Around the world, many people are choosing to delay treatment for serious and chronic ailments because they are worried about being exposed to COVID-19 in healthcare settings. In the early months of the pandemic, some hospitals in the United States saw a marked decline in the number of heart attack and stroke patients arriving at emergency rooms. Hospitals and general practitioners in some parts of Australia estimated a 50% drop in attendance during the first few months after the pandemic emerged.
Although there are no concrete figures, anecdotal evidence collected by members of the Hospital Association of South Africa (HASA) suggests that this worrying trend is also playing out in South Africa’s private clinical settings – among them acute, sub-acute, day and psychiatric hospitals. HASA represents the owners of most of South Africa’s private sector hospitals.
Dr Suseth Goosen, Quality Manager for the National Hospital Network, says clinicians from the network’s approximately 230 member facilities have noted that the problem seems to be especially serious at acute hospitals.
“Patients are presenting late with very serious conditions, including heart attacks and strokes,” Dr Goosen says. In some cases, patients didn’t follow up with specialists after being identified as being at risk; in others, she says, they “left it late” after experiencing symptoms.
While fear of COVID-19 exposure is likely a big driver of patient delays, Goosen believes that their anxiety may be “more complex than simply a fear of the virus”. People may have stopped taking chronic medication because of their financial circumstances, for instance, or may have cut back on their medical aid plans because they need to save money against a backdrop of economic uncertainty.
Group Medical Director of the Netcare Group, Dr Anchen Laubscher, said: “Medical practitioners at Netcare hospitals and Medicross medical and dental centres have observed a decline in the number of people coming for doctor consultations and receiving treatment for potentially serious chronic medical conditions such as diabetes, high blood pressure, heart disease, cancer and others.”
This decline could be attributed to “restrictions imposed during the first phases of the lockdown, and lingering concerns by some about the safety of seeking care from doctors and healthcare facilities as lockdown restrictions were relaxed”, Dr Laubscher said.
“There were even cases in which people avoided seeking help from emergency departments for serious acute health conditions, which in some cases unfortunately had avoidable, long-term health consequences for them.”
The importance of an early diagnosis
Mediclinic Southern Africa’s Chief Clinical Officer, Dr Stefan Smuts, says that “informal feedback from patients, relatives and the doctor community” suggests people are “coming in at a later stage in the disease process to get help”. This is especially true for “more subtle symptoms”. He gives the example of someone who has experienced back pain for more than a year and realises it is getting worse but postpones a specialist visit because of COVID-related anxieties. Such a postponement, Dr Smuts points out, may ultimately lead to delayed diagnosis and treatment. Some cancerous conditions may also initially present quite subtle symptoms that require testing and examination by a good clinician to pick up the underlying disease.
And of course, he says, there is enormous value in knowledge: “An early diagnosis means that you know what you are dealing with, rather than delaying it and wondering what it could be. Even if it’s benign and nothing to worry about, just knowing can help.”
The possible consequences of a late diagnosis
Lenmed’s Dr Liezl Balfour echoes these sentiments: “The consequence of neglecting to treat a chronic condition timeously has a huge impact on the quality of life of the person.” Some conditions, if not timeously detected and managed, have long-term ripple effects, she adds. “Neglecting to treat high blood pressure could lead to complications such as a stroke, which limits the person’s quality of life and involves an extended recovery and rehabilitation period. The consequences of neglecting to manage diabetes and blood glucose levels could lead to complications such as the loss of limbs, which involves major surgery and a complicated recovery process,” Balfour says.
Netcare’s Dr Laubscher concurs. “Many patients unfortunately did not manage their chronic health conditions appropriately during lockdown, especially during the earlier stages. This has resulted in doctors and hospitals now seeing a number of patients who have developed complications as a result of not managing their chronic conditions, some to the point that they became serious medical emergencies.
“This demonstrates the fact that persons with chronic conditions, such as diabetes and high blood pressure, not only have an elevated risk of developing complications if they contracted COVID-19, but that the chronic conditions themselves must be properly managed to avoid unnecessary serious health consequences. It also highlights the importance of patients ensuring that their chronic conditions are properly managed in consultation with their doctors.”
Possible solutions
None of this is to suggest that people’s anxieties about COVID-19 shouldn’t be taken seriously. On the contrary, says Mediclinic’s Smuts: “We absolutely must not underplay the fear that people have of going to hospitals and doctors’ practices.” And the best way to deal with your fears? “If you have specific concerns, talk to your doctor. They can talk you through the options that are available, like telemedicine or video consultations.”
Part of people’s anxieties may stem from the visible nature of COVID-19 protection in hospitals, like doctors and nurses wearing masks and visors. Dr Goosen, from the National Hospital Network, points out that hospitals have always had infection controls in place and that while masks and visors may look foreign, they add to a facility’s safety.
“Hospitals know what they’re doing, and people shouldn’t be scared.”
Source: Hospital Association of South Africa (HASA)