Monday | 7 October 2024 | Reg No- 06
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Monday | 7 October 2024 | Epaper

Address collateral damage of non-Covid patients

Published : Thursday, 19 August, 2021 at 12:00 AM  Count : 759
ZUBAIR KHALED HUQ
There are two reasons why people decide not to visit the doctor or the specialist--voluntarily and involuntarily. On the one hand, patients take it upon themselves to cancel appointments already made, or simply avoid seeking help. The reasons may be to avoid contact with other sick people at the hospitals. Even we see physicians seeing patients virtually and giving suggestions.

We have seen during the first wave of the pandemic, non-COVID patients were not seen in private clinics. Hospitals remained busy addressing COVID patients, ICUs were full, and appointments with specialists were cancelled or simply missed an appointment. General practitioners were scarce. Still we are not able to overcome this situation. We are praying and trying to get out of this situation sooner than later.

Due to the C-19 pandemic, emergency room visits have drastically decreased for various non-COVID conditions such as appendicitis, heart attack, and stroke. Patients are, may be, avoiding seeking medical attention for fear of catching the deadly condition. This delay in seeking care can lead to increased morbidity and mortality, which has not been figured in the assessment of the extent of damage caused by this pandemic. These cases illustrate an example of "collateral damage" caused by the COVID-19 pandemic. What would have been a shift of elective operation date? Does this delay hamper the total outcome of results, is it food for thought? A delay in seeking medical attention by an unsuspecting patient, can turn a case from chronic to acute.

The world has been reeling under Covid-19 pandemic, and none have remained unaffected, directly or indirectly.  With its high velocity of spread and magnitude, it has had a significant impact on the health-care delivery system and posed a challenge across the globe. With over thousands of deaths in Bangladesh, our healthcare system is under tremendous pressure. We have already lost many renowned physicians, journalists, police officers, bureaucrats, bankers. This pandemic has a direct negative effect on public health, social welfare and economy.

The other major concern has been the collateral impact on non-Covid-19 patient care, namely the corona collateral damage syndrome, which has been predicted to have a higher mortality than Covid-19 itself, and it is also difficult to measure. This clinical condition results from delay or avoidance of seeking medical care for non-Covid-19 acute emergency conditions and has been attributed to fear of patients getting infected on coming to the hospital and social stigma attached to it. This was further reinforced by policies like lockdown and directives of staying indoors.             

However, there is another cause, and it is related to a change in priorities of working, drastic shift in the working pattern, and focus on health-care institutions, i.e., managing only Covid-19 patients at the cost of non-Covid-19 medical and surgical patients.  It was based on the giant surge and wave of patients suffering from Covid-19 infection, who were getting admitted and overwhelming the health-care services in certain nations. Health-care systems adopted an overcautious and defensive approach so as not to exhaust the medical services and preserve its resources and manpower from the jaws of Covid-19. Fear was also an underlying factor in the minds of all health-care workers, and it was about perceptions of the worst and the unknown.

This once in a century situation has had no parallels and with the passing phase of time and increasing clarity regarding the understanding of the disease process and its trend, the knowledge, attitude, outlook and perceptions will change thereby allaying the fear of the unknown. With the successful advent of vaccination and the better gearing up of resources, there is a fresh ray of hope regarding the control of this pandemic.

Individuals in poorer health, like those with chronic conditions, face a double-edged sword with COVID-19. On one hand, they are more likely to develop severe forms of COVID-19 if they become infected. This gives them incentive to limit social exposure, including contacts with health-care providers and clinic environments. On the other hand, these individuals are likely to become more seriously ill if their conditions are not properly managed and monitored, which requires contacts with the health-care system.

The use of telemedicine has jumped during the pandemic, and while this may have helped those with chronic conditions, follow ups. Telemedicine approach has to be with better internet access. However, the need for care does not go away with a lack of opportunity. A person who is ill will, in general, continue to be ill. And the postponement of a case will only make matters worse, leading to a deterioration of the condition as time passes.

This deterioration is all the more important when people are in poor health, people with a chronic disease see their state of health deteriorate more quickly than people without chronic disease. Thus delays, cancellations and foregone health care can increase the risk of morbidity and mortality. We need to deal quickly with those who have missed out on testing opportunities. We need to create a comprehensive public health plan and make sure not to wait too long. All other disease states must be equally dealt with utmost importance to avert a possible disaster in public health.

Effective coordination among the Government policymakers and the local healthcare workforce is necessary to ensure emergency health services can deal with the pandemic more effectively. The decision to start mass vaccination is a perfect example of fulfilling the pledge of getting vaccinated all in age range.

Heart disease is among the most common pre-existing health conditions in people who die infected by the virus. During the outbreak, emergency hospital admissions for heart attacks and strokes halved, leaving many people dying at home, or suffering devastating damage to their heart or brain. The postponement of heart surgeries and other elective procedures has also led to an increase in preventable death and disability, and to a waiting time backlog which will be difficult to reabsorb.

The longer these disruptions continue, the greater the collateral damage will be. COVID-19 is having a catastrophic impact on mental health like, anxiety, depression, and other forms of psychological distress.
Dr Zubair Khaled Huq,
Family medicine, Gerontology,
Public Health Specialist






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