I’m a pediatric brain surgeon and I’m concerned about the impact of delayed diagnoses on my patients due to COVID-19
The incidence of childhood brain cancer in Canada is three in 100,000. Brain cancers are treatable if they are localized, but the prognosis worsens and they become less treatable as they grow in size, spread throughout the brain and in some cases metastasize through the cerebrospinal fluid along the spine and around the brain. They are aggressive, as brain cancer is the second most common cause of childhood cancer after leukemia, but the most common cause of childhood cancer death.
Many aggressive brain cancers occur before the age of five and are difficult to diagnose in young children. Also, children are unable to verbalize many complex or subtle neurological symptoms such as dizziness or double vision.
Very often in the past year I have seen children for the first time when they have already reached the end stage of brain cancer. These are children whose disease is terribly obvious. They are children whose lives we could have saved had they been diagnosed even six months earlier.
I know why that hasn’t happened: the COVID-19 pandemic and its effects on our healthcare system and its patients. Sometimes families were too reluctant to take their children to their GP, or regular care was only accessible through online appointments, where so much less information is available to the doctor. This includes the vital observations that can only come from a physical examination.
Seeing a patient on a screen is nothing like examining a child in person. There are signals that we receive, such as muscle tone, eye clarity, and subtle breathing, which, along with other information, can signal serious problems in time for us to treat.
Young children cannot articulate neurological symptoms such as dizziness or double vision. (Shutterstock)
The fear and distraction caused by our approach to the pandemic drowned out other concerns, with dire consequences. So while these kids didn’t die from COVID-19, they certainly did.
Unfortunately, I’m sure that these preventable deaths are happening throughout healthcare, both in children and adults. Patients have postponed seeking diagnosis and treatment because they feared the virus more than anything that happened.
Read more: Collateral Damage: The Unmet Care Needs of Non-COVID-19 Patients
My colleagues talk about adult patients who skipped diagnostic procedures such as colonoscopies, ignored chest pain, or failed to investigate other serious problems. People who suffer from other conditions have become the collateral damage caused by the ongoing pandemic.
This is heartbreaking and frustrating. Public health messages across North America aim to protect people from the pandemic. Based on what I see in my own practice, I worry it was too alarming and too negative. The reports may have deterred patients and caused them to avoid hospitals and clinics for fear of contracting COVID-19. And the media coverage of the pandemic brought vigilance to COVID-19 at the expense of watching for symptoms of other illnesses.
I fear that once the full magnitude of these preventable deaths is known, it will far exceed the number of deaths from COVID-19.
Healthcare after the pandemic
As we appear to be emerging from the worst stages of the pandemic, I brace myself to see more children with advanced terminal cancer, knowing they could have lived without this well-intentioned but misguided approach.
It was encouraging to see the recent announcement from the Ontario government about adding resources to non-COVID-19 care to help overcome backlogs, but the fact is that for too many patients, the care they are now receiving is too late. will come.
Ontario’s health minister Christine Elliott says the province will spend up to $324 million to address a backlog of operations.
The public definitely needed to be aware of and protect themselves from the threat of the pandemic virus — the collective action of clinicians, scientists, frontline workers and others outside the medical system has helped mitigate the damage.
However, since the spring of 2020, it is almost as if there is no health problem other than COVID-19. As we diligently wash our hands, wear our masks, keep our distance and get our vaccines in the foreground, the rumble of other serious health problems continues as steadily as ever.
If we had all had the choice to tackle the new crisis, I would venture to say that we would have preferred a more balanced, nuanced message about treating all health problems simultaneously, rather than replacing almost everything else with a single public health problem that is ultimately worse than the one we were trying to prevent.
Even in healthcare, I think too many people were too willing to cut off face-to-face contact with patients in primary care, community clinics, imaging and other diagnostic services, all essential channels for an earlier diagnosis of symptoms that patients may not feel. identify.
I fear what my colleagues and I have yet to discover as more patients emerge from the terrifying shadow of COVID-19. There will be months, even years of catching up as we try to care for people with advanced illnesses and conditions, as new cases of the diseases and conditions that usually sustain our system continue to develop.
As a doctor I want to help people to be as healthy as possible. I do my best with the circumstances, but at home, late at night, I think about the suffering of my patients and their families and my heart fills with sadness. I feel powerless.
The barriers were unintentional, but the impact is terrible.
We will probably see more pandemics, and sooner than we would like. When they come, I hope we will meet them with the needs of all patients in mind.