As Covid-19 Overwhelms Health Systems, What of Non-Covid patients?

While the Omicron variant may be less severe than Delta, the sheer numbers are seeing hospitals and related health services overwhelmed. Health care staff themselves are in isolation/quarantine.

The wait time for a hip or knee replacement in the UK has blown out dramatically. The situation was bad before the pandemic – now it is worsening.

Patients are facing five-year waits for hip replacements as backlogs reach crisis point, according to an orthopaedic surgeon who quit the NHS.

Almost 6 million people are on waiting lists for hospital treatment in England.

I booked a mammogram here in Melbourne in early August – the appointment was in November. In some jurisdictions in Australia, mammograms were not being done at all during parts of 2021, due to Covid-19. How many cases were not detected early enough and this has impacted the outcome for the patient? Will we ever know? While Covid-19 has no direct effect on the performance of mammograms, the changes required to minimise spread of the disease do.

The term “elective surgery” SOUNDS, well, elective – as in not really necessary. Having been through a total knee replacement and watched my boss wait for his hip replacement (he was only fifty, by the way) I can assure you there is nothing “not necessary” about joint replacement surgery. The pain and loss of quality of life can be horrific. The difference is an excruciating knee won’t kill me, so it is considered non-urgent.

“Our health system is at a very different place than we were in previous surges,” emergency medicine professor Dr. Esther Choo said. “This strain is so infectious that I think all of us know many, many colleagues who are currently infected or have symptoms and are under quarantine,” said Choo, associate professor at Oregon Health and Science University. “We’ve lost at least 20% of our health care workforce — probably more.”

The above is the USA. Here in Australia we have changed our isolation guidelines for health workers due to the shortage of staff.

Doctors say a decision to exempt health workers in New South Wales from self-isolating if they are close contacts reflects an “extremely desperate situation”, with warnings the policy change will increase the Covid risk to hospital patients.

NSW Health announced late on Friday night that in “exceptional circumstances”, frontline workers who are asymptomatic close contacts will be exempt from having to self-isolate for seven days, to avoid disruption to key services.

We have even suggested flying in nurses. Where from, I’ve got no idea as many countries are just as short of health care workers as we are. This is, after all, a GLOBAL pandemic: a point some of our politicians seem to conveniently overlook.

Critically understaffed public hospitals in New South Wales are planning to fly in nurses from overseas, a leaked memo reveals, as managers beg staff to cancel leave and take on extra shifts amid surging Covid cases.

Early in the pandemic, when the scientific and medical communities were still learning much about how to handle this new challenge, I had my own health case disrupted and affected by Covid-19. In early 2020 I was booked for a total knee replacement. That was cancelled due to an early lockdown. Thankfully, I was rescheduled for late May. While I waited I lived on non-steroidal anti-inflammatory drugs (NSAIDs) and Tramadol. Despite ramping up my Pantoprazole under medical advice, the sustained use of NSAIDs still saw me in hospital some time later for gut issues.

When I did end up in the emergency department some months later with excruciating left upper quadrant abdominal pain, due to Covid-19 restrictions gastroscopies were not allowed unless there was evidence of internal bleeding. I joke I was diagnosed the old-fashioned way!

Sara shares she is currently waiting, in extreme pain, for some of that elective surgery.

Non-Covid patients in many hospitals can’t have visitors, with some exemptions permitted.

From a Melbourne hospital web site

Being unable to have visitors can be traumatic for patients, especially if they are in hospital for a considerable length of time. This can affect their recovery.

We talk mostly about the Covid-19 patients themselves: do we have enough ICU beds, enough nursing staff, enough tests and medications to cope with the explosion in numbers. Yet the impacts on non-Covid cases are not being widely reported in the mainstream media at all. This links in with my earlier article where I discussed health systems are FINITE.

We, the people, yes us, we cry out for more doctors, more nurses. Where, exactly, are these health care workers supposed to miraculously appear from? It is not possible. There are limited trained health care workers in the world – not just here, in the world. Not enough to care for WAY too many sick people. We have to accept that as a fact.

The Covid-19 patients take priority everywhere as their need is certainly super urgent, but that means non-Covid cases have to be sidelined and a backlog develops (or existing backlogs worsen).

There are long term costs. The cases worsen, are therefore more expensive to “fix”. In some cases, unfortunately, death may ultimately result from delayed treatment.

On New Year’s Day I was in a lot of pain. Just about every enthesis in my body (except hips and TMJ) decided to go haywire. I thought about taking myself to the emergency department, but the concern of exposing myself to a hospital environment made me stay home. Now, my entheses aren’t going to kill me: but what of other cases, such as a suspected stroke or heart attack, where the patient stays home for similar reasons (avoiding possible Covid-19 exposure)?

Here is a thread on Twitter about a man who collapsed in a carpark, Type 1 diabetes. The closest ambulance was at least one hour away. While the ambulance delay may not have been directly attributable to Covid-19 use of resources, it is indicative that the extra load on the system places non-Covid patients at risk.

I don’t have a solution. After all (again), health systems are finite. I do expect to see better media coverage of the risks to all of us. What, if anything, is being done to manage the global crisis facing non-Covid patients?

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Robyn Dunphy

I offer exercise guidance to those with chronic medical conditions where exercise is beneficial.

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