Hopefully, the Covid-19 pandemic will end soon and the infections that emerged from the latest variant will recede. This will make it easy for many Americans believe they have survived another surge. But in fact, we don’t have a simple way of measuring the long-term impact of Omicron — or the pandemic as a whole — on everyone’s health or what kinds of consequences it will have on our health care system. “Even from the early days of the pandemic,” says Caleb Alexander, a professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health, “it’s been clear that there are going to be any number of large collateral effects.” What’s less clear at this point is how to even define those effects, let alone quantify them.
There’s virtually no aspect of our lives that the pandemic hasn’t changed. The limited data sets suggest that it will have a huge impact on other health conditions. The final analysis of 2020 mortality data was released by the National Center for Health Statistics in December. The two most common causes of death were still heart disease and cancer. Covid-19 was the third. The age-adjusted death rate for the U.S. population increased nearly 17 percent, the greatest jump in more than 75 years. This rise was not due to covid deaths. The death rates from cardiovascular disease — that is, strokes and heart disease — increased by 9 percentage points and from Alzheimer’s by 8.7 percentage points. Diabetes deaths increased by almost 15 percentage points.
The death certificates upon which these figures are based only provide limited information about the possible contributing factors. Some of them may have been misclassified, with a Covid infection at least partly responsible, according to Elizabeth Arias, a researcher at the National Center for Health Statistics and one of the report’s authors. Diabetes, cardiovascular disease and Alzheimer’s all put people at greater risk from Covid, which can in turn exacerbate those conditions. “Or these were deaths that resulted from people who did not attend their doctor’s visits or go to the hospital because of Covid,” Arias says. “At this point, all we can do is speculate.”
Anecdotal reports, modeling and studies of smaller groups all suggest that many of those deaths were very likely preventable — a result of changes in lifestyle and in access to health care and medication caused by the pandemic. The Alzheimer’s Association posits that social isolation, difficulty managing other health conditions and the “disruption of steady routines and close care provided by family members” may have contributed to the rise in Alzheimer’s deaths. C.D.C. calculates that 64,000 more people than expected died from Alzheimer’s since Feb. 1, 2020. Controlling diabetes and cardiovascular disease each include eating a healthy diet, exercising, reducing stress and adhering to a regular schedule of medications — all of which were made difficult by the pandemic, particularly for those whose access to health care was already limited. In the last two years, diabetes has caused the death of 35,000 more people than was expected, and circulatory disease has caused the deaths of 136,000 more.
“It confirms what many of us have been seeing: I don’t think people are getting as much routine care for chronic diseases during the pandemic as they did before,” says Elizabeth Seaquist, director of the division of diabetes, endocrinology and metabolism at the University of Minnesota Medical School. She points out that many patients have been reluctant to travel to seek treatment because of fear of infection. “I have patients who I haven’t seen in a long time, and when I see them, it’s concerning.”
The changes that doctors and patients notice are often hard to quantify unless there is a way for government agencies to track them. Alexander states that researchers will first need to decide where to look in order to determine how the pandemic has affected care for people suffering from opioid-use disorder and adolescents with depression. “The questions are too broad and the implications of the pandemic too diverse for there to be a single information repository that we can rely on to understand what’s going on.”
Hospitalization statistics, one of the few indicators of health care system in real time, show a correlation between Covid surges as well as other fatalities. The Cybersecurity and Infrastructure Security Agency conducted a November study that examined hospital data between July 4, 2020 and July 10, 2021. This included the rise of the Delta variant. It found that I.C.U. was more commonly used than it is now. The study found that if the beds in America reached 75 percent capacity, 12,000 more deaths from all causes could occur in the U.S. within the next two weeks. If the capacity is 100 percent, it would be 80,000 deaths.
Other unnecessary deaths are just now being planned. Elective surgeries are delayed when hospitals are overcrowded during Covid surges. Yet “elective” — a designation that applies to everything from cancer removal to joint replacement and accounts for about 90 percent of operations in the U.S. — doesn’t mean “optional.” “Elective cases are no less essential, but they can be scheduled,” says Patricia Turner, executive director of the American College of Surgeons, which published guidance early in the pandemic for how hospitals should triage patients. “Patients who delay their surgery may be worse by the time they get to the operating room.” If they have complications or don’t survive, however, that Covid-related delay won’t be listed as their cause of death or disability.
The same applies to missed cancer screenings. Although the National Cancer Institute does not have any statistics for 2020, Norman E. Sharpless (director) predicts that there will likely be a decline of reported cases. “Not because coronavirus prevented cancer,” he says, but “because less cancer was diagnosed. I don’t think that’s a good thing.” More than nine million people in the U.S. missed screenings for breast, colorectal and prostate cancers, a drop that occurred largely between March and May that year, according to a 2021 paper in JAMA Oncology that generated estimates based on the insurance records of 60 million people. By July 2020, monthly screening rates were almost back to normal. But, Sharpless adds: “We don’t think we will ever be able to make up those missed number of screenings. Those cancers that would have been detected by screening will still be diagnosed but at a later stage when it’s harder to treat.”
The Coronavirus Pandemic: Key Information
In June 2020, Sharpless published an editorial in Science predicting a 1 percent increase in deaths from colon and breast cancer alone over the next decade as a result of missed screenings — an additional 10,000 fatalities. That prediction, though, which assumed “a moderate disruption” in care that ends after six months, is most likely a significant underestimate.
Tonette KrouselWood, president of American College of Preventive Medicine, said that delays in any type of preventive care will result in higher financial costs for patients and the system. But they will also increase costs that we don’t have metrics for, like time lost and diminished quality of life. “When you have earlier detection and earlier treatment and earlier management, you have less unnecessary suffering and pain,” she adds.
It will be difficult to determine which efforts to prioritize once the virus has subsided. (This includes the untold number cases of long Covid for which doctors are still searching for treatments. “Sure, mortality counts, but so, too, do the number of heart attacks or strokes or cases of bacterial pneumonia,” Alexander says. “Colonoscopies and mammograms and concern about surgical delays — those are just scratching the surface. They may be easiest to observe and count, but the pandemic has undoubtedly affected the health care of tens of millions of Americans in fundamental ways that I think are only beginning to be able to be understood.”
Kim Tingley contributes to the magazine.
Source: NY Times