A nurse treats an elderly patient in a clinic in Guerneville in February 2020. Doctors fear that delays in medical care due to the pandemic could lead to poorer health. Photo by Anne Wernikoff for CalMatters.
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In his clinic in East Los Angeles, dr. Efrain Talamantes recently saw three patients – all elderly with dementia – who had not visited his office for more than a year. Finally, seeing them in person, after being vaccinated, feels like a big win. But Talamantes are concerned that many patients have slipped through the cracks, endangering their health by delaying the care of their diseases during the pandemic.
“While focusing on recovery, we must ensure that we are vaccinated,” Talamantes said, “but also that we make a concerted effort to deal with the chronic diseases that do not receive the necessary attention to avoid complications.”
Aside from COVID-19, Californians died last year at the same rate for most major causes. Slightly more people are dying from the biggest killer – heart disease – and strokes, while deaths from cancer have remained roughly the same as the pre-pandemic rate. An exception is a fairly large increase in Alzheimers; about 11% more people died from the disease last year.
Doctors and other health experts predict that the prolonged delays in patients seeking medical care could cause deteriorating health conditions, delayed diagnoses and earlier deaths in the near future.
“Unfortunately, we know we are going to see some tragedies related to the delays.”
– Dr. Wiley Fowler, oncologist at Dignity Health in Sacramento
The consequences are likely to be felt most severely in high-risk color communities – such as those experienced by dr. Talamants served – which have more dangers due to dilapidated medical care. For patients with life-threatening, chronic diseases such as diabetes and asthma, routine care is critical.
As the coronavirus swept through California last spring, many people canceled their medical appointments, or their providers temporarily closed their doors. Telehealth visits have been booming in recent years, but there is just as much that doctors and nurses can do through a screen. Dental visits, mammograms and annual wellness examinations were postponed.
About a third of Californians who had an urgent health problem not related to COVID-19 and wanted to see a doctor did not receive care, according to a survey of 2,249 adults surveyed by the California Health Care Foundation summer. And nearly half of the respondents did not get care for their non-permanent physical health problem.
Because they feel more confident after getting their COVID-19 vaccinations, many Californians, especially the elderly, are finally catching up with medical appointments. But others still fall behind with routine grooming.
Dr. Wiley Fowler, an oncologist at Dignity Health in Sacramento, has seen a steady increase in people over the past two months. But its patient volume is still only about 85% of what it should be.
‘There is a reason and a reason behind the recommendations for interval follow-up. We will encourage people to go to their clinics and move on, ”he said.
“Unfortunately, we know we are going to see some tragedies related to the delays.”
Top killers
About 48,000 more Californians died in 2020 than in 2019 – largely due to the 25,971 deaths attributed to the pandemic last year. (January 2021 was the deadliest month for COVID-19).
But heart disease and cancer remain the leading causes of death in 2020.
About 2,846 more Californians died of heart disease last year than in 2019, and 2,545 more than in 2018, an increase of about 4%, state data shows. There were also 917 more deaths due to strokes than the previous year, an increase of 5%.
Because emergency visits to non-COVID-19 nationwide dropped by about 42% in the early months of the pandemic, experts believe people could have had worse results because they avoided hospitals after heart attacks and strokes.
Cancer deaths have remained about the same, with a decrease of less than 1% in 2020 compared to the previous two years.
However, this status quo may be temporary: the National Cancer Institute predicts that pandemic-related delays in breast cancer and colorectal cancer screening and treatment alone could lead to nearly 10,000 deaths in the U.S. in the next ten years alone. That would amount to about 1,200 deaths in California due to the two types of cancer. Experts believe this is a conservative estimate because it is only a six-month delay in care and people are delaying care longer than that.
“Instead of finding it on a mammogram … the patient now comes in because he feels something and we later make the diagnosis in the course of the disease, which unfortunately means a lower probability of being cured,” the dr. Richard Bold said. chief physician at the UC Davis Comprehensive Cancer Center.
For Alzheimer’s disease, 1,883 more Californians died last year than in 2019. Although difficult to pinpoint exact reasons, experts believe it could have been driven by isolation and the sudden pandemic-related closure of support services on which Alzheimer’s patients rely. word.
“We all try to maintain our mental health with technology, but it’s not always an option for these individuals,” said Elizabeth Edgerly, executive director of the Alzheimer’s Association, Northern California. “They lost physical contact – those living in congregations were confined to their room.”
For some cancer patients, “we make the diagnosis later in the course of the disease, which unfortunately means a lower probability of being cured.”
– Dr Richard Bold, Chief Physician at the UC Davis Comprehensive Cancer Center
California also had about 12,000 additional ‘other’ deaths – a category that includes causes that are not the 13 most important, identified by the Centers for Disease Control and Prevention. State health officials were not available to explain why they provided details prior to publication.
Anecdotally, Bold said he had heard from colleagues over the past two to three months what was worse.
This could be because people have delayed performances and other tests. During the state’s first home order, investigations into cervical cancer dropped about 80% for the 1.5 million women in the Kaiser Permanente Southern California network, according to one study. After the order was lifted, performances picked up again, but were still between 24% and 29% lower than in 2019.
Many children also skipped visits to doctors.
In early March, significantly fewer infants and children visited doctors in person or by telehealth under the state’s Medi-Cal program, which serves low-income residents. In the past, visits increased, but declined rapidly once the pandemic began. In August, the number of visits decreased by 40% compared to August 2019, according to preliminary data from the Department of Health Care and Human Services.
Return to the doctor’s office
Howard Dalton wheeled his first colonoscopy last year. The 50-year-old Sacramento resident also skipped routine physical examinations and dental visits.
The only personal care he has sought in the past year is routine blood work required by someone who has had HIV for 20 years. But all the other things were off the table; he simply does not feel comfortable sitting in a waiting room with other people.
“I’m pretty obsessed with my health and it bothers me that I’m probably back there now, no matter what stage I was at,” he said.
Dalton recently received his first COVID-19 shot, which already offers him spiritual relief. He waits for his second dose before even thinking about returning to a doctor’s office. And he said, “I’m probably wearing a mask until next winter.”
Bold, of the Davis Cancer Center, said there is no longer a reason for patients to postpone examinations and other care. He said medical offices are safe – healthcare staff are largely vaccinated, everyone is asked to wear a mask and patients are screened on COVID-19 when they enter a facility.
Talamentes, an internist and chief operating officer of AltaMed, said his East Los Angeles clinic is still working on limited capacity to enable proper safety protocols. When person slots are available, he is discussed almost immediately.
AltaMed, a federally qualified health center, offers vaccines to patients and their families, and when they get their chance, they are reminded to plan wellness checkups and dental visits.
Last year, AltaMed clinics saw about half the number of people with high blood pressure – high blood pressure – than in previous years, Talamantes said. The concern is that treatment may develop delayed to worse, uncontrolled heart disease, which then makes them more vulnerable to diseases such as COVID-19. Diabetes and obesity are two more common conditions in its patient population, which also require management and routine care.
One silver lining, Talamantes said, is that some of its patients have become more in tune with their health after experiencing devastating losses in their families.
‘If someone in their family has died (from COVID-19), we often hear’ well, they did not take care of themselves, estaban gorditos, so I have to take care of myself. ‘”
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CalMatters COVID-19 coverage, translation and distribution are supported by generous grants from the Blue Shield of California Foundation, the California Wellness Foundation and the California Health Care Foundation.
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