Studies reveal the unintended consequences of delaying surgeries, drop in ER visits due to pandemic

In August 2019, during a softball league game, his friends noticed that his breathing was starting to strain. Finally, after an indirect trip to different specialists, Caledon, Ont. The man was told he had an airway obstruction and needed a CT scan.

By then, the end of February 2020, the beginning of the pandemic, and soon the Ontario government was shutting down all elective surgeries and procedures. So Perkins had to wait.

As the weather gets hotter and the humidity rises, breathing becomes more and more difficult.

“It was like trying to breathe as if you were sucking thick milk.”

Perkins finally had a CT scan at the end of May 2020 that showed a “large” tumor cutting off 70 to 80 percent of his airway.

He was designated as a priority patient 1, who was Define interrupt Such as “any condition in which failure to diagnose and initiate treatment would result in serious morbidity/mortality.”

Despite this, he still had to wait another three months for the biopsy.

Perkins is not alone – the backlog of operations in Ontario is estimated to be more than that More than 257,000 cases and increasing. As in the first wave, The county told hospitals last month To suspend non-urgent measures to free intensive care beds as COVID cases surge in third wave.

Only now are studies beginning to reveal some of the consequences of those delays.

excess deaths

according to The study was released last week According to the Ontario COVID-19 Scientific Advisory Schedule, it is possible that these delays have contributed to the increased deaths in the province.

After analyzing cremation data in Ontario, the study found a roughly 13% increase in the number of deaths during the pandemic compared to the baseline average from data taken between 2017 and 2019.

Almost some of these deaths were due to COVID-19 but were not counted as such, especially in the first wave when testing was not widely available, said Dr. Peter Johnny, scientific director of the advisory schedule and co-author of the study. .

He said that although the study data did not include a cause of death, it is possible that many of the excess deaths were not related to COVID because they occurred between epidemic peak periods when deaths from the virus were low.

“In an already strained healthcare system, what we are starting to see is people are struggling…to get proper care,” Johnny said. Dr. Brian Goldman, host Potion and white coat, black art.

The main causes of these additional deaths are likely cancer and cardiovascular disease as it is Two main causes of death In Western countries, Johnny said, and with both, “we know that if you’re late with care, that negatively affects the prognosis.”

He said reduced trips to the emergency during the pandemic due to fears of contracting COVID-19 may also be a factor in these excess deaths, depending on the situation.

some “good news”

a A new study was published this week in the Canadian Medical Association Journal showed that emergency department visits for common conditions such as appendicitis, miscarriage, cholecystitis and ectopic pregnancy decreased significantly in the first wave of the pandemic.

The researchers compared emergency department visits in Ontario from the first half of 2020 to the first half of 2019, given those four conditions – chosen because they are measurable, very common, and managed in a standard manner. During the first wave of the epidemic, they found a 20 to 39 percent reduction in appendicitis and miscarriage visits.

But the study also found something surprising – patient outcomes for these conditions were not affected. Despite fewer emergency department visits, there was no increase in adverse patient outcomes, such as patients appearing later in the emergency room or increased death rates.

Study co-author Dr. David Gomez, an acute care and trauma surgeon and scientist at St Michael’s Hospital in Toronto, has a theory for why this is the case: the potential overuse of the emergency department before the pandemic.

“This does not mean that [people] They are just suffering at home now” — instead they are successfully managing their care at home or getting health care elsewhere, likely virtually.

Mild appendicitis, for example, can be treated at home or managed with virtual healthcare visits, Gomez said.

“A lot of the care provided in emergency departments can be very effective and, perhaps, timely, administered through a variety of other means, through urgent care centers, virtual visits, [and] Long hours of primary care practitioners.”

Gomez said avoiding emergencies can certainly have negative consequences for some cases, but he said these study findings are a reminder that the pandemic’s impact on the health care system is “not all bad news.”

As we emerge from the pandemic, Gomez believes we’ll see more evidence of a health care system that adapts and transforms in certain situations, such as virtual care, and that these changes “hopefully will continue over time.”

“This is a one-in-a-generation opportunity to reassess how care is delivered at all levels.”

Watch | The backlog of surgeries in Ontario creates uncertain waiting times for cancer patients:

The COVID-19 pandemic has caused a backlog of more than 250,000 surgeries in Ontario, including cancer operations, forcing patients to wait for procedures that could save their lives. 2:03

We have a big job ahead of us

Perkins finally underwent an open neck biopsy in August of last year, a year after his first symptoms.

The tumor was benign and in October, he underwent surgery to remove it. But Perkins said he and his family had to live with months of not knowing if he had cancer.

Target time for Priority 1 patients like Perkins to have a CT scan, according to Quality of Health in Ontario, within 24 hours of receiving the order, not the three months I have been waiting. (As of March 2021, Provincial tracking site showed that 78 percent of patients are screened during that target time.)

“It took him seven months or more to get a biopsy, and nine months to have surgery to remove the tumor, despite being a grade 1 cancer patient with not being able to breathe,” he said.

“This was a situation where the tumor was benign…. If it was malignant, waiting alone would have been enough to kill me.”

The province has resumed “non-urgent” surgeries and the Ontario government has promised $300 million in its 2021 budget to help reduce the backlog of surgeries.

But Johnny said there was “no way” an already overburdened health care system could catch up in time to save everyone on “long, long waiting lists”.

“These excess deaths are likely to persist in an already challenging health care system after the pandemic.”

Written and produced by Willow Smith.