Last week, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci urged states with rising COVID-19 rates to consider a new round of lockdown restrictions.
"You may need to pause, you may need to drop back a little bit," Fauci said. "I don't think you necessarily have to revert to go all the way back to reclosing."
As they try to get the coronavirus' spread under control, states must resist the urge to impose blanket stay-at-home orders. Such draconian measures can cause people to postpone important medical care unrelated to COVID-19. The health costs of this foregone care are substantial – and could end up outweighing the benefits of another shutdown.
According to a recent FAIR Health analysis, nationwide health care utilization fell a whopping 68% in April, when lockdowns were at their peak, compared with the previous year. In the Northeast, then the epicenter of the outbreak, utilization rates dropped 80 percent.
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The consequences of foregoing medical care on such a large scale can be catastrophic. Consider that, back in April, hospitals across the country reported sharp decreases in the number of heart attack and stroke cases. People didn't suddenly stop having heart attacks and strokes. It's far more likely that they opted not to seek care for acute conditions like these.
The fall-off in utilization coincided with a reduction in diagnostic testing for a range of serious illnesses. Between February and April, screening rates for some cancers plummeted by as much as 90 percent, as patients put off everything from colonoscopies and PSA tests to mammograms and pap smears.
As one might expect, fewer tests have led to fewer diagnoses. A study published last week in JAMA Network Open, a medical journal, looked at diagnoses for six different forms of cancer between March 1 and April 18. It found a 46.4 percent decrease in the average weekly number of newly diagnosed cancer patients, compared with the period between January and February.
What this suggests is that an extraordinary number of Americans are now living with undiagnosed cancer. If they're ordered to stay home – or even discouraged from venturing out for routine medical care – then it could be months before their disease is detected. At that point, it may be too late for treatment.
The steep decline in demand for medical care doesn't just have implications for patients. It's become an existential threat for health care providers.
And even though most of the country has opened back up in some form or another, health care utilization rates have yet to return to pre-pandemic levels. The health insurance giant Cigna reported on July 30 that, after a significant dip earlier in the year, utilization was "closer to normal" in June, but lagging, nonetheless. The firm expects a similar level of utilization in July.
The steep decline in demand for medical care doesn't just have implications for patients. It's become an existential threat for health care providers. A report published in mid-July by McKinsey found that 53 percent of independent physicians weren't sure that their practices would survive the COVID-19 crisis. Just under half of these practices had less than four weeks of cash on hand.
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Even before the pandemic, one-third of the nation's hospitals lost money on patient care. Stay-at-home orders compounded those financial problems by helping drive annualized personal medical spending down by over $1 trillion in April. That same month, the economy shed 1.4 million health care jobs.
Another round of lockdowns could lead to mass closures of health care facilities, leaving many patients – particularly those in rural areas – without access to care.
Then there are the psychological consequences of sheltering-in-place, which include feelings of isolation, depression and anxiety that could have lasting effects on one's mental health.
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Public officials must consider the very real trade-offs associated with stay-at-home orders. Their price may be increased suffering and death due to cancer, heart disease, mental illness and countless other health problems. And they may put health care providers out of business, at a time when access to care continues to be critical.
If states like California, Texas and Florida ignore these costs and move ahead with another round of blanket lockdowns, they could end up making a bad situation even worse.
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