Sidelining of non-Covid patients will exact heavy toll

No one can argue with the overall effectiveness of our national response to the Covid-19 pandemic. Swift and measured action put us ahead of the United Kingdom and the United States in particular. The infamous curve has been flattened and hiccups in relation to personal protective equipment and testing overcome.

Yes, it looks as if we overshot the runway in terms of making extra hospital beds available in anticipation of a surge of very sick people hitting the health system. But if you are going to make an error, it’s far better to overprepare than underprepare. So again kudos to politicians, medical and nursing leaders and Health Service Executive staff: you have played a blinder.

However, one of the sequelae of such a massive campaign is a loss of focus on the rest of the health service and in particular a sidelining of patients with non-Covid-19 related illness. The numbers of people not being seen at doctors’ surgeries and consultant clinics for non-Covid health issues is shocking.

This cannot continue.

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People will pay a heavy price.

Let’s look at two areas of medicine in particular: cardiovascular disease and cancer. Together they are the major cause of premature death in the Republic.

Every GP sees about four stroke cases a year as well as four new cases of angina (chest pain from coronary heart disease). If we stay in coronavirus pandemic mode for three months, that means every GP in the country will not see one person with each of these life-altering conditions. It means, at the very least, some 5,000 people losing out on life-saving treatment every quarter.

The Irish Cancer Society says it is concerned that people are putting their lives at risk because of a reluctance to seek medical help if they notice cancer symptoms. A GP sees six to eight patients with cancer every year. But if these people opt not to attend their local doctor with an unexplained lump, a pain that doesn't go away, unexpected weight loss or unexplained bleeding, they risk losing the opportunity of early treatment and cure.

One of the major factors in the success of the national cancer control programme is the way it lays out standardised pathways for the management of suspected cancer. Take colorectal cancer as an example: more than 2,500 cases are diagnosed here each year, accounting for 12 per cent of all invasive cancers diagnosed. The guideline clearly states that all urgent cases must have an internal bowel examination (colonoscopy) within four weeks.

If you have experienced rectal bleeding and unexplained weight loss since the coronavirus emergency commenced, are you on schedule for urgent colonoscopy?

The same concern applies to all cancers and raises the question: how many people have already lost the chance of an early cancer diagnosis and curative treatment?

The HSE has told The Irish Times that, up to April 17th, more than 3,200 patients had been treated or had procedures in private hospitals since it had taken over these institutions. “Services include chemotherapy, radiology, time-dependent procedures such as endoscopy, cardiovascular surgery and cancer surgery,” it said. But it was unable to tell me how many of the private sector’s 2,340 beds were occupied.

However, informed sources on the ground in private hospitals put the occupancy rate in the region of 20 per cent. In one private hospital late last week, some 28 out of 145 beds had patients in them; in another, just 25 beds out of an available 110 were in use.

When combined with low bed occupancy in our public hospitals now that the initial surge of Covid-19 patients has passed, it means we are not making available a huge slice of our health service to people with serious illnesses.

We have dropped the ball in a big way. It’s now clear we need to establish two parallel health systems: one for Covid -19 and one for all the currently neglected ‘other’ diseases that haven’t gone away.

[ mhouston@irishtimes.com ]