The Consequences of Skipping Doctor Appointments During the Covid Pandemic

Studies show patients put off mammograms, pediatric visits and shots for flu, shingles and other maladies. A pandemic-induced delay in screenings could lead to 10,000 breast and colorectal cancer deaths over the next decade, researchers estimate.

“These delays potentially have long-term consequences that we still don’t know about,” says Mona Shah, senior program officer at the Robert Wood Johnson Foundation, which funded two analyses by the Urban Institute looking at healthcare in children and adults under 65. In a survey in September, more than one-third of 4,000 adults said they delayed or didn’t seek care either because they worried about potential exposure to coronavirus or because their healthcare provider was offering limited services.

Those more likely to do so were African-American or had a chronic health condition, Ms. Shah says. One-third of people who delayed care said it affected them negatively, by harming their health or limiting their ability to work or do other daily activities.

Mary Findling, assistant director of the Harvard Opinion Research Program, which conducts public-opinion surveys on health and social policies, says national Census surveys in recent weeks found that 25% of adults are still reporting not getting needed medical care. “More than a year into the pandemic, that’s still super-concerning,” says Dr. Findling. “What’s surprising is just how long this is going on.”

A JAMA health forum study she co-wrote looked at five national surveys and found that one in five people surveyed said they delayed care for a serious problem and more than half said they faced negative consequences as a result. Many people are delaying vision and dental care, in addition to screenings, surgical procedures and wellness visits, according to the study. The survey questions specifically asked patients if they delayed care due to the pandemic—and not for other reasons, Dr. Findling said.

A September report from the Centers for Disease Control and Prevention found that 41% of U.S. adults said they delayed or avoided medical care, including routine and emergency or urgent care, says Commander Kristie Clarke, a pediatrician and medical epidemiologist at the CDC and an author of the report.

Those more likely to avoid routine or emergency care were unpaid caregivers for adults, people with disabilities, young adults aged 18- to 24-years-old, Hispanic adults, students and people with two or more underlying medical conditions, says Cmdr. Clarke, who serves in the U.S. Public Health Service, part of the Department of Health and Human Services. “Particularly concerning is the delay of care among people with two or more underlying medical conditions,” she says, noting that 54.7% of such people reported delayed or avoiding care. “Those are certainly the people who can least afford to be missing care.”

Routine medical appointments are important because they are opportunities for vaccinations and early detection of new conditions, says Cmdr. Clarke. CDC researchers are doing a follow-up study to see if healthcare is still being neglected later in the pandemic, she says.

While telemedicine helped fill gaps when appointments were canceled, Dr. Figueroa said she often had to persuade patients to leave home, for example, to have a mass on a leg examined.

Jerry Krishnan, professor of medicine and public health at the University of Illinois Chicago, says telehealth was useful during the pandemic but some problems require a physical exam. Diagnosis of new health conditions, monitoring of various conditions, and healthcare decisions were all delayed, he said.

“There will be consequences,” Dr. Krishnan says. “It’s particularly dramatic in lower-income, socioeconomically disadvantaged populations” where access to care is already a problem. “We were not able to do certain screening tests,” he says, due to infection-control precautions that limited technology or lack of personal protective equipment for patients and staff.

Certain tests, such as spirometry—a lung-breathing test used to diagnose asthma and chronic obstructive pulmonary disease—couldn’t be done for more than six months in some centers because it is aerosol-producing and posed too high a Covid-19 transmission risk, says Dr. Krishnan. Instead, patients were diagnosed based on their symptoms, which can mean delays in proper care.

“I think the consequences are going to show up in the coming years,” says Dr. Krishnan. “This includes cancers that could have been detected and treated earlier.”

Shalom Kalnicki, chairman of the department of radiation oncology at Montefiore Health System in the Bronx, N.Y., says the number of weekly cancer diagnoses just began reaching normal levels in February, nearly a year after the pandemic began. “We are anecdotally seeing more patients whose cancer is of a higher stage than before,” he says.

The number of mammograms done is now exceeding pre-pandemic levels, Dr. Kalnicki says. Lung-cancer screenings decreased dramatically during the pandemic and doctors are now urging those at increased risk of lung cancer due to their smoking history and age to come in for CT scans. Colonoscopies also are picking up, Dr. Kalnicki says.

Write to Sumathi Reddy at [email protected]