Be careful you don’t become a victim of ‘secondary Covid’

Fingers crossed that we can avoid full lockdown over the festive period. But with Covid-19 numbers in the community at a high level and a slow but inexorable increase in people requiring intensive care treatment in our hospitals, we may be approaching a tipping point in this fourth wave of the global pandemic.

It wasn’t supposed to be like this, of course.

Vaccination rates of over 90 per cent should have seen us enjoy a “Covid-adjacent” Christmas rather than one where we are once again under the novel virus’s jackboot. That scenario may have come to pass had the original Alpha version of the microbe prevailed; but then came Delta and it’s selfish ability to remain highly transmissible despite the vaccines’ success at blunting the severity of Covid-19 disease.

What I am choosing to label “secondary Covid” is not some newly discovered knock-on illness attributable to Sars-CoV -2. Rather it is the growing problem of undiagnosed disease and late-presenting serious illness that has been with us since March, 2020. I’m talking of missed cancers, preventable heart attacks and strokes, and hidden chronic disease– all of which are the result of us having difficulty accessing non-Covid health services.

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At this point may I state clearly that this is in no way the fault of individual patients. Apart from the demands of Covid there are two reasons why the health service has effectively ceased to function: it’s parlous and dysfunctional state for many years resulting in too few hospital beds, not enough consultants and a severely underdeveloped community health system; and an understandable fear of hospitals for many people at a time when they are seen as a likely place in which to become infected with the coronavirus.

A recent survey carried out on behalf of health insurer Laya Healthcare confirms the extent of this fear. Some 39 per cent those surveyed stated that they are afraid of attending hospital due to Covid-19.

Sadly, some 20 months into the pandemic, people are already suffering. According to the Irish Cancer Society (ICS) higher numbers of late-stage cancers are being diagnosed as a result of screening delays caused by Covid-19. Significantly, it found that a full quarter of a million fewer people were screened for cancer in 2020 compared with the previous year, leading to ICS chief executive Averil Power to say there is "a cancer crisis" in the State at present. She said the pandemic "disrupted every single part of the cancer care continuum from screening to diagnostics to treatment and end-of-life care".

It will take some time before we see the effects of this crisis on cancer mortality rates, but see them we will. And very probably we will see similar poorer outcomes for cardiac and stroke patients.

Canadian paediatric neurosurgeon Dr Sheila Singh of McMaster University Hospital, who is seeing children with larger, more advanced brain tumours, told CBC's White Coat, Black Art programme she believes the delays in diagnosis have been caused by patients staying away from hospitals because: they are afraid of catching Covid-19; there is a lack of in-person visits with their family doctor; and there is an anchor bias to look for Covid-19 symptoms to the detriment of flagging other serious diseases.

“There’s no doubt there will be collateral damage,” she said, “and some of that will be death and poor outcomes from diseases that could have had better outcomes.”

I would like to appeal to readers not to become “victims” of a delayed diagnosis. Yes, waiting lists are long and access to care is difficult. But that is a problem for politicians and health service chiefs. Please do not ignore red flag symptoms such as unexplained bleeding or weight loss. Don’t put off having that chest pain investigated.

Look for the care you are entitled to and avoid becoming a “secondary Covid” statistic.

[ mhouston@irishtimes.com ]