Delayed or missed health care may have led to thousands of non-COVID-19 related deaths during pandemic: report

Health-care delays and missed treatments during the pandemic may have contributed to more than 4,000 excess deaths in Canada between August and December 2020, according to a new report commissioned by the Canadian Medical Association.

The report released earlier this week noted the number of excess deaths not related to COVID-19 in 2020 was greater than can be explained by the virus alone, peaking in September 2020 at five per cent more than the expected mortality rate for a normal year. The association noted excess deaths can also be attributed to other causes, including accidents and natural disasters.

Association president Dr. Katharine Smart said the group has seen a broad impact across the system when it comes to people being able to access acute care for non-COVID-related issues.

“(We’ve seen) many cancelled surgeries, many cancelled procedures, patients reluctant to go to the hospital for fear of COVID, or maybe worrying that their problem wasn’t significant enough, presenting late in the course of an acute illness when it was too late to actually be able to reverse the course of what was happening,” Smart said. “So, all of these things have had really significant impacts in terms of people’s survival outside of COVID itself.”

The report also found self-reported mental health challenges increased, as well as emergency department visits and hospitalizations for substance use disorders.

Family physician Dr. Anna Wolak said she has also noticed more people seeking help when it comes to mental health.

"The biggest thing that I and other family doctors in B.C. have been seeing is a rise of mental health concerns," she said. "But accessing care, and for us to be able to find people to refer to, that’s gotten significantly harder. The resources just aren’t there, or if they are there, they’re stretched so thin."

The report also conducted an estimate of the accumulated backlog for eight different surgical and medical procedures from April 2020 to June 2021. It found the number of time lost to perform these procedures ranged from 46 days for breast cancer surgery, to 64 days for a CT scan, and up to 118 days for a hip replacement.

This week, the federal government said there are an estimated 780,000 delayed surgeries across Canada.

Speaking from Victoria, Beth Campbell Duke said her husband needed hernia repair surgery in December 2019, following another procedure stemming from injuries he had suffered in a car accident.

“And then, of course, COVID hit,” she said. “I don’t know what the normal wait time for hernia repair surgery is, but for us, it took a year. So it was December 2020 when we got the paperwork from the surgeon.”

She said he finally had the operation done in February of this year, at Vancouver General Hospital, as he is also a lung transplant recipient.

“He’s a complex patient,” Campbell Duke said, and added the year of waiting was hard.

“It has an impact on your mobility as well.”

The association estimated at least $1.3 billion in additional funding would be needed to return wait times to pre-pandemic levels.

Dr. Wolak said she has also heard of patients who have had surgeries postponed.

"Even though something is not immediately life-threatening to somebody, any prolonged delay could affect at least quality of life, if not have a potential to eventually lead to a later diagnosis or something that would be harder to recover from," she said, and added there have also been delays in receiving screening results from Pap tests, due to a backlog. "For a while we were looking at about four to six months, when we were used to four to six weeks."

Dr. Smart said the report shows how health-care systems are overwhelmed.

“When you have the combination of under-funding, and then under-resourced in terms of people, you end up with a system that’s very stressed, and it’s very hard then to ramp that system up when you’re facing an acute crisis like COVID,” she said. “We really need to look at how we can better retain the health work force we have, and at the same time, we need human health resource planning to better understand for the future the number of people we need to recruit into the health professions so that we don’t end up in this situation again.”

Campbell Duke said her husband is doing well now, but they have seen first-hand the strain the system is under.

“Things were stretched ... beforehand, and it’s far worse now. I honestly don’t know how we still have a system,” she said. “Kudos to every health-care worker who shows up to work under the conditions that they’re under ... It’s surviving solely on the goodwill of the frontline professionals who are showing up every day.” 

The number of in-person visits for chronic disease assessments remained below 2019 levels at the beginning of this year according to the report, and ranged from 60 per cent lower for patients with hypertensive heart disease to 87 per cent lower for patients with diabetes. While the report also referenced data from Ontario pointing to an increase in virtual care services, it noted “virtual visits are not always a good substitute for in-person care.”

The report found the number of home-care assessments, which help determine if someone may need to enter long-term care, also dropped in the early days of the pandemic, with 60,000 fewer full assessments being conducted in B.C., Alberta, Ontario, and Newfoundland and Labrador between March and June 2020, as compared to the same time period in 2019. By June 2020, screening assessments were back at March 2020 levels, but full assessments remained 60 per cent below February 2020 rates.

The report also said the number of completed cancer screenings have not recovered to pre-pandemic levels, and referred to data from Ontario which showed while screening services have resumed, they had not returned to normal as of December 2020, with estimated backlogs in the hundreds of thousands for Pap tests, mammograms, and fecal tests.

Earlier this year, BC Cancer reported rates of cancer screening and new diagnoses both took a hit in the province, with the agency seeing about a 20 per cent decrease in new cases in the initial state of the pandemic.

Though the numbers had risen again, they had not reached pre-pandemic levels as of February of this year. In an emailed statement, BC Cancer said its mammography screening centres are now back to 100 per cent of pre-COVID capacity, but they did not expect to have an updated number on overall new diagnoses for 2021 until spring of next year.

Dr. Wolak said one thing people can do to try and help is follow public health measures, including mask-wearing and getting vaccinated against COVID-19.

"Basically so that we don't overwhelm the hospitals with COVID-related things so that other things can just continue flowing through," she said. 'We need to make sure that we're not letting our guards down too soon...we're just at such a precipice now that any little thing could kind of tip us over the edge."