There is never a good time to get cancer, have a stroke or develop heart disease. But this year is shaping up to be one of the least favourable in England when it comes to the chances of recovering with minimum damage.
As hospitals brace for the full impact of a second wave of Covid-19, healthcare professionals are alarmed by an escalating crisis in the shadow of the pandemic: the number of patients with other diseases who have been dying untreated at home, or developed irreversible conditions without seeing a doctor.
“For a few months, it was possible to jolly people on with telephone conversations, no face-to-face appointments and medicine on the fly,” said David Hildick-Smith, consultant cardiologist at the Royal Sussex County Hospital in Brighton. “As things go on, the fact people haven’t actually been seen is getting more and more important.”
The resurgence of coronavirus has come after a summer in which the NHS worked flat out in an attempt to restore referrals and treatments for cancer, cardiovascular and other diseases to near normal levels. They had dropped dramatically after a decision during the first wave of the virus to halt or greatly reduce many services. At the same time, people stayed away from hospitals and clinics for fear of catching the virus, or in response to government calls to “protect the NHS”.
As a second national lockdown came into force on Thursday, some hospitals were already struggling to cope with the fresh influx of Covid-19 patients. This raised the likelihood that energy and resources would be diverted from tackling the growing backlog of patients needing treatment for other illnesses.
On Tuesday, Simon Stevens, chief executive of NHS England, put the service on its highest alert level and said that operations were already being cancelled in some areas ahead of what looks increasingly like a bleak winter.
At the peak of the first coronavirus wave, Dr Hildick-Smith said some patients sat out a heart attack at home. After wards were cleared to make way for victims of the pandemic, some hospitals remained relatively empty.
“There were a lot of people in April and May who didn’t come in and to some extent their fears were justified — Covid was everywhere,” he added. Later some turned up with debilitating heart failure, with implications for their long-term quality of life, because they had failed to get emergency care.
“What we desperately need is for there not to be the same overreaction as the first time when it took a pandemic, ironically, to empty hospitals.” That was understandable then, he said, because so little was known about the virus. “It would be less so a second time around,” Dr Hildick-Smith said.
Analysis of data to mid-September by the Office for National Statistics showed that about a third more deaths than usual — 25,472 — took place in English homes this year.
This included a 25 per cent increase in deaths from heart diseases among men, and a 75 per cent increase in deaths from Alzheimer’s and dementia in England among women. The latter is possibly explained, according to Jackie Cassell, deputy head of the Brighton and Sussex Medical School, by a fear of being locked away alone.
“At the moment there is evidence people are not going into care homes beyond the point where they can be looked after at home, because they are worried they will never see loved ones again,” she said. “Going to hospital is also different from what it was,” she said.
Signs that trouble is being stored up as a result, can be seen in more detailed analysis of appointments cancelled and diagnostics deferred. Sonya Babu-Narayan, associate medical director at the British Heart Foundation, a charity, said there was also a continuing reluctance to go to the NHS for fear of overwhelming it.
“People haven’t been seeking medical care in the way they normally would. One of the main reasons is fear of putting pressure on the NHS, another is fear of catching coronavirus,” she said.
The number of echocardiograms conducted in England fell 67 per cent in April and May 2020 compared with February and were still 40 per cent down in June, according to the National Institute for Cardiovascular Outcomes Research, Nicor. The drop in people going to hospital with heart failure also fell by 66 per cent by the end of April and into May compared to February.
Routine procedures such as endoscopies remain much more time consuming because of the need to carry them out in a protected environment.
“There is a tidal wave coming in terms of the backlog in care,” said Dr Babu-Narayan.
The backlog for cancer patients could be even worse. According to research by Macmillan Cancer Support, the charity, there were 50,000 fewer diagnoses for cancer to date this year compared with the same period in 2019.
A September survey of general doctors by Cancer Research UK found that more than half were worried that older adults were not contacting them when symptoms appeared — underscoring the fact that primary care, has also been ravaged by the pandemic. The resulting backlog, Macmillan fears, could take 20 months to clear.
Sara Bainbridge, head of policy at the charity, said the NHS in England had been missing its targets on cancer waiting times long before the emergence of Covid-19, partly because it is so overstretched. When the pandemic started, the NHS was buckling already from historic underfunding. Across England, 40,000 nursing positions lay vacant, according to the Royal College of Nursing.
“This pandemic has only added to the pressure,” said Ms Bainbridge, adding: “We need to make sure the NHS has everything it needs to look after people with Covid-19 and people with other conditions. This has to be done in a way that the NHS doesn’t have to decide between them.”
The best way to do that, although it may be too late, is to make sure the hospitals are not overwhelmed, said Michael Head, senior research fellow in global health at Southampton university. “The obvious answer is that if you don’t want people to die of cancer, you don’t want the hospitals filled with Covid patients.”
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