DOCTORS see cost of delayed preventive care.

With medical visits picking up again among patients vaccinated against covid-19, health providers are starting to see the consequences of a year of pandemic-delayed preventive and emergency care as they find more advanced cancer and rotting and damaged teeth among other ailments.

Brian R. Rah, chairman of the Cardiology Department at Montana’s Billings Clinic, was confused in the early days of the coronavirus pandemic. Why the sudden drop in heart attack patients at the clinic? And why did some who did come arrive hours after first feeling chest pains?

Two patients, both of whom suffered greater heart damage by delaying care, provided what came to be typical answers. One said he was afraid of contracting covid-19, the disease caused by the coronavirus, by going to the hospital. The other patient went to the emergency room in the morning, left after finding it too crowded, then returned that night when he thought there would be fewer patients — and a lower risk of catching covid-19.

“For a heart attack patient, the first hour is known as the golden hour,” Rah said. After that, the likelihood increases of death or a lifelong reduction in activities and health, he said.

J.P. Valin, executive vice president and chief clinical officer at SCL Health of Colorado and Montana, said he is “kept awake at night” by delays in important medical tests.

“People put off routine breast examinations, and there are going to be some cancers hiding that are not going to be identified, potentially delaying intervention,” he said.

Valin is also concerned that patients aren’t seeking timely treatment when suffering appendicitis symptoms such as abdominal pain, fever and nausea. A burst appendix generally involves more risk and a week’s hospitalization, instead of one day of treatment for those who get care quickly, he said.

Fola May, a gastroenterologist who is a quality director and a health equity researcher at UCLA Health, worries about the consequences of an 80% to 90% drop in colonoscopies performed by the health system’s doctors during the first months of the pandemic.

“All of a sudden we were downplaying health measures that are usually high-priority, such as trying to prevent diseases like cancer, to manage the pandemic,” May said.

Along with exacerbating existing health problems, the pandemic has caused a host of new medical concerns in patients. The American population will be coming out of the pandemic with teeth worn down from grinding, back problems from slouching at makeshift homework stations and mental health problems from a combination of isolation and being too close to family.

Despina Markogiannakis, a dentist in Chevy Chase, Md., said patients don’t argue when she tells them they have been grinding or clenching their teeth and might require a root canal, dental implant or night guard.

“These are people stuck at home all day and feeling lonely and feeling a little depression. It is induced by the world we live in and all the changes in our lives,” Markogiannakis said.

A recent American Dental Association survey found that more than 70% of member dentists reported an increase in patients grinding or clenching their teeth since the pandemic began. More than 60% reported an increase in other stress-related conditions, such as chipped and cracked teeth.

Gerard Mosby, a Detroit pediatrician, finds his young patients are suffering more stress, depression and weight gain than before the pandemic. They are confined in their homes, and many are living in multigenerational homes or foster homes, or they have experienced covid-19 illnesses or death among family members.

“Since their ability to get out is limited, they can’t vent to friends or other family members. Also, most will not have access to mental health for grief counseling,” Mosby said.

Nancy Karim, a Bridgeport, Conn., licensed professional counselor and art therapist, said that in addition to struggling with isolation, her patients are conversely stressed by living too closely with people whom they were accustomed to “getting space from each other on workdays and school days.”

Meanwhile, optometrist Matthew Jones, who practices in Blytheville and Osceola, Ark., reports worsening eye conditions for patients, some of whom stopped taking drops during covid-19 for conditions like glaucoma. He’s also seeing much more eyestrain “because people are spending so much time in front of a computer screen” and recommends eyeglasses that filter out blue light to his patients.

Physical therapy needs are also on the rise.

“Patients that have transitioned to remote work are typically working with poor ergonomic setups and spending a lot more time sitting,” said Kaylee Smith, a physical therapist and founder and president of Smith Physical Therapy and Performance Studio in San Diego.

“I am seeing more pain and injuries related to poor posture (i.e., neck pain, low back pain, etc.) and a significant increase in patients coming in with tight hips related to increased sitting time,” Smith said in an email.

Some providers report they are finally nearing pre-pandemic patient levels, but others still face covid-19 resistance.

“Although we have seen an improvement over the past six weeks, it’s still not much,” said Neville Gupta, administrator at Gupta Gastro in Brooklyn and Far Rockaway, N.Y. “Our patients are still avoiding getting the care they need, no matter the safety precautions in place.”