The delays in care accumulated during the health crisis have multiple reasons but they converge on an essential question: what consequences on the health of patients? Excess mortality from cancer, delays in transplants, loss of autonomy… In their book ” Delays in care: the ticking time bomb » published on April 3, Sylvain Labaune et Jean-Yves Paille, journalists at the Medical Press Agency (APM), trace the first repercussions thanks to numerous testimonies from researchers, health professionals and data analysis. And offer some ways to make the health system better prepared in the event of a new pandemic. They tell us more.
Swept away by busy health news, the consequences of delays in care for non-Covid conditions accumulated during the health crisis seem to have faded into the background. They are however important in number and seriousness, weigh and will weigh on the health system. In mid-March, the president of the French Hospital Federation himself mentioned a “debt” of more than 3.3 million non-Covid stays since the start of the pandemic.
After learning regarding care management during the pandemic, it’s time to take stock. Two questions arise: what are the consequences for patients and the healthcare system? How to avoid reaching this point in the event of a new epidemic?
In our book “Delays in care: the ticking time bomb”, we investigated the consequences of deprogramming, postponements of care and screening activities through numerous testimonials from health professionals and officials in the administration.
We find that the emergency context which prevailed undeniably explains a large part of the deprogramming and postponement of care, in addition to the fear of patients to consult a doctor in town or to come to the hospital for treatment. But that does not justify everything. From doctors to general managers of ARS, many professionals recognize in the followingmath only preventable mistakes were made.
Stopping transplants or cancer screenings
These errors have contributed to inflating this “debt” of care. They were mainly committed at the start of the epidemic, during a period of stupefaction. We can cite the cessation of certain transplants or cancer screenings, which will certainly result in additional mortality. Moreover, our survey revealed that cancers have been detected at more advanced stages since the end of the first epidemic waves, with larger tumors on average.
Or once more, the disorganized monitoring of diabetic patients at the start of the epidemic raises fears of decompensation in the medium or long term which might have been avoided.
The recurrent difficulties of the health system in keeping patients in the circuit of the care system have also led to loss of visual acuity for patients with macular pathologies requiring regular intravitreal injections.
Other errors or questionable choices have punctuated the Covid epidemic, in particular a insufficient attention given to the elderly and postponed scheduled surgeries that raise fears of increased loss of autonomy in the future. Disagreements between the administration and the medical world, the lack of transdisciplinary vision to measure the urgency of certain non-Covid care raise questions.
These delays in care have particularly affected cancers, transplants, ophthalmology, chronic diseases, and cardiovascular diseases, as we have seen with health professionals and through scientific publications on the subject. But these delays also concern other medical disciplines which deserve to be analyzed in detail.
To our knowledge, no large-scale study has been conducted to concretely measure the consequences and their extent of these delays for all disciplines. From what we have explored, these are and minin several tens of thousands of people who suffer or will significantly suffer irreversible consequences.
Necessary adaptation of the health system
Measuring the extent of this phenomenon also means understanding that, during an epidemic, we cannot focus solely on Covid patients (or those suffering from other infectious pathologies). The health system absolutely must be able to preserve other support to prevent harm to other patients.
This is why a reflection must be carried out on the lessons to be learned and the actions to be taken. For example, preserving a French mask production sector seems obvious. However, following the non-compliant mask scandal and the ensuing shortage, several French factories closed… It will be necessary to have a sufficient number of critical care beds and to be able to open quickly resuscitation beds. This will inevitably go through a massive recruitment of new health professionals.
You will also have to think regarding the architectural projects to deal with epidemics and effectively separate infected and uninfected patients. More generally, it will be necessary strengthen the link between the city, the hospital and the medico-socialin order to allow smoother cooperation.
A prepared health system will avoid costly and heavier care.
The former Minister of Health, Olivier Véran, had put forward, in the summer of 2020 during the conclusions of the Ségur de la santéthe theme of a strong public health to better prepare and better fight new crises which are bound to arise and which will affect the health of the population”. It is clear that this no longer appears in the priorities displayed today by the executive.
Sylvain Labaune, Jean-Yves Paillé
