If pursuing a national lockdown was the biggest mistake in our history, shutting down “elective” medical procedures was the biggest mistake of the lockdown. Call it destroying health care to “save” health care.
Even a broken clock is right twice a day, and on March 15, the American Hospital Association ominously warned the surgeon general what would happen if medical care were shut down under the guise of preparing for an overload of COVID-19 patients (which failed to materialize in almost every city). While cautioning for a more nuanced and balanced approach to allow health care providers to perform “vital services to others in the community who need care,” the AHA warned about the misconception of the term “elective” surgeries.
It is imperative to note that “elective” simply means a procedure is scheduled rather than a response to an emergency. For example, “elective” surgeries could include replacement of a faulty heart valve, removal of a serious cancerous tumor, or a pediatric hernia repair. Often, if these types of procedures are delayed or canceled, the person’s condition gets rapidly worse and can even be life threatening. This is particularly true with children who are all in an active phase of their life growth and development. The resulting decline in their health could make them more vulnerable to COVID-19.
A blanket directive to cancel elective and non-urgent procedures usurps the proper role of the physicians caring for patients and their families, collaborating closely with the hospital, to determine what is in the patient’s best interests.
Tragically, six weeks later with no end in sight in some states, we can only imagine the enormous number of cancer surgeries, heart surgeries, transplants, life-saving diagnostic tests and biopsies, and complex orthopedic surgeries that have been pushed off – and the corresponding life years that will be lost as a result.
According to the Bureau of Economic Analysis, 46 percent of the lost GDP for the first quarter of this year (exclusively from the lockdown in the final days of the quarter) was from the health care sector. That is simply astounding, given that one would think that during an epidemic, the one industry that would do well, at least financially, is the health care industry. But the surge in hospitalizations never materialized in most places; most other procedures were shut down by edict; and the remaining emergency care plummeted by 40 percent in most states because people were so terrified to go out, thanks to the over-exaggeration of the case fatality rate of COVID-19. Hospitals were left with the worst of all worlds, both financially and for the health of their patients.
It’s therefor no mystery as to why Oregon had twice as many excess deaths this past month as deaths from COVID-19. While the article’s author gropes in the dark to discover the culprit, he lets the cat out of the bag when he reports, “Nearly all the above-average deaths occurred at home, among Oregonians both receiving and not receiving hospice care.”
With Oregon’s hospital system at a 40 percent reduced capacity, it doesn’t mean that there has miraculously been a 40 percent reduction in any health problem – from cancer and stroke to heart attacks and hypertension – other than from car accidents. It means that, as Dr. Scott Atlas of Stanford warned on my podcast last week, many cancer surgeries, transplants, and heart procedures are being delayed, and many people experiencing emergent health conditions are too scared to go to the emergency room. That is likely why they are dying at home.
The New York Times actually reported this earlier in the week. “Emergency rooms have about half the normal number of patients, and heart and stroke units are nearly empty, according to doctors at many urban medical centers,” reported the Times. “Some medical experts fear more people are dying from untreated emergencies than from the coronavirus.” The new Oregon data corroborates this theory.
Again, this is why the fatality rate of the virus is so important. There’s a big difference between a 0.1-0.5 percent fatality rate and a 5-10 percent fatality rate, as we see if you merely divide the deaths by the known, confirmed, tested cases. It’s not that a highly contagious virus with a fatality rate at or slightly higher than that of the flu, especially for elderly people, is not a serious situation. It’s that, in a cost-benefit analysis, it doesn’t warrant the level of panic that will keep people from seeking medical attention who, without it, are more likely to die from their existing ailment than from catching the virus.
The panic sowed into the culture by the political class and media is passive, but the indefensible shutdown of health care procedures even for those who seek help is actively insidious. The Minneapolis Star-Tribune reports that there is now a backlog of thousands of surgeries for cancer resections, heart procedures, gallbladder removals, surgeries for those born with serious genetic organ problems, and complex children’s orthopedic surgeries. Minnesota had fewer than 1,000 COVID-19 hospitalizations, yet the state arbitrarily shut down health care and caused the furloughing of 40 percent of the staff at the Mayo Clinic, where so many vital surgeries are performed.
Let’s just try to quantify the loss of life from the delay of cancer screenings, biopsies, diagnostics, and surgeries. The difference between conducting these procedures immediately and delaying them a few weeks, much less a few months or longer, is often the difference between dealing with an operable tumor and an inoperable tumor.
Last week, a group of researchers in the U.K. published a study attempting to quantify the loss of life resulting from delaying cancer surgeries. They found that a six-month delay in surgeries for patients with stage 2 or 3 cancers of the bladder, lung, esophagus, ovary, liver, pancreas, and stomach results in an over 30 percent reduction in survival. They found overall for all cancer patients that a six-month delay would result in 10,555 excess deaths and a cumulative loss of 205,024 life years in the U.K.
Obviously, their formula and modeling was only geared toward U.K. cancer surgery data, but if we extrapolate for America’s population, which is five times greater, that would be close to 53,000 cancer deaths and over 1 million life years lost. If this is allowed to continue, many surgeries will be delayed by a lot more than six months. The clock is ticking.