13.07.2020

Covid-19: Impact on healthcare

The impact of Covid-19 has wrecked havoc amongst society and healthcare systems, could this open a door for heightened digitisation in medicine?

The Covid-19 Pandemic continues to infect millions worldwide. Whilst the immediate consequences on health are the core focus, the indirect impacts of the virus lurk in the background.
Corona Folgen Pandemie Kollateralschaden
Nature: a virus is sweeping Africa

At the beginning of April, the renowned scientific journal Nature reported on a recent viral outbreak in the Congo, which has killed over 6,500 children. The culprit? The old, familiar and often underestimated adversary: measles.

Currently, it is difficult to think of any other contagious potentially lethal virus other than Covid-19, however in Africa the measles virus continues to rage. Mass vaccinations have made it possible to increasingly control the spread of the virus. However, since the Strategic Advisory Group of Experts on Immunization (SAGE) of the WHO recommended a temporary halt to all preventive vaccination campaigns at the end of March due to the Covid-19 outbreak, experts fear a renewed increase in infections in view of the 78 million children now unvaccinated.

Experts warn of “medical collateral damage”

It is not just on the African continent that routine healthcare has been compromised, but across the developed world also. For example, in the Austrian Der Strandard , public health experts warn of “medical collateral damage”.

There are a large number of patients who are not receiving the same standard of routine care before the pandemic gripped the world. Cancer Research UK has reported a drop-off in cancer screening and referrals, equating to 2,700 fewer cancer diagnosis every week. This is a particularly menacing situation as the key to so many successful outcomes in oncology lie in early diagnosis. In essence, Covid-19 does not have to infect an individual to have a severe consequence on their health.

Covid-19 has turned healthcare systems, economy and society throughout the world upside down in just a few months. The current discourse focuses mainly on the health consequences of the virus and its socio-economic consequences. The rapid deployment of forces dedicated to managing patients with the virus and culling its spread has been seismic. However, emergencies and patients who have chronic health conditions have not simply vanished. 

Covid-19 affects all patients in need of help

With all the good intentions for the wellbeing of humanity, the Covid-19 response has created medical collateral damage. Patients with chronic illnesses are at greater risk than before the emergence of the pandemic. They are categorised as experiencing worse outcomes if they are infected with SARS-CoV-2. However, the tightened hygiene measures also mean that many routine appointments are cancelled for this group of patients.

Restricted access to specialists and hospitals due to stricter admission criteria, fewer personal contacts with family doctors and significantly more difficult (outpatient) care impair care. In the long term, this will lead to increased morbidity and mortality. A special role is played by patients suffering from cancer. Here too, treatment appointments are postponed for safety reasons. In a message to Health Minister Spahn, the German Society for Urology DGU explicitly warns of a danger of “metastasis of a tumour disease on the waiting list”.

The additional burden of fear and isolation also increases psychological morbidity. Current figures from China already confirm what is known from similar situations in the past. A recently published UN report has warned that the world must brace itself for the emergence of a global health crisis as a result of Covid-19 isolation, poverty and loss. The director of the WHO’s mental health department stated that the isolation, fear, uncertainty and economic turmoil as a result of the pandemic all manifests in severe mental health consequences. 

Additionally, the German Hospital Association (DKG) considers the situation in emergencies to be particularly problematic. Hospitals throughout Europe and the United States report a conspicuously lower number of patients who come to the clinics with strokes or heart attacks. There are patients who are refraining from attending hospitals out of fear of infection with the virus. A Chinese study shows that this is detrimental to the treatment of ST elevation attacks. Since the outbreak, the authors have observed a prolonged time from the onset of symptoms until medical contact is made and adequate therapy is initiated.

The next crisis is coming

As Europe begins its attempt of lifting lockdown measures and finds its feet in establishing a “new normal” many experts warn of future waves of the virus. Kissler et al. forecast in the renowned magazine “Science” that further Covid-19 outbreaks will continue until 2025 in the absence of a vaccine. So how can management of an acute crisis and all the collateral damage be prevented?

Countries like Germany and Ireland are increasingly striving for a “South Korean model”. Through coping with the SARS and MERS epidemics, the country has already gained experience in handling such situations and was lauded for its efficient handling of the initial outbreak of the virus. The main reasons for the sharp decline in the spread is the high testing frequency and the use of digital technologies. However, even the seemingly virus savvy South Korea has reintroduced some restrictions due to a resurgence of Covid-19 cases in Seoul’s nightlife district as of May 13th.

Digitisation mitigates capacity shortages

Digital applications can complement the measures to contain Covid-19. In this respect, the pandemic has greatly accelerated the integration of digital solutions into health care systems and has fostered new discussions on regulation and safety standards. Remote monitoring, telemedical consultations, apps for triage or patient education have been used successfully in many cases to compensate for the increased patient burden local medical care practices are experiencing.

Various applications allow a self-assessment of the probability of contracting Covid-19, thus reducing the workload of emergency rooms and information centres. The App ifightdepression became more widely known after it was made freely available, as general practitioners and psychotherapists reached their stress limits. The exit strategy of the German government also provides for a tracing app that conforms to data protection regulations in order to be able to implement a gradual relaxation of the current restrictions. 

 The way into the future

Looking beyond the current situation, an evaluation and restructuring of the way we think about patient care is essential. This pandemic teaches us that digital solutions are indispensable for overstretched healthcare systems in order to minimise the consequences of exceeding existing capacities.

There is the opportunity to digitally support feedback loops between doctor and patient that have been incomplete up to now. The stark reality is that experts predict future waves of this virus and the emergence of future viruses is inevitable. Considering this, we must look beyond the expected peak the pandemic will bring in the coming weeks and reassess how healthcare in the newly-changed world can operate to best serve the needs of all patients. Digital health solutions are best placed to offer that, with their need not merely being an idyllic aspiration, but a necessity. 

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Covid-19: Impact on healthcare 1
written by:

Lion Thiel

Medical student at the Charité. Writes for heartbeat about science, medicine and politics.

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Quellen:

  1. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr. 2020;33(2):e100213. Published 2020 Mar 6.
  2. Tam CF, Cheung KS, Lam S, et al. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. Circ Cardiovasc Qual Outcomes. 2020;13(4):e006631.
  3. Kissler SM, Tedijanto C, Goldstein E, Grad YH, Lipsitch M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period [published online ahead of print, 2020 Apr 14]. Science. 2020;eabb5793.