“I know of one patient with colon cancer — a condition that is reassuringly curable in its early stages — whose operation has been continually delayed because of COVID pressures. Sadly, the cancer has metastasized and he is now in the terminal stages of the disease.”
– Angus Dalgleish, M.D., Professor of Oncology
Back in May, hundreds of doctors from across the nation signed petitions and sent an open letter to President Trump. They weren’t warning of the deadly coronavirus ravaging the nation.
Instead, their concern was over the lockdowns designed to prevent the spread of the virus.
While lockdowns may slow the spread, these doctors warned they could result in a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-coronavirus patients.
Now, more than six months later, the research suggests they were right.
Since the COVID-19 pandemic began in early 2020, health service providers around the world have focused their attention on protecting people against the virus. To achieve that goal, they’ve accepted limiting access to many other health services.
This effort may have been carried out with the best intentions, but it has inevitably led to millions of sick people being denied medical services they would otherwise have received.
While some of these treatments are elective or postponable – a hip replacement, for instance – others are important and some are a matter of life and death.
Big increase in deaths from other diseases
The New York Times reports that as a direct result of the lockdowns there will be 1.4 million excess tuberculosis deaths, half a million excess HIV deaths, and 385,000 excess malaria deaths worldwide. Those are somebody’s estimates, perhaps wide of the mark, but they are a fair indication of the scope of the damage.
According to the journal The Lancet, during the first lockdown dementia patients had a 53 percent greater chance of death and elderly patients with severe mental illness had a 123 percent greater chance of death.
The Centers for Disease Control (CDC) estimate 93,814 non-COVID “excess deaths” in 2020, including 42,427 from cardiovascular conditions, 10,686 from diabetes, and 3,646 from cancer. All of these, reports the CDC, will happen because “non-essential” care has been canceled.
Now, those estimates are based on more reliable data than The New York Times’s projections of the worldwide toll. And CDC numbers suggest we’ve paid a horrendous price to keep people safe from COVID.
As I write this there have been around 289,000 U.S. COVID fatalities (so we’re told), so the 93,814 deaths attributed to denial or refusal of service for other health conditions is not quite comparable – but it ought to give us pause.
Massive drop in cancer screenings
One of the petitions that made the rounds in the wake of the first lockdown warned of these “collateral harms” and was signed by 50,000 scientists and doctors.
These “harms” included a reduction in cancer screenings and treatments which, these medical professionals say, will lead to a huge number of increased deaths in the months and years ahead.
Another group of over 600 physicians warned about “the lack of consideration for the future health of our patients. The downstream health effects…are being massively underestimated and under-reported.
“These include 150,000 Americans per month who would have had a new cancer detected through routine screening that hasn’t happened.”
My guess is that a lot of those positive tests would have been for nearly-harmless skin cancers or early-stage prostate cancers where immediate treatment is not essential. Still, the number should make us think twice.
There is no doubt the figures relating to the cutback in cancer services are alarming.
According to data from electronic medical records, just comparing the months of March and April to the same periods in previous years, screenings for breast, cervical and colon cancers fell between 86 and 94 percent; colonoscopies and biopsies dropped by nearly 90 percent; new colorectal cancer diagnoses were down by a third and colorectal surgeries fell by 53 percent.
These are all serious cancers. The real deal. For some of these patients the lack of early detection will be a death sentence.
For instance, cervical cancer has a five-year survival rate of 92 percent if diagnosed before it’s had a chance to spread, but just 17 percent when it’s at an advanced stage.
The Great Barrington Declaration
In October, a petition called The Great Barrington Declaration was initiated by three leading scientists at Harvard, Stanford and Oxford. They called for governments to adopt a COVID control health policy that gives priority to those at the highest risk, leaving everyone else to return to normal life.
Older people, they wrote, are a thousand times more likely to die of COVID-19 than younger people, so older and high-risk patients are where resources should be focused. Younger and healthier people should be allowed to attend school and keep businesses open.
Deferred cancer treatment is not the only lockdown danger. Concentrating on COVID-19, the Great Barrington signers point out, has increased domestic violence and deaths from suicides, caused mental health to suffer, reduced childhood immunizations, and worsened cardiovascular disease outcomes in addition to increasing cancer deaths.
One of the founding signatories of The Great Barrington Declaration is Angus Dalgleish, M.D. and professor of oncology at St. George’s hospital, London.
He believes theirs is a “more humane approach that recognizes the collateral damage from the current restrictions.”
When medical care is the difference between life and death
Dr. Dalgleish describes the focus on COVID as “a disaster, particularly in my field of cancer where early detection can mean the difference between living and dying.
“Thanks to remarkable advances in medicine and surgery,” he writes, “survival rates have soared for cancer patients who receive treatment in time. But because of COVID, those gains could soon be lost as patients are forced to wait.”The problem in securing face to face appointments where symptoms can be properly discussed and examined can lead to tragic outcomes.
Dr. Dalgleish gives as an example a 33-year-old with a sore throat, severe weight loss and a lump on his neck.
After a telephone consultation he was prescribed antibiotics. When symptoms worsened he was put on stronger antibiotics. Soon afterwards he died of lymphoma.
50,000 excess cancer deaths
Another oncologist who has been sounding the alarm is Karol Sikora, Chief Medical Officer of Rutherford Cancer Centers in the United Kingdom, former director of the World Health Organization’s Cancer Program and a world authority on the disease.
He wrote back in April that 2,300 cancer diagnoses are being missed in the U.K. each week either because patients aren’t visiting their doctors or they’re not being referred to the hospital for urgent tests and scans.
“Indeed, the cancer diagnostic system has all but seized up.”
He added that the suspension of bowel, breast and cervical screening services would lead to 400 of these cancers being missed each week alone and that there would be at least 50,000 excess deaths from these cancers in the years ahead, and that’s just in the United Kingdom.
Like Dr. Dalgleish, he’s extremely concerned about the lack of meetings with doctors in person.
“It isn’t an illness that can be diagnosed on Skype or Zoom.
“Most people present with vague symptoms such as hoarseness, a cough, weight loss, grumbling stomach pain, back ache. Only a doctor knows to look out for these symptoms and order proper diagnostic checks such as CT or MRI scans.
“But I’m afraid that thousands of people are today living with symptoms of a disease which will eventually kill them.
“Abandoning…non-coronavirus patients as we are doing is unacceptable – and a stain on us all.”
Patients now present with more advanced cancers
In early November, just before the second lockdown in the United Kingdom, Dr. Sikora said that because of the delays in cancer diagnostic services from earlier in the year he is seeing an increase in patients with late-stage conditions, particularly breast cancer patients who are disproportionately impacted.
“…we cannot allow breast cancer to become the forgotten casualty of this pandemic,” and it’s essential that there is no repeat of the earlier lockdown strategy; otherwise it “would be disastrous for cancer patients.”
In an interview in September, Norman E. Sharpless, director of America’s National Cancer Institute, described the cutbacks in screening, delayed diagnosis and treatment, and suboptimal care, as having “substantial” consequences for cancer patients.
“We are worried about swapping one public health emergency for another public health emergency,” he said.
Although cancer mortality typically declines by between one and two percent each year, it’s now moving at the same rate in the opposite direction.
The drop in screening for colon and breast cancer by 75 percent over six months means that by “conservative” estimate this will increase deaths from these cancers — for which accurate models of predicting mortality are available — by 10,000 over the next decade.
What’s more, he said there was no reason to suppose the same effect won’t be seen in lung, prostate, pancreatic and other cancers.
Even short treatment delays prove deadly
In April, a large research group led by University College London, using “conservative assumptions” of the consequences of the huge drop in diagnostic referrals and treatments, estimated an extra 33,890 deaths from cancer in the following twelve months in the U.S.
I do not know whether this spring prediction (or others cited above) played out as expected. During the summer there was some rollback of the lockdowns. But insofar as we’re back in lockdown mania this winter, the warnings are still relevant – and then some.
In fact, there is not the slightest doubt. In November, researchers from Canada and the United Kingdom published in the British Medical Journal a review of studies on mortality due to the delay in cancer treatment.
They analyzed 34 studies involving over a million patients with bladder, breast, colon, rectum, lung, cervical or head and neck cancers. Prostate cancer was excluded because they didn’t consider delays of short duration to be a risk for mortality.
The researchers found that each four-week delay in surgery increased the risk of death by six to eight percent. This rose to nine percent for head and neck radiotherapy and 13 percent for colorectal chemotherapy.
An eight-week and 12-week delay in breast cancer surgery increased the risk of death by 17 and 26 percent respectively. Over the course of a year a 12-week delay in breast cancer surgery would be expected to lead to an extra 6,100 deaths in the U.S.
Consequences will be felt for years to come
Professor Richard Sullivan, a member of the research team, commented, “The results of this study are both staggering and sobering. No delay is safe. We now need to count the previously invisible cost of COVID-19 on people with cancer.
“The focus has up to now been on deaths caused by COVID-19 but there’s been little attention paid to the indirect impact on other significant health conditions caused by the lockdowns which are linked to huge delays in diagnosis and treatment.
“The pandemic’s impact on cancer care and outcomes will be felt long after the virus reaches global equilibrium.”
Do lockdowns do much good? That’s a huge, controversial subject, beyond the scope of this article. But I recently came across three studies in respected medical journals (including Lancet) that suggest they don’t. You can read them for yourself if you want to go into it:
A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes – EClinicalMedicine (thelancet.com)