The hidden health costs of the SARS-CoV-2 pandemic
UNDER THE MICROSCOPE
By this time, most if not all of us have suffered grievous losses due to the pandemic. Personally, I have lost a grandnephew, a classmate, family members of friends and have had to scramble to help many others during their COVID-19 infections. Worldwide, over 5.1 million deaths have been recorded with over 45,000 deaths alone here in the Philippines. The figures are staggering. But is that all there is to the pandemic? Unfortunately, the answer is no.
The pandemic has impacted the health system immensely, with most resources being shifted to combat the mounting numbers of infections and hospitalizations. Overnight, hospitals have become battlegrounds with almost all attention given to COVID-19 cases. It is a public health emergency after all. The public had come to fear hospitals as places to die in and most shunned going to their doctors for fear of contracting the virus.
Renal dialysis patients stopped going for their treatments and many died as a result. Cancer patients had to forgo their chemotherapy and radiation treatments. Others with small tumors did not seek consultation. Chronic anemia patients failed to get their blood transfusions. In fact, blood donor drives stopped leaving many patients without their regular blood supply. Patients who needed surgery had to wait indefinitely, prolonging their suffering. The list goes on.
In my Pathology practice, when we used to see few breast cancers of large size, the specimens we were receiving during the pandemic were huge and more often than not, the cancer has spread to the armpit lymph nodes. It became more personal when a friend’s mother recently had surgery to remove a very large breast tumor.
So I checked out what this all means in terms of the harm done indirectly by the pandemic. In our world in data, figures on excess mortality during the pandemic are available and up to date. It paints a depressing picture.
Excess deaths is the difference between reported number of deaths in a given period in 2020-2021 and an estimate of the expected number of deaths had the pandemic not occurred. For the Philippines, it is 31 percent excess deaths had the pandemic not happened. However, this may not be an accurate picture, since there might be under reporting especially in more remote areas. Nonetheless, it’s a big jump in number of deaths from 49,494 in 2019 to 54,412 in 2020 (projected 52,063) to 68,025 in 2021.
We can expect to see more excess deaths as the years go by since the effects of neglected health issues will likely be reflected later on.
Other impacts will be felt in the public health area. Routine childhood vaccinations all but stopped as did the TB control program with its Directly Observed Treatment (DOTS) protocol. Child nutrition programs took a hit as well. We expect to see outbreaks/epidemics of these childhood diseases and in combination with malnutrition, expect more deaths from these vaccine preventable diseases.
The ill effects on the hospital system are huge. With PhilHealth currently swamped with claims that are not paid yet, the hospitals are struggling to keep afloat while trying to serve the population. If the hospitals make good their threat not to accept PhilHealth patients, expect even higher mortality.
The health care workers have borne the brunt of the pandemic since the start. Deaths among doctors, nurses and others have reduced the already limited work force in the health system. They labor for long hard hours in hot and uncomfortable PPE. No matter how detached we may be, the death of a patient one had cared for brings sadness and feelings of helplessness. Many are depressed. Most are exhausted.
What is most galling is that the health care workers are hailed as heroes but are not compensated properly. Even now, after rallies of indignation by medical frontliners, we still have to see them given the appropriate salaries and benefits. To add insult to injury, we saw how some gained so much illegally from pandemic items government purchases. Even worse, the supplies are either substandard or lacking.
No wonder our nurses are resigning in large numbers. One can only take so much while unappreciated and given what is rightfully theirs. They would rather go abroad where they can get higher pay to send to their families and where work conditions are infinitely better. But the government has limited the numbers of health workers who can leave the country. Frustration will likely get worse with many opting to go into other fields like business process outsourcing.
Likewise, many doctors have retired early for fear of contracting the deadly disease. Their ranks are not being replaced fast enough due to the constraints on medical education. Even the board examinations have been postponed.
The quality of medical and nursing education is also in doubt due to the lack of in-person classes and lack of clinical patient experience. There is no substitute to interviewing and examining a live patient. Empathy is likely to be lacking when the student is detached from the patient he/she is supposed to serve.
Our health system is on the verge of collapse. It will take a huge effort to correct so many of the inequities in the system caused by years of neglect and lack of financial support from the government. It’s time to take stock and act on this looming crisis. The pandemic did not cause all of this. It just exposed the cracks in the dam which can burst any time now.