LONDON — Lara Wahab had been waiting for more than two years for a kidney and pancreas transplant, but months had passed without any word. So she called the hospital last month to find out the devastating news.
According to the transplant coordinator, there was a good match for her in October. The hospital would have normally accepted her. The transplant team couldn’t find her a spot in the intensive care unit for postoperative treatment because of the high number of Covid-19 patients. They had to decline the organs.
“I was just in shock. I knew the N.H.S. was under a lot of strain, but you don’t really know until you wait for something like that. was under a lot of strain, but you don’t really know until you’re waiting for something like that,” she said, referring to the National Health Service. “It was there, but it sort of slipped through my fingers,” she added of the transplant opportunity.
Ms. Wahab, 34, from North London, is part of an enormous and growing backlog of patients in Britain’s free health service who have seen planned care delayed or diverted, in part because of the pandemic — a largely unseen crisis within a crisis. These problems will have long-lasting effects.
The numbers are staggering: In England, 6 million procedures are currently being delayed. This is a significant increase on the backlog of 4.6 millions before the pandemic. The current delays most likely impact more than five million people — a single patient can have multiple cases pending for different ailments — which represents almost one-tenth of the population. Hundreds of thousands more haven’t been referred yet for treatment, and many ailments have simply gone undiagnosed.
Before the pandemic, there was already a large and growing backlog of patients. But the unrelenting burden of coronavirus cases and the strain on hospital capacity and staff caused by the coronavirus case spread, saw it rise to unprecedented levels. The most recent official figures are nearly two months old. Experts say that severe staffing shortages this year and the wildfire spread Omicron variant have almost certainly made matters worse.
“Just because we’ve got Omicron doesn’t mean that other illnesses have just stopped still and don’t emerge and develop in people, sadly,” said Saffron Cordery, the deputy chief executive of N.H.S. Providers is a membership organization for health professionals.
Public health experts are concerned that even though the pandemic may ease some of the immediate burden, the delayed care and the pandemic could cause lasting damage to the health system and patients.
A report from the parliamentary hys committee this month revealed a complex and troubling picture, including record waiting lists, high caseloads, and severe staffing problems. It stated that an important expansion of the labor market was necessary, but that the government was not doing enough in terms of training and recruiting health workers.
Britons have been waiting longer than Americans to get treatment for generations. Most accept that as a cost of providing care for everyone. The problem has gotten worse over the past ten years, with critics accusing Conservative governments for steadily underfunding it.
2.25 million cases were awaiting specialist treatment in England in 2012. According to the N.H.S., the backlog had increased to 4.6 million cases by 2020.
The caseload stood at six million as of November 2021. More than 300,000. People have waited more than a full year for planned care. Ten years ago, there were less than 500.
Experts and government officials believe that the backlog is actually much larger. The report of the health committee highlighted that the pandemic had greatly disrupted the normal patterns for primary care doctors’ assessments and referrals, which has led to people being left out of the official statistics.
A recent report from the National Audit Office estimated that there were 7.8 million to 9.8 million “missing” referrals — those that ordinarily would have occurred but never did — by primary care physicians from the start of the pandemic to September 2021, including 240,000 to 740,000 for suspected cancer cases.
“We are likely to see knock-on effects with people with other diseases, including but not limited to cancer, where treatment got delayed or postponed or we missed out on it,” said Peter English, a retired consultant in communicable disease control. “And they died because they didn’t have treatment they would otherwise have had.”
Ms. Wahab was already on the transplant list for several months by the time the pandemic struck Britain. Her doctor informed her in April 2019 that she had kidney failure from Type 1 diabetes that she had suffered since she was seven years old. She recommended that she undergo a simultaneous kidney transplant and pancreas transplant.
Her doctors advised her that it would take approximately six months to be placed on the transplant list. It takes about a year to match with a donor.
However, in 2020, overcrowded hospitals across the country stopped providing nonemergency care. This included transplants. Staff were diverted to the coronavirus response.
Since then, the transplants have resumed and been stopped repeatedly. With each pandemic surge that filled intensive care units, the first treatments to be put on hold were planned procedures requiring intensive care beds — like transplants.
Ms. Wahab is more likely to be a successful transplant candidate than her condition because she has been able to keep off dialysis despite her worsening condition. She isn’t sure how long she can keep going.
“It’s having a devastating effect on my day-to-day life,” she said. “I feel really hopeless going into 2022 — I’ve been waiting for this operation now for nearly three years.”
James Wilkinson (46) was diagnosed with endocarditis. It is inflammation of the lining his heart due to an infection that ate away his aortic valve. He was originally scheduled for an operation in May 2020. The pandemic forced the cancellation of the operation. The operation was then canceled three times more.
Mr. Wilkinson, who testified in front of a parliamentary committee late last year about his experience, said that he had eventually turned to private care to have the operation — something few people could afford.
“If it wasn’t for the private health care, we don’t know when my operation would have happened,” he said.
Not only are those who wait to get the care they need, but also those who are already suffering. Delays in diagnosing cancer can have devastating consequences, warn cancer charities.
Macmillan Cancer Support, a charity, estimates that some 50,000 people across Britain have not yet been diagnosed with some form of cancer that should have been caught earlier, in a direct result of the pandemic’s hindering screenings and referrals. The number of women being diagnosed with Stage 4 breast cancer — which means that the disease is advanced and very dangerous — has jumped by 48 percent in recent months.
Danni Moore, now 31, discovered a lump inside her breast in the early 2020s, just before pandemic. Ms. Moore was a mother of two children and believed she had a blocked milk tube. Her doctor referred her for specialist care.
The pandemic forced her to cancel the appointment. She rescheduled but had to cancel because her partner had been infected and the household had to be isolated.
“The knock-on effect Covid had has made everything much more difficult, and I had the lump way longer than I should have,” she said. “And it’s partly my fault. I should have gone much sooner, but equally hindsight is a wonderful thing.”
Ms. Moore stated that she put off scheduling another appointment for months. The lump continued to grow and was finally diagnosed with breast cancer in spring 2021, one year after she found it. She has documented the exhausting and complicated journey of chemotherapy and complications that she has endured over the months on her Instagram account.
Although her treatment has been ongoing this year, and she credits her doctors and nurses for saving her life, she also knows that her initial diagnosis would not have come as quickly without the pandemic.
Her decisions about what to do next have also been affected by the surgery backlog. Ms. Moore is scheduled to have a double breastectomy in February. She said that she felt she could more readily live with having both breasts removed than having one removed and waiting an unknown length of time to have reconstructive surgery to reach a “new normal.”
“I have two young children,” she said. “I’ve already given up over a year to having cancer.”
She added: “I just don’t want to sit and just wait for another two or three and make this process longer than it ever needed to be.”
Source: NY Times