DELAYED MEDICAL CARE
In mid-March, just before Governor Janet Mills declared the state of emergency, the U.S. Surgeon General called on states to delay “elective” medical procedures to attempt to conserve personal protective equipment (PPE) and hospital capacity in the event of exponential growth in serious coronavirus cases. A more specific, tiered framework was distributed by the Centers for Medicare and Medicaid Services in April 2020 to help medical professionals and hospitals develop a standard of care within the new paradigm.
The list of so-called “non-essential” procedures include regular check-ups, cancer screenings like mammograms, joint surgeries, as well as some preventative care visits such as pediatric vaccinations.
Patients who had to postpone their biopsy or cancer screening delayed a potentially earlier diagnosis crucial to ensuring recovery. The Maine CDC’s Shared Community Health Needs Assessment Report 2022 recognized that pandemic-era “challenges in accessing care have impacted chronic disease management and caused delays in nonemergency procedures.”
In August 2020, Maine Policy warned about the effects of canceling or postponing important medical procedures like these, referencing a report published in the National Institutes of Health (NIH) Public Health Emergency COVID-19 Initiative that noted the “consequences of surgical delays will likely manifest in increased costs to the health care system…often requiring more intense and more costly treatment.”
Given NIH’s 2020 warning, public health officials should be looking into how delayed medical care played into the overall need for health care services, as well as disease progression among patients who could not see their provider. Are these effects evident in the provisional mortality data, or is it too early to tell?
CDC WONDER data on cause-of-death by ICD-10 coding show that excess deaths among Mainers attributed to circulatory system failure (I00-I99) rose 3.5% in 2020, but doubled proportionally over the next year to 7%. The Wall Street Journal reported similar data nationally: “Mortality rates from heart disease and stroke rose 4.3% and 6.4% respectively in 2020.” Heart disease, the number one cause of death for Americans, driven by the nation’s concurrent epidemics of obesity and diabetes, is rampant even in “good” years.
Deaths attributed to diseases of the endocrine system (E00-E88) in Maine were 6.7% higher than expected in 2020, a proportion which nearly-tripled to 17.9% the following year. Despite many delayed or skipped cancer screenings and treatments over 2020, deemed “elective procedures,” neither Maine nor US mortality data show significantly higher excess deaths attributed to cancers. It is possible that the effects will not be seen in mortality data for many years.
These examples of delayed and withheld medical care pertain to non-COVID causes, but some suggest that top-down approach to developing care protocols for COVID-19 also led to greater mortality attributed to the virus.
Several doctors found success experimenting with multi-drug protocols to treat COVID-19 illness in the first months of the pandemic, but were ultimately ignored by leading public health officials. Dr. Pierre Kory of the Frontline COVID-19 Critical Care Alliance (FLCCC) testified to a Senate committee in May 2020 that lack of recommending methylprednisolone, a steroid which he noted was used with success in prior coronavirus outbreaks like SARS and MERS, is “causing needless death.” The National Institutes of Health (NIH) never included it in its directives, even recommending against several other commonly-used drugs and supplements mentioned in FLCCC protocols, like vitamin D, vitamin C, Zinc, and Ivermectin.