As primary care providers we must partner with our patients to navigate the pandemic as best as we can, and safely guide to resume health maintenance and preventive care. COVID-19 virus hit the world like nothing we have ever experienced. As the virus ravaged the communities, patients shied away from hospitals and doctors offices for fear of contracting the virus. Many primary care providers followed closely at the heels of their patients filing out through the exit door. With patients, the behavior was quite profound even among those who had serious illness with whom one would have expected a greater willines to brave the lockdown in serach of care. For example, compared with the 10-week period from Jan. 5 to March 14, emergency room visits were down by 23% for heart attacks, 20% for stroke, and 10% for diabetic hyperglycemic crisis from March 15 to May 23. Elective procedure and routine screening plummeted and in some cases ceased entirely because people avoided hospitals and the doctors offices.
As the curve flattens and restrictions ease we now can take stock and patients must resolve to live again now and even after COVID-19. There is no longer a doubt we are in this for the long haul, either in one continous swoop or in seasons. Doctors appointments missed, cancelled or deferred amount to missed screening and preventive procedures. Screening and preventive care programs are well researched tools designed to seek and identify diseases including diabetes, cardiovascular diseases, cancer etc among populations, ages and gender where the disease would occur most frequently - and where the best outcomes will be attained when we intervene at its very earliest stage. With no screening comes delayed diagnosis and treatment. Cancers and many afflictions are picked up when a patient experiences symptoms and quickly checks the symptoms by going to his or her doctor. Yet it is well known that delay in almost all cases means that we end up dealing with advanced stages of the disease. Naturally in the pandemic we find ourselves, we must place surviving the virus a first priority. After all done, surviving past the virus becomes equally as important. And we can set to work both goals carefully in a safe and effective manner. There will be consequences if we don't, least of which includes losing much of the gains in survival due to early detection, appropriate cycled treatment protocols. Some models suggest that due to the disruption and delay in seeking care in non COVID-19 problems, we will see increased death unrelated to the virus itself as early as in a year or two and certainly within the next 10 years. In a model referenced by Norman E. Sharpless in an editorial in Science, he said that "the effect of COVID-19 on cancer screening and treatment for breast and colorectal cancer (which together account for about one-sixth of all cancer deaths) over the next decade suggests almost 10,000 excess deaths from breast and colorectal cancer deaths; that is, a ∼1% increase in deaths from these tumor types during a period when we would expect to see almost 1,000,000 deaths from these two diseases types”. That number many argue is a drop in the bucket compared to the more than 125,000 deaths in the US alone in six months of the pandemic. But If that model be the case 10 years out, then COVID-19 would still be winning our battle with it. Now may be the time we begin to see to it that we win instead. We must resume screening and preventive care and not defer, delay or cease altogether in a safe and predicable way that prioritizes patient, staff and provider safety. We must navigate the circumstances we find ourselves somehow before we go too far out and get lost and too far down the road to return. We must resume and act now and possibly make up for lost time.
CREDITS: (GRAPH) V. ALTOUNIAN/SCIENCE; (DATA) NATIONAL CANCER INSTITUTE
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