DALLAS — The shoulder pain and dizziness started before the pandemic, but Shane Hardin, 46, didn’t think much of it.
Aches and pains come with the territory of aging, and Hardin’s job in homebuilding can be exhausting. The spread of COVID-19 in North Texas further deterred him from seeing his GP for a checkup.
For more than two years, patients like Hardin have pushed back routine health care visits as offices were closed to non-emergency cases and the threat of the coronavirus loomed. It could take years for the healthcare system to see the full effects — both physical and financial — of delayed care, North Texas doctors say.
When Hardin sat down in a new doctor’s office in September, after more than a year since his last medical, he was shocked by the stern warning: he needed to see a cardiologist, and fast.
The doctor “was a bit in disbelief that I hadn’t been referred to a cardiologist sooner,” Hardin said. His family’s family history of heart disease was worrying enough to warrant an immediate visit to a specialist.
Six weeks later, Hardin was in an operating room for a quintuple bypass.
Hardin will never know if his heart condition would have been caught during a checkup he missed in 2020 or early 2021. But his story matches an alarming trend of medical issues being taken to later, more serious stages due interrupted preventive care.
“We are now starting to see patients pass, with a higher proportion of patients who are diagnosed with more advanced cancer,” said Dr. John Sweetenham, associate director of clinical affairs at the Harold C. Simmons Comprehensive Cancer Center. from UT Southwestern. .
Routine procedures performed to catch cancer and other serious illnesses early in their progression were not on the minds of patients navigating the pandemic. For example, the Simmons Comprehensive Cancer Center saw an almost 20% drop in the number of people coming to the center for mammograms, Sweetenham said.
A study of more than 358,000 patients in Ontario, Canada, published in the Journal of the National Comprehensive Cancer Network, found an immediate drop in the average cancer rate early in the pandemic – but that’s not necessarily a good thing. Researchers estimated the presence of 12,601 undetected cancer cases from March 15 to September 26, 2020 in the Ontario region.
Time is critical in the treatment of serious illnesses. Ignoring symptoms or routine preventative visits can limit treatment options as the disease progresses. “The best opportunity to cure cancer is when it’s at a very early stage,” Sweetenham said. “Each time the stage increases, you lose, to some extent, that possibility of healing.”
The financial burden
Although most doctor’s offices reopened to elective visits after the first months of the coronavirus, some are just starting to catch up with pre-pandemic schedules.
Texas Health Resources obstetrician and gynecologist Dr. Sheila Chhutani said her practice rescheduled Pap smear appointments for the first time from six to eight weeks in 2020, leading to interruptions for month.
Pandemic-related financial hardships have also diverted patients from their usual healthcare schedule. Some of Chhutani’s patients have lost their jobs or been made redundant, leading to financial malaise and, at times, loss of insurance.
More advanced disease leads to higher costs for patients and healthcare systems. A 2016 study of breast cancer patients published in American Health & Drug Benefits found that, on average, insurance companies allowed costs per patient of about $82,000 in the first year. of treatment for patients with stage I/II tumors, compared to almost $135,000 for female patients. with stage IV tumors.
In Texas, which has the highest rate of uninsured people of any US state, higher costs leave patients vulnerable to life-changing bills. Even for insured patients, Sweetenham said, co-payment can result in a heavy financial burden.
A January study by the Commonwealth Fund, which supports independent research into health conditions, found that Texans in 2020 spent more than 14% of the state’s median income — about $9,300 — on premiums and deductibles.
Mental and physical barriers
In addition to postponing preventive screenings, doctors like Sweetenham noticed that patients early in the pandemic were less likely to present for common illnesses. Mental and physical roadblocks kept some at home.
Nicholas Saunders, 24, said before the pandemic he went to the doctor about three to four times a year for checkups and sick visits. Fear of being exposed to COVID-19 made him reluctant to see his primary care provider.
During the months of confinement, “I had regular illnesses, like the flu and stomach aches,” said the Collin College student. “I might have had treatment if it wasn’t during a pandemic, but I chose not to and tried to self-medicate at home.”
In Austin, Robin Orlowski, 43, had no choice but to consult his neurologist. Her epilepsy is controlled by medication that requires regular dosage adjustments based on her weight, which cannot be measured during a telehealth visit.
While she was nervous about being exposed to the coronavirus at her doctor’s office, her biggest hurdle was finding a way to make it happen. Orlowski’s local bus line has reduced its frequency, leaving him with limited options.
“I have people who can drive me, and normally outside of a pandemic you can rely on them,” she said. “But they live in other houses and since in a pandemic you have to be isolated from others, they couldn’t pick me up when the bus wasn’t running reliably.”
Most cities and towns in Texas have resumed pre-pandemic operations, making it easier for people like Orlowski to get to their appointments. The introduction of vaccines and the currently low number of COVID-19 cases have eased the spirits of people like Saunders, who has been on a mad rush over the past few weeks to catch up on appointments he’s missed.
For those who haven’t seen their doctors and dentists yet, it’s not too late to resume a regular health care schedule, Sweetenham said. The sooner patients return to routine checkups, the better.
“If you’ve delayed getting tested, or if you’ve put off looking for a symptom or sign, now is a good time to come back and get that tested,” he said.