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Greenville Business Magazine

The Doctor Will See You Now

By Liv Osby

The coronavirus pandemic caused millions of Americans to stay away from work and school, from restaurants and movie theaters, even from family and friends.

But it also kept many from seeing their health care providers for fear they might become infected with the deadly virus.

Some 41 percent of adults nationwide had delayed or avoided medical care by last June 30, including emergency and routine care, because of their concerns about Covid, according to the U.S. Centers for Disease Control and Prevention.

Now, health care experts worry that might have resulted in delayed diagnosis and treatment, and they’re advising people to get back to their doctors, their regular checkups and screenings.

“People have been worried about contact with the medical community,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

“But we need to start doing these things now,” he told Greenville Business Magazine. “If it’s discretionary, fine. But… cancer doesn’t get better with time.”

Cancer screenings, vaccinations and wellness visits where a condition like diabetes might be detected are among providers’ concerns, says Dr. Eugene Hong, chief physician executive for MUSC Health and MUSC Physicians.

“People were reluctant to come in for wellness visits or elective procedures … for understandable reasons,” he said. “That’s concerning for us as health care providers.”

National data from the BlueCross BlueShield Association show that claims for preventive services in all age groups were down 10 percent overall between January and November 2020 compared to the same time in 2019, he said.

“It went down to 65 percent lower compared to the year before in April, during the first surge,” he said, “but it slowly climbed back up.”

In general, wellness visits and cancer screenings decreased by 13 percent while vaccinations declined by 6 percent, he said.

Specifically, screenings for breast cancer dropped by 10 percent, for cervical cancer by 18 percent and colon cancer by 23 percent, he said, while prostate and lung cancer screenings also declined, but to a lesser extent.

“What that translates to … one study looks at possibly over 80,000 positive cancer diagnoses that could be delayed,” Hong said. “And that means delayed treatment, and possibly not as good outcomes.”

Childhood vaccinations for measles and whooping cough dropped 26 percent each and polio dropped by 16 percent, accounting for 9 million doses, according to BCBS.

And that could lead to a higher risk for outbreaks, Hong said.

While there’s no data for MUSC yet, he is concerned because the local situation mirrors the national data anecdotally.

“We are concerned that we don’t know the full effects of this public health crisis over the past year,” he said, “but we will remain vigilant about what these potential impacts might be.”

Dr. Jennifer Vogel, a radiation oncologist with Bon Secours St. Francis Health System, said it’s been well documented that patients went without routine screenings such as mammograms, colonoscopies and low-dose CT scans for lung cancer that are designed to catch cancers when they’re most treatable.

The number of mammograms at St. Francis declined from 27,808 in 2019 to 25,265 in 2020, and colonoscopies from 2,909 to 2,244, the hospital reports.

“This will certainly delay catching cancers that could have been caught at an earlier stage,” Vogel said. “It makes a difference in how aggressive the treatment needs to be and what the cure rate will be.”

Lung cancer, for example, is the most common and most deadly cancer, But it’s often caught in the late stages, making a difference in the intensity of treatment and the outcome.

And it’s not just cancer. People who put off routine doctor visits or annual exams during the pandemic could see chronic conditions go undiagnosed or worsen, she said.

Conditions like diabetes, high cholesterol and high blood pressure have cumulative impacts and the earlier they can be caught and managed, the lower the chances are that a patient will suffer long-term effects, she said.

“High blood pressure could cause damage to the heart or a stroke, and diabetes can have an impact on kidneys, eyes and circulation,” she said. “Early management and continued management of all these is really important.”

Prisma Health cardiologist Dr. David Manly recalls the patient who showed up suffering both a stroke and heart attack after weeks of chest pain and shortness of breath. And the young man who had symptoms of a heart attack in July but wasn’t seen until August.

“There are numerous anecdotes between myself and my partners of patients showing up with a heart attack who had symptoms on and off for a week, but were so scared to come to the ER because they were worried about Covid,” he said.

“I do think there are some people who are extremely anxious over Covid, but there are ways to communicate and get help,” he added. “And telemedicine visits are certainly possible.”

Because the longer symptoms go without treatment, the risk of irreversible heart damage increases, he said.

“Cardiovascular disease is still the leading cause of death, so certainly if someone has symptoms that could be attributable to heart disease, it’s never good to wait,” he said. “Delaying treatment by hours and days can be the determination between life and death.

“Unfortunately, throughout this pandemic, this happened.”

Dr. Robert M. Malanuk, a cardiologist with Lexington Medical Center, said research shows there was an increase in deaths nationwide in 2020 over 2019, and while most of that was from Covid, a good portion was from other causes, such as heart disease.

Conducted by researchers from Virginia Commonwealth University and Yale and published in the Journal of the American Medical Association, the study concluded that 65 percent of the 87,000 excess deaths recorded in the U.S. between March 1 and April 25, 2020, were from Covid, but the rest were from other causes.

Malanuk said that when people didn’t have access to their providers, either out of fear or confusion or because offices were closed for a period of time, they were often sicker when they got to the hospital than if they’d been getting regular care.

“When the world shut down in April, our visits plummeted,” he said. “The number of diagnostic tests, and lab tests and prescriptions written declined during the early period of 2020 when people weren’t accessing health care like they should.”

While providers and patients adapted quickly to telehealth, Malanuk said there are certain things that require face-to-face visits, noting that clinics are back to full capacity now.

“People are certainly seeking out appropriate care (now),” he said. “Our patient population in the Midlands has gone back to life as usual.”

Hong said that confidence in using the health care system increases as more people are vaccinated.

“We would strongly encourage people to catch up on wellness visits, cancer screenings, vaccinations, if they are behind,” he said. “We would equally strongly encourage people to get vaccinated.”

Vogel said that besides options for virtual or phone visits, strict Covid precautions have made patient visits safer at the cancer center and physician offices.

“There has been a huge change in the way that people practice to make it safe and feasible to work with physicians,” she said.

Manly said that between use of precautions and vaccinations, medical spaces are some of the safest places there are.

“Our frontline workers have been so amazing and courageous,” he said.

“They’re doing everything they can to keep themselves and the community safe.”