Deferral of care during COVID-19 has emerged as a growing concern for healthcare professionals and public health leaders....
We now know what happens to the U.S. economy when you push the pause button on restaurants, retail stores, hair salons, and travel and tourism for months on end. The impacts have been scrutinized obsessively by economists and reported on daily, with one grim headline after another highlighting stats like 51 million unemployed, 30% of U.S. companies at risk of credit default, and a projected 53% decline in U.S. GDP in the second quarter.
But what about healthcare? The world has been fixated on the acute problem of COVID-19 itself, with a staggering 25.8 million confirmed cases worldwide and 858,000 deaths, and new local flare-ups across the Sunbelt of the United States. Yet few resources have been devoted to understanding the ripple effects of the pandemic on other parts of healthcare.
We’ve begun to do just that, and the results are startling. Since March, we’ve been tapping into our Healthcare Map of real-world patient data to start to understand the gaps in care that are emerging during the COVID-19 pandemic, and how they might affect healthcare over the near and long term. The scale of the disruption we’re seeing is hard to overstate. It’s not just routine screenings and annual check-ups that are being missed, but critical ER care and cancer diagnoses are also falling through the gaps created by COVID-19.
These are not things that can wait for the world to get back to “normal,” particularly when new emerging hot spots make the timeline so fluid. We need to start rigorously tracking behavioral trends across a wide swath of routine, chronic, and acute care encounters to address the effects of the last few months of healthcare deferral and the next several months of consumer trepidation and avoidance when it comes to going to the doctor.
Preventive Care Put on Hold
Routine, preventive screenings were the first to go when stay-at-home orders started being issued and people started avoiding hospitals and doctors’ offices at all costs. According to an analysis we published on April 28, routine disease management and preventive screenings declined significantly in the weeks following widespread shelter-in-place guidelines throughout the U.S., with the most significant declines seen in cervical cytology screening (-68.2%), cholesterol/lipid panels (-66.6%), and hemoglobin A1c tests (-64.7%).
The steep drop-off was even more pronounced in the initial COVID-19 “hotspots” such as New York, where HbA1c tests declined 82.6% through April 16. In Manhattan, HbA1c tests were down more than 90% from average levels before COVID-19. In Massachusetts, lipid panels were down 80.5%, and in California, cervical cytology screenings were down 76.3%.
On some levels, these trends make sense. During the pandemic, individuals are faced with a difficult choice in which there seems to be a trade-off between mitigating the risk of COVID-19 exposure or going to the doctors’ office for important care and screenings, like a cholesterol test. The problem is: how long will that pattern of behavior last? Was it just a two-month blip in the pandemic’s early days and the healthcare system will absorb this pent-up demand over the next several months, or will people continue to avoid contact with the healthcare system for routine care? If the latter, we could be facing another significant public health challenge in short order.
Deferral of Critical Care
More alarming, we’ve found significant evidence of people deferring critical care during the pandemic. An analysis we conducted in partnership with the colorectal cancer advocacy group, Fight CRC, echoes the findings we’ve seen in other preventive screening procedures, with the total number of colonoscopies down 89% from the same period last year. We also found that the number of colorectal cancer surgeries fell by a startling 53%, and new colon cancer diagnoses were down by more than 32% versus last year.
Colon cancer won’t wait for COVID-19 to run its course. The fact that diagnoses are down by this amount simply means that more people are living with undiagnosed colon cancer right now. And that’s a problem we cannot afford to leave unaddressed.
It’s not just “silent killers” like cancer and heart disease that are going undiagnosed and untreated right now, we’re also seeing massive declines in emergency room occupancy. According to our data, ER visits were down 75% on a year-over-year basis in April. And that includes the surge of volume for COVID-19 and related symptoms.
Mind the Gaps
These are important data points when it comes to analyzing patterns of healthcare behavior across large swaths of the American population. Drill deeper into any of them, and you’ll see stark variations based on geography, socioeconomic factors, and a host of other variables that will all be critical to monitor as we track the recovery of the healthcare system in the weeks, months, and years following the COVID-19 pandemic.
Even before COVID-19, identifying and addressing the discrete variables that led to gaps in care was a major challenge, one that was fraught with data accessibility issues, lack of coordination between providers, and institutional inertia. Now, with the entire healthcare system disrupted, there is an opportunity to get to the root of the problem by tracking real-world, real-time patient encounters with the healthcare system and immediately addressing those areas where behavioral, structural, or economic variables are preventing the right actions from taking place.