COVID has indirect impact on health

There’s little doubt that COVID-19 has been the top item on the news and the dominant topic of conversation for the last year – from masks and lockdowns to hospital capacity and vaccines.

But one of the less-discussed aspects of the pandemic is the indirect effect of the virus.

As the healthcare system grapples with COVID-19, the measures taken to combat the pandemic — and our own behavioural responses — have had an impact on our health.

We work in acute care medicine and are the first to stress the importance of rules such as “wear a mask, physical distance, stay in your bubble.”

There is one, very critical, exception however – please seek medical attention if you need it.

Unfortunately, we have seen that COVID-19 has resulted in a reduction in utilization of ambulatory care; in select procedures such as bronchoscopy, colonoscopy and certain types of surgery; and access to other medical services.

Some of the reasons why are understandable.

If you go to an emergency department, you are likely to be COVIDscreened before anyone asks “what brings you here today?”

Extra precautions appropriately taken by all hospital staff take time and delay care. If you are admitted to hospital, with restrictive visitor policies, you are, well, alone.

When we hear these stories, or about outbreaks in hospitals and in long-term care facilities, or speculation that intensive care units might run out of beds (which hasn’t occurred) , there is no mystery why some people are choosing not to seek care.

We know some people are scared to access the healthcare system for nonCOVID-19 related problems, or believe it’s too much hassle. Those chest pains must be indigestion, right? And that lump can wait, surely?

Very early on in the pandemic, it was noticed in Italy there were significantly fewer acute heart attack and stroke admissions.

This pattern has repeated around the world, including Alberta, where there was a drastic fall in the rate of admission to hospital for stroke and heart attack in March and April of 2020. Those who finally came to hospital were extremely sick.

The same pattern is now repeating itself again this winter. These are what we call “time-dependent” conditions, where effective, life-saving treatments are routinely used, but they need to be applied very early after symptom onset. This has long-lasting implications. Without treatment, you may end up dead – or seriously disabled. You may survive that heart attack while staying at home, but might then develop heart failure, which has a worse prognosis than many cancers.

In some cases, the deferral of care is unavoidable. But in others, it is a behavioural choice by the patient.

Virtual care has made great strides but it is simply not a substitute for in-person evaluation in some circumstances, like those noted above.

Without a physical examination, we will not catch things like that new heart murmur. You have to tell us something is different.

If you have central chest pressure radiating into your left arm, “funny” indigestion or you have any of the

F.A.S.T signs for stroke (face, arm, speech, time) then you need attention immediately.

Please know the health system is here for you and ready to provide life and disability-saving intervention.

All AHS facilities enforce rigorous infection prevention and control standards, screen staff for COVID-19 symptoms and exposure risk, and have staff follow continuous masking and diligent hand hygiene policies. They are safe places to seek care.

Family doctors are available and able to assist you with health concerns. Primary care offices screen patients for COVID-19 and take precautions to ensure that they can provide safe treatment for their patients. They will work with you to decide if your concerns can be addressed by phone, or require an in-person visit.

Wear your masks, respect physical distancing, and find new and creative ways to stay in touch. When it’s your turn for the vaccine, head to the front of the line.

But those chest pains need to get checked out now, and that facial droop and arm weakness means a trip to the Emergency Department immediately. Let’s all stay safe… and healthy. Michelle M. Graham, MD, FRCPC: CoSenior Medical Director, Cardiovascular Health and Stroke (CVHS) Strategic Clinical Network (SCN) and VP,

Canadian Cardiovascular Society

Colleen M. Norris, PhD, NP: Scientific Director, CVHS SCN

Michael D. Hill, MD, MSc, FRCPC: CoSenior Medical Director , CVHS SCN