Editor’s Note: H. Gilbert Welch is a general internist in the Center for Surgery and Public Health at Brigham and Women’s Hospital and author of “Less Medicine, More Health.” Vinay Prasad is an oncologist, associate professor of medicine at Oregon Health and Science University and author of “Malignant: How Bad Policy and Bad Medicine Harm People With Cancer.” The opinions expressed in this commentary are those of the authors; view more opinion articles on CNN.
The concern was that Covid-19 would overwhelm the medical care system with patients. While that has happened in some hot spots, the broader picture is just the opposite: Covid-19 has deprived the system of patients.
Some of these would-be patients have surely been hurt: having either shied away or been told to stay away from interventions that would have helped them live longer and/or live better. For others the delay may not matter; they will do equally well with intervention at a later date. But it is important to consider another possible outcome: some do better with less medical care.
No one has national data yet, but the turn of events is remarkable.
In mid-March hospitals began to cancel elective surgeries both to protect patients and to provide surge capacity, following guidance from the American College of Surgeons. This not only halted hernia repairs and joint replacements, but also surgeries for low-risk cancers – specifically, early stage breast and prostate cancer.
Next, emergency care unexpectedly plummeted. Emergency rooms in Boston, Detroit and Minneapolis/St. Paul saw substantial drops in volume, and ER doctors are experiencing cuts to both their hours and pay. The decline in volume doesn’t appear to be confined to fewer minor injuries and self-limited illnesses, it also includes fewer heart attacks and strokes.
But the impact of Covid-19 goes well beyond the hospital to include all physician/patient encounters. Despite the advent of telehealth, primary care practices are seeing fewer patients and laying off staff. The American Academy of Family Physicians estimates that about 40% of family medicine clinics are at risk of closing by the end of June – more than doubling the number of US counties with a significant shortfall in health care providers at the end of March.
Given fewer outpatient visits, one downstream effect is wholly expected: fewer lab tests and X-rays. This limits efforts to find disease early in asymptomatic individuals. Most notably, cancer screening has been effectively shut down.
What can we learn from this cataclysmic disruption in medical intervention?
Previous research on the