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The Next Health-Care Crisis? The Patients Who Have Been Waiting Out COVID-19

HuffPost Canada logo HuffPost Canada 2020-05-15 Sherina Harris

After over a decade in constant, debilitating pain, Teya Friesen could finally see the finish line.

The 23-year-old Winkler, Man. resident had previously been diagnosed with endometriosis, a condition where endometrial tissue grows outside the uterus, and had undergone several surgeries. But she was later diagnosed with adenomyosis, a condition where endometrial tissue grows within the wall of the uterus. It can cause so much pain Friesen would feel like she was in labour.

She decided to get a partial hysterectomy, a surgical procedure to remove the uterus. After months of waiting and getting the required approvals, her surgery was scheduled for March 24.

On March 23, Manitoba began suspending non-urgent surgeries to free up staff, beds, equipment and supplies for its COVID-19 response. 

Friesen’s surgery is now scheduled for the beginning of June. She has been to the emergency room eight times since March, and said there were many other times her pain was bad enough to go to the ER but instead she curled up on her bed, took strong painkillers and tried to distract herself with Netflix. She said at one point she considered suicide because her pain was excruciating. 

She also thinks about the others who have found themselves in similar situations, waiting for crucial treatments or procedures. 

“It’s very difficult to hear all the people, with not even this condition, who have been waiting for surgeries,” Friesen told HuffPost Canada. “It is just a heartbreaker to [have been] really close, like days away, to know that [I] had an end in sight.”

A provincial government spokesperson told HuffPost there was no interruption to surgeries that were urgent or could not be delayed. Some surgeries are now resuming.

“The urgency and priority is determined on a patient-specific basis, depending on the health condition and individual circumstances of each patient,” the spokesperson said, adding the priority for surgeries will be evaluated on a case-by-case basis moving forward.

a little girl smiling at the camera: Teya Friesen and her daughter smile for a photo on March 25, 2020. © Provided by HuffPost Canada Teya Friesen and her daughter smile for a photo on March 25, 2020.

Friesen is one of many Canadians for whom long-awaited medical care — not to mention routine screenings and appointments — is on hold amid the COVID-19 pandemic.

Most provinces in Canada cancelled elective surgeries to prepare for a surge of COVID-19 patients. Now, several provinces are planning to resume those scheduled surgeries and procedures, alongside the emergency or essential surgeries they had still been performing.

Friesen’s condition is not life-threatening, but has significantly affected her quality of life. She said she’s glad her daughter, who turns one later this month, won’t remember her mom not being able to care for her because of her constant pain. 

The data in Canada

Statistics Canada gave a first look at the magnitude of the pandemic’s indirect health effects Wednesday, releasing provisional data on deaths and excess mortality in the first quarter of 2020. The data does not include cause of death, though, and is from Jan. 1 to March 31, 2020, so it does not include the time frame where COVID-19 infections and deaths continued to rise across the country. 

Data from Ontario and New Brunswick is not included in the data because information about deaths is received more than 60 days after the events, meaning the data is currently incomplete. The second quarter numbers will likely give a better picture of the indirect health impacts of the pandemic.

Peter Frayne, a spokesperson for Statistics Canada, said the agency will work with provincial and territorial vital statistics offices to get timely information on causes of death and is committed to making available data from other provinces when it can. 

Ontario’s Financial Accountability Office (FAO) has estimated that between March 15 and April 22, up to 52,700 procedures were cancelled or avoided. This led to hospitals freeing up 6,849 acute care beds and 585 critical care beds, the FAO said.

Estimates from Toronto’s University Health Network suggest 35 people may have died in Ontario because their cardiac surgeries weren’t performed during this time. 

Data from the Ontario Ministry of Health provided to HuffPost shows a decrease in the number of scheduled surgeries from the same period in March to April this year over last. 

 

The Public Health Agency of Canada is exploring options to collect this data, media relations advisor Natalie Mohamed said in an email. 

“This pandemic is unprecedented so the impacts of COVID-19 on injuries, violence and mental health are not well understood,” she said. “The data we are planning to collect will be used to understand the impacts of COVID-19 and could be used to inform modelling during subsequent pandemics.”

The true toll of COVID-19 is important to know right now because it can help medical professionals see the demographics of those who are affected and plan interventions, says Dr. Jennifer Kwan, a family physician in Burlington, Ont. 

In addition to the official COVID-19 numbers — already available in updates from provinces and local public health units — all-cause mortality data includes missed COVID-19 deaths and indirect deaths, such as those from cancelled procedures or where patients were afraid to go to the hospital. 

Domestic violence, mental health issues also factors 

Kwan notes there are also non-death outcomes of COVID-19, such as worsening mental health conditions or grief.

“I think people are often fixated on the daily numbers of deaths and cases in COVID-19. But that does not take into account the bigger picture of how COVID-19 is affecting Canadians — not just even the direct and indirect deaths and health concerns but also social economic issues that may lead to more poverty [and] unemployment,” she told HuffPost.  

One in 10 women is very or extremely worried about violence in their home during the COVID-19 pandemic, according to Statistics Canada

The Globe and Mail reported that at least nine Canadian women and girls were killed in domestic homicides during the pandemic. 

There are also concerns about child abuse while children are at home and not going to school, where they may be referred to social services. 

I think we were in a crisis before.Dr. Juveria Zaheer

In a recent statement, Addictions and Mental Health Ontario (AMHO) warned the government that a mental health and addictions emergency could constitute a “second wave” of the COVID-19 outbreak. 

“We do know that there are well-established [suicide] risk factors that are kind of being activated and potentially worsened by COVID,” said Dr. Juveria Zaheer, a psychiatrist and researcher at the Centre for Addiction and Mental Health.

With a major stressor like the pandemic, we may not see the mental health repercussions until months or even years later, she said. 

“Access to mental health care is challenging across the country. And I think we were in a crisis before,” Zaheer said. 

That means data about how people are accessing support, if they are, can help improve Canada’s system overall — and prioritizing talking to people about their lived experiences can also uncover ways to address the potential risks right now, she said.

‘A careful balance’

It makes sense that provincial governments and hospitals have prioritized COVID-19 patients and ensured there is hospital capacity for it because of the threat it poses and the dangers associated with community transmission, says Dr. Barry Pakes, an associate professor at the University of Toronto Dalla Lana School of Public Health who also works clinically in the local COVID-19 public health response. 

“It’s not just about making a decision to focus on coronavirus spread and death right now — it’s a matter of, if we don’t do that, then the consequences are going to be far worse,” he told HuffPost. 

“But it’s always a careful balance, because it’s the people who aren’t sick yet of COVID that we’re protecting, and there are clearly people who are sick right now [from unrelated diseases].”

He noted that without strong measures to slow the spread of COVID-19, more health-care workers could have been at risk, creating further challenges in the system’s capacity down the line. 

He also points out that some deaths can be difficult to categorize because they are so contextual. For example, patients who have difficulty breathing or a lung disease typically can be temporarily put on a BiPAP machine, a type of ventilator, and recover.

However, that machine aerosolizes contagious droplets — so doctors can’t use it in case a patient has COVID-19. So a patient’s only option is to be intubated and put on a ventilator, which some choose not to do because they don’t want to be sedated with a tube down their throat. Some patients have made an advanced care decision, choosing not to be intubated, meaning they’d likely die.

“That’s one tiny, tiny little example of a situation where we’re never going to be able to capture that,” he said.

Pakes said not all hospitals are running at full capacity, and doctors are still encouraging people to come in if they have urgent concerns.

“People are naturally fearful. And for that reason, they’re either getting worse, some people are certainly deferring treatment and dying. So it is a really important consideration,” he said.

Most screenings also cancelled during pandemic

Surgeries aren’t the only medical appointments that have been cancelled to free up hospital capacity.

Dr. Judy Illes, professor of neurology and Canada research chair in neuroethics at the University of British Columbia, noted another indirect effect of COVID-19 could be cancelled routine or annual screenings aimed at preventing more serious health issues from arising at a later time.

That means as other parts of medical care start to resume, there needs to be a focus on prevention and screening, she said.

She said it was ethically necessary to postpone elective surgeries when the pandemic was at its peak. “So we have to resume [other medical procedures] but we have to resume [them] with a thoughtful strategic plan.”

Part of that plan needs to include measures so that patients and health-care professionals alike aren’t putting themselves at further risk, she added.

People in rural areas, as well as marginalized populations in urban areas and people who have disabilities, are also more vulnerable and will need strong health policy to address pandemic-related health-care gaps, she said. 

“I think there’s going to have to be really good health policy that focuses explicitly on those populations to ensure that they are brought back into a place of where they were before, if not better than where they were before.”

With files from The Canadian Press

This article originally appeared on HuffPost Canada.
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