments.
Hospitals are also severely limiting visitors for all patients, including women giving birth who, in some cases, can no longer have even one partner or support professional in attendance. This is likely to lead to more unwanted Caesarean sections and other medical interventions that result in longer hospital stays and thus greater risk of infections, as well as drains on needed hospital resources. As a result, some women are avoiding hospitals and considering alternatives — including planned homebirths – which come with their own risks.
Recommendations for people to stay at home and avoid coming into doctors’ offices or hospitals unless in-person care is urgently needed is having an effect on other areas of health care, particular for those with chronic conditions. We have heard in our discussions that some patients are wondering if they should stop their current treatments, especially if they act on the immune system — for example, patients wondering if they should stop their immunosuppressive medication as it might put them at higher risk of coronavirus infection. Patients are also debating whether to postpone or skip non-essential procedures, including biomarker testing, if they think visiting a health care facility for such tests may put them at higher risk of virus exposure.
According to data provider IQVIA, total prescriptions for acute care use have plummeted since February, with vaccine use declining even more as people stay home and avoid seeking preventive care for a disease they don’t yet have. The impact of the pandemic on health screening may be particularly acute, as patients ignore initial signs and symptoms of disease and stay home. The likely result: more patients being diagnosed at later stages of their disease, with a resulting worse prognosis. However, while “shelter-in-place” restrictions are reducing prescriptions related to acute or preventive care, prescriptions for most chronic disease medications have so far stayed steady or increased, as have sales of drugs for diabetes, mental health disorders, and respiratory conditions.