One of the issues that have been exercising people during the Covid-19 panic has been what impact the lockdowns have had on access to essential healthcare for other life-threatening conditions.
In particular there is increasing concern about the possible impact that lack of hospital referrals may be having on the long term prospects and mortality of people with cancer and other diseases.
A submission to the Dáil Covid Committee on September 30 from the Irish Cancer Society addressed one aspect of that.
The Society said that of the 1,389 Covid related deaths recorded at the date of their submissions, 14% were of persons who had been diagnosed with cancer. They went on further to claim that the impact of the virus on overall health care is causing “significant decreases in cancer survival,” and that the numbers of excess deaths from cancer could “dwarf” those from Covid.
“Covid-19 has had a damaging impact on cancer patients and people anxiously awaiting important diagnostic tests and screening,” they reported. “212 Covid-related deaths in cancer patients have been recorded to date, but we have yet to see the full scale of its secondary impact on cancer mortality due to delayed diagnoses and treatment.”
“Early indications from other countries suggest significant decreases in cancer survival in high-income countries could happen as a result of Covid-19, which would dwarf the number of deaths caused by Covid-19, and reverse hard-fought improvements in recent decades,” they warned.
Unlike other countries, the Irish state has conducted no research on all of this, or if it does have a picture of what the consequences have been to date, then it is keeping that information to itself.
Other states have more precise overall statistics. In the Netherlands for example, there had been a drop of 360,000 in hospital referrals for all other conditions.
There has been a 60% decline in the numbers of people being referred to hospital in England for cancer, and similar falls in relation to lung disease and other conditions. In a report called “The Forgotten C”, research by the Macmillan Cancer Support agency suggests there are currently 50,000 undiagnosed cases of cancer due to the disruption caused by the diversion of resources to fighting Covid-19.
The British Office for National Statistics have also reported significant increases in people dying at home, amid fears that sick and elderly people are staying away from hospitals and having difficulty accessing care. The ONS reports that since the Covid-19 crisis in March of this year, deaths from dementia and Alzheimer’s disease have risen by 79% in private homes, diabetes deaths at home have risen by more than 85%, and deaths at home from cardiac arrhythmias during the same period rose by 105%.
Public Health England reported an excess of deaths at home of 23,619 and of over 23,000 in care homes. The numbers dying in care homes are far higher proportionately than those dying in hospitals. Only around 10% of deaths of people at home are from Covid-19, which would suggest that many of those dying in their own homes are dying of conditions that might otherwise have seen them being referred to hospital.
Of course a large number of those dying at home were of the age cohort who also make up the overwhelming number of those dying from the virus both in care homes and hospitals, but the surmise must also be that people who are dying at home might very well have improved their chances of survival had they been referred to hospital.
That is certainly part of the conclusion of the Centre for Evidence Based Medicine (CEBM) in Britain which states that: “The data suggest that mortality has shifted from hospital to home, especially for deaths not associated with COVID-19. This “displacement” may be due to the reluctance of individuals to receive treatment in hospital or of clinicians to admit non-Covid patients or a combination of these.”
The CEBM in Britain recently reported on statistics from Public Health England which shows there were excess deaths of people suffering from heart disease, strokes and diabetes mellitus, but notably fewer from acute respiratory disease.
The latter is interesting as it raises the question as to whether deaths from other lethal respiratory conditions are being recorded as Covid deaths if people with those other respiratory conditions also contract Covid. This would add weight to the claim from the Irish Central Statistics Office that almost 50% of all Covid related deaths would have occurred anyway, which highlights the role of underlying causes in the incidence of virus deaths
Those statistics from Britain which has a similar demographic to Ireland underline the need for the Irish health services to conduct similar research, and make available the findings. This would incur little cost as the raw statistics are obviously available and would only require that they are sorted according to different criteria.
What is clear, even anecdotally and from the bare information that can be gleaned from the Irish Cancer Society and others is that there is a real and present danger that we face a rise in deaths from all other causes as the healthcare system remains focused on Covid-19 to the detriment of treating other illnesses. It should be noted that the numbers of deaths from Covid is nowhere near the level that was forecast earlier in the year, and that the ratio of deaths to cases is a fraction of what it was in April.
Allied to that, is the increasingly perception that other serious health conditions are being neglected in terms of hospital care, and that this is having current impacts on the rates of survival, and will as those involved in cancer care and research have stated, lead to higher numbers of deaths over the coming years. The same will unfortunately be the case with other conditions that already have a poor prognosis in terms of likely mortality