Dr Kevin McCarroll
Medical Matters
It’s now nearly seven months since the first confirmed case of Covid-19 in Ireland and the start of an unprecedented journey of restrictions and lockdowns that has radically changed the way we live. While we avoided a surge that could have swamped our health service, the death toll stands at over 1700, many times more than the worst flu season.
With the number of new infections rising and a second wave already underway, there’s a foreboding sense of what may come as we head into the winter. Despite this, we know so much more about the virus, what to do to contain it and how to approach treating it. We also know that 80% of cases are mild and even in older adults, the majority who contract it will survive. We’ve learned of the crucial importance of testing and isolating in nursing homes where over 50% of Covid-19 deaths occurred – lessons which place us in better stead this season.
We also can’t simply look through the narrow lens of Covid-19 deaths in assessing the impact of the pandemic but rather encompass in a much broader way the effects on society at large – physical and mental health, social and economic and the cost not just now but that continues into the future. Indeed, it’s hard not to disagree with the criticism that many of the public health recommendations came from a relatively small group of people within a limited niche with little voice from experts in other areas.
The repercussions of Covid-19 have rippled into nearly every aspect of healthcare which was already under huge pressure. For the first time, the number of patients on the National Hospital waiting list surpassed 800,000. Hospital capacity remains about 80% reduced for infection control reasons.
The impact on cancer services, not least screening, has also been huge. For example, a suspension of Cervicalcheck for just over four months resulted in a build-up of 100,000 women to be seen before October. There was also an estimated 50-70% reduction in the number of breast diagnostic procedures and breast cancer diagnoses during Covid-19.
In fact, the Irish Cancer Society estimates that more than 450 cancers and 1600 pre-cancers are likely to have gone undetected due to the interruption in screening. A study published in the Lancet Oncology estimated an increase in cancer deaths (up to five years after diagnosis) in the UK due to the pandemic of about 10% for breast cancer, 15% for colorectal cancer and 5% for lung and oesophageal cancer.
The policy of cocooning for older adults resulted in many becoming physically deconditioned impacting on their mobility and now presenting to geriatric services for physiotherapy. Worse, there are cases were some fell and fractured their hips and sustained other injuries. Earlier in the year, fear of presenting to hospital resulted in delays in the diagnosis and treatments of stroke and heart disease.
A recent Irish survey of 1,032 adults nationwide (aged 18 – 85) found that a third are experiencing serious mental health difficulties due to Covid-19 and 50% are feeling negative effects on mental wellbeing. In June, a report based on a survey of 200 psychiatrists also noted a major increase in referrals to psychiatric clinics due to social isolation and reduced access to community based mental health services. Furthermore, charities such as Alone have also seen an increase in the numbers of older people contacting them about social isolation, loneliness and suicidal ideation.
And of course, the longer term implications to people’s livelihoods as a result of the economic recession – unemployment peaked at about 28% in April but some jobs may never be recovered and restoration of economic activity to pre-Covid-19 levels isn’t expected until 2022. The economic costs for the government this year equate to €30 billion but this doesn’t factor in lost opportunity costs and the overall impact on health.
The phenomenon of what’s unofficially called ‘ longCovid’ where patients have symptoms for more than two weeks and up to several months after infection is well reported. The true incidence isn’t clear and in larger studies occurs in about 5-10%. Symptoms include fatigue, breathlessness, muscle aches, joint pain, memory loss, lack of concentration and depression and while it appears to be related to Covid-19 severity it’s also been noted with milder illness.
On a positive note we know that steroids reduce death rates in Covid-19 by about 17% in patients on oxygen and by up to 36% in those assisted with ventilation, with benefits also in those treated more than seven days after symptom onset. The antiviral Remdesivir can also shorten time to recovery by about four days in those with Covid-19 pneumonia. Fears of a bad flu season also haven’t been borne out in Australia, but do make sure to get your flu vaccine. Finally, we should have the results of phase three vaccine trials by the end of the year on which so much will hinge!