It honestly feels to me like there’s a cull of patients who can’t be cured
Chilling words. But with ops cancelled and treatments delayed, cancer sufferer Jane is far from alone in fearing Covid-19 will also kill thousands with other chronic conditions
IN THE six years since Jane Dabner’s breast cancer was diagnosed, she has endured it with dignity and good humour. The 57-year-old says despite tumours that have ‘popped up everywhere’, most recently in her skull, she continues living a fulfilling life – thanks to cutting-edge drugs administered at The Clatterbridge Cancer Centre on the Wirral every three weeks.
And as the mother-of-two – who lives in nearby Bebington – recently became a grandmother for the first time, she plans to visit her tiny grandson as soon as lockdown is lifted. She says she has ‘a lot of life left to live’. Or so she had hoped – until her future began looking very uncertain.
Jane, it seems, was regarded as collateral damage in the fight against Covid-19 – one of thousands of patients across the NHS told their life-prolonging treatments would be cancelled or delayed until after the crisis has passed. And when that will be, of course, no one knows.
‘It honestly feels like there’s a cull of patients who can’t be cured,’ Jane says. ‘But we’re not ready to be written off yet.’
Jane, as it is becoming painfully clear, is not alone. Around the country, another growing health crisis is developing – the true extent of which may not be felt for many months or years to come.
In cancer care alone, 2,300 tumours are being missed every week as the number of patients being referred for urgent hospital appointments plummets by 75 per cent, according to Cancer Research UK. Postponements and cancellations are also affecting those awaiting heart operations, organ transplants and patients on dialysis for kidney failure, The Mail on Sunday has learned.
The decisions are made, in many cases, because treatments for these conditions can suppress the immune system – making patients more vulnerable to coronavirus.
But NHS Trusts have also been forced to divert resources to the front line, with swathes of doctors from all specialities being redeployed and hospital departments transformed into makeshift Covid-19 wards.
PATIENTS at greatest risk from the virus, due to pre-existing illnesses, have been told to ‘shield’ – to practice stringent social distancing by staying home at all times and avoiding any face-to-face contact. Yet there are growing concerns. While self-isolation may protect them against the ravages of the virus, there may be a brutal payoff as many may see their conditions worsen. And some, say experts, may die as a result.
Professor Stephen Powis, medical director of NHS England, yesterday confirmed a 50 per cent reduction in people attending A&Es during April – equivalent to one million fewer patients.
When asked if people had already died after failing to get treatment quickly enough, he said: ‘Of course, that’s our concern – it’s that people will be coming to harm if they don’t attend hospital.’
He added it was important to start reintroducing routine surgery now Covid-19 numbers were starting to decline, but warned this would ‘take a bit of time’.
Indeed, a worrying trend of nonCovid-19 fatalities may have already begun.
Data released by the Office for National Statistics for the week up to April 10 has revealed a shocking spike in deaths, to 18,516 – nearly 8,000 more than expected. Exactly 6,213 of the excess deaths were attributed to the virus, but 1,783 – about one in five – were not.
During the previous week, 43 per cent of excess deaths did not have Covid-19 on the death certificate, which Professor Sir David Spiegelhalter, an expert in risk at the University of Cambridge, said had left him upset and shocked. ‘How much is collateral damage of the lockdown?’ Sir David asked. ‘We just don’t know.’ Place of death, however, may provide a clue, he says.
Due to the lack of community testing, many of those who die of Covid-19 at home, in care homes or in hospices may not be recorded as victims of the virus. Indeed, analysis of the ONS figures reveals 70 per cent of the extra deaths in care homes and at home are not labelled as Covid-19, which means under-reporting may be an issue.
But significantly, there has been a 27 per cent drop in non-Covid deaths in hospital, closely matching a 29 per cent drop in hospital admissions in March. In other words, some of these deaths may be patients with other illnesses who have gone untreated.
Sir David said: ‘It is not clear how many of these non-Covid excess deaths are under-diagnosis, and how much collateral damage. But an apparent shift of non-Covid deaths from hospital to community points to a substantial impact of the current lockdown on vulnerable people who do not have the virus.’
Dr Jason Oke, statistician at the
Nuffield Department of Primary Care Health Sciences at the University of Oxford, said: ‘If these deaths are found not to be directly linked to coronavirus, but are instead a sad side-effect of lockdown, then what we gain by protecting people from coronavirus may be lost.’
Justin Stebbing, professor of cancer medicine at Imperial College London, admitted most oncologists were having to make ‘heartbreaking decisions’ about which patients to prioritise, based on often conflicting guidance. ‘Cancer, plus coronavirus, plus [the side effects of] chemotherapy is not a good combination,’ he warned. ‘But patients, and their doctors, are being forced to make a choice – risk dying from the virus or the cancer.’
Guidance from the National Institute
for Health and Care Excellence (NICE) recommends cancer centres prioritise patients most likely to survive, but Prof Stebbing said individual centres and regions were also producing their own guidelines, based on how able they were to continue providing treatment. He said one of his patients at Central London’s Charing Cross Hospital, a 37-year-old woman with advanced breast cancer, would die ‘within weeks’ if her treatment was withdrawn. While her care would continue, he said, similar patients at other hospitals might face having theirs stopped.
The picture for other conditions is equally worrying. Thousands of joint replacement, hernia and cataract operations have been cancelled to free-up hospital beds, and transplant centres are carrying out only the most urgent cases.
Meanwhile, NHS England has said just 60 per cent of acute hospital beds are occupied compared with 90 per cent a year ago.
Intensive care specialist Dr Ron Daniels, founder of The UK Sepsis Trust, said: ‘Normally I would expect to see at least a patient a day referred to us with sepsis [a life-threatening condition resulting from an infection].
‘In the past few weeks I haven’t had a single one, and that’s alarm
ing – where are those patients?’ The numbers treated for heart attacks alone in England dropped by half during March – from 300 a day to just 150. This does not mean fewer people are having heart attacks, just that fewer are going to hospital.
Cardiologist Dr Ramzi Khamis, fellow of the British Heart Foundation, said the number of patients coming into his heart attack centre at Imperial College Healthcare NHS Trust, London, had halved, and many who did had ‘significantly delayed’ seeking help. He said: ‘We want to stress that we have the staff, equipment and resources to treat heart attacks. Delays in treatment puts lives at risk, and will result in more pressure on the NHS, not less.’
The same is true in stroke care, where speed of treatment is often the difference between life and death. Stroke specialist Dr Paul Davies, at North Cumbria Integrated Care NHS Foundation Trust, said the number of patients admitted and referred to stroke clinics across the country over the past few weeks was ‘considerably fewer’ than normal.
He added: ‘Our big worry is that there are people with stroke symptoms, such as limb or facial paralysis on one side of the body, confusion and speech problems, who are too frightened to come to hospital because of Covid-19.’
But without treatment, many could end up at risk of a ‘possibly bigger stroke’, he said – and this could be fatal.
GPs across the country report they are seeing half the number of patients they would normally, which means a whole range of symptoms – from minor to potential red flags for more serious disease – are not being picked up. Screening for breast, cervical and bowel cancer has been suspended.
Sarah Woolnough of Cancer Research UK said the ‘stay at home’ message was having ‘unintended consequences’. She added: ‘The danger is treatment being delayed for too long and then [a cancer] becomes inoperable.’
Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, has already warned that sick children have died because of delays in taking them to hospital.
One paediatric intensive care nurse said: ‘Everyone has been saying this: the kids they’re seeing are, generally, sicker than they would’ve been previously, as parents are reluctant to go into a healthcare setting.’
ALL the experts urge parents to ‘listen to their instincts’ and seek medical help for any unusual symptoms. But for many, such as Katy Whitehorn, it is a confusing time. Her son Harry, 11, became extremely ill with what turned out to be bacterial pneumonia, but unsure where to seek help, she eventually took him to hospital ‘on the cusp of it being too late’.
Katy, 40, who lives near Salisbury, Wiltshire, said: ‘On the one hand, I didn’t want to burden the NHS when it is already overstretched, and on the other I thought we might get coronavirus if we went into hospital.’
Harry was taken to Salisbury District Hospital when NHS 111 called an ambulance. ‘Everyone did their job with such kindness and I can’t thank them enough,’ Katy says. ‘But many parents I’ve spoken to still don’t know what to do in a crisis.’
These are not, after all, normal times. And this in itself could be storing up mental health problems, not just among those with a history of anxiety or depression. Mental health charity Young Minds surveyed more than 2,000 young people with a history of mental illness and found 83 per cent felt the pandemic had exacerbated their condition.
And a paper in The Lancet medical journal last week suggested school closures could cause mental illness among children to worsen, and added that there may also be ‘considerable difficulties adjusting when school resumes’.
There is no sign – yet – of getting back to normal, but officials are urging everyone to continue to use the NHS. Professor Chris Whitty, the Chief Medical Officer for England, said: ‘I want to encourage people that, if they have other medical emergencies, the NHS is open for business.’
There are green shoots appearing. Some hospitals which have had fewer Covid-19 patients than expected are sending redeployed staff back to their jobs. And after the MoS intervened, Clatterbridge Cancer Centre told Jane Dabner on Friday that she will now receive her treatment. It said decisions to delay were ‘never made lightly’.
The great hope is that others, too, will receive good news. Otherwise, while coronavirus may have reached its peak, a cascade of problems in the longer term could yet overwhelm the NHS.