Canada

Opinion: Greater focus needed on pandemic's collateral damage

It is imperative that we start implementing comprehensive strategies to address things like surgery waitlists and mental health problems.

An operating room as seen in 2012: During the pandemic, thousands of Quebecers have had surgeries cancelled or postponed to make way for COVID-19 patients, making already-long waitlists even longer, Janusz Kaczorowski and Claudio Del Grande say.

As we approach the first anniversary of lockdowns, we have recently passed the grim milestone of more than 10,000 deaths attributed to the COVID-19 pandemic in Quebec. It is becoming increasingly apparent that this statistic may well pale in comparison with the collateral damage inflicted by the pandemic on social, economic, psychological and physical well-being, including short- and long-term mortality.

Furthermore, not only will the pandemic’s aftermath reverberate for months and years to come, but, as we have seen during the pandemic itself, a very unequal impact on different groups within our society is likely to continue.

The recent death of Quebec actress Rosine Chouinard-Chauveau, 28, highlighted the plight of thousands of Quebecers whose surgeries have been postponed or cancelled to make space for COVID-19 patients. Even prior to the onset of pandemic, Quebec had some of the longest waiting lists in Canada for many elective procedures and surgeries.

In a report released in January, the Quebec government estimated that more than 4,000 people with cancer went undiagnosed in 2020 due to a drop in screening programs. Early diagnosis and treatment are the most important predictors of positive outcomes for most cancers.

Also suffering collateral damage are patients with a wide range of conditions whose diagnosis, initiation of treatment or ongoing management by physicians was significantly disrupted.

A study from Ontario examined the number and types of family physician visits from March to July 2020 and compared these with the same period in 2019. It found almost a 30-per-cent decrease in the overall number of visits. While the shift to virtual visits was rapid and they now represent over 70 per cent of all family medicine consultations, they did not make up the gap.

While the accelerated shift to virtual consultations is long overdue, we have to get it right. This includes not only successfully addressing the digital divide and digital literacy issues, but also identifying for which patients, what conditions or what types of visits virtual consultations are optimal, and how they can be further enhanced with remote monitoring. We can hypothesize that the elderly and other vulnerable populations, who are disproportionately affected by underlying medical conditions, might be reluctant to initiate in-person contacts while lacking the required technology or digital skills to participate in virtual consultations.

The indirect toll of the pandemic on other aspects of our lives, both short- and long-term, is much more challenging to quantify and might never be fully appraised. Many of us are more sedentary, less physically active, spend more time in front of screens, are more depressed or anxious, consume more cigarettes, alcohol and cannabis, and are more lonely and socially isolated than ever before. This will likely translate into higher rates of obesity, chronic diseases and mental health problems for years to come.

The economic impact is profound, but also very asymmetrical. In 2020 there was a net loss of almost 210,000 jobs, the sharpest decline since 1976, when data became available. Many if not most of the job losses were in hospitality, retail and entertainment industries, characterized by low-paying jobs and disproportionately employing members of racialized groups, young people and women.

As the vaccine rollout is picking up and we are beginning to see the light at the end of the tunnel, it is imperative that we start implementing comprehensive strategies to reverse some of the collateral damage. One of the most pressing issues is to rapidly resolve the backlog of roughly 140,000 Quebecers who are currently on a waiting list for surgery. Another is to do much more to address the mental health needs created or amplified by the pandemic.

Janusz Kaczorowski, PhD, is professor and research director in the Department of Family and Emergency Medicine at Université de Montréal. Claudio Del Grande is a PhD candidate in the School of Public Health at Université de Montréal.

  1. The entrance to the emergency room at the Royal Victoria Hospital in Montreal Monday March 14, 2016. These days, emergency rooms are quieter than usual as many patients who should be seen are staying away for fear of catching COVID-19.

    Opinion: Next health challenge is to minimize collateral damage

  2. Depression and anxiety are common among older Quebecers according to Dr. José Morais, the director of the division of geriatric medicine at McGill University.

    As lockdown extends, isolated seniors are 'collateral damage'

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