RETURN OF THE COVID THINKPIECES…

Let one thing be made clear: this is not a contrarian, myopic blasting of lockdown policies. It is irrefutable that Australia’s choice to lock down and lock out during the worst times of the pandemic, before the development of vaccines and emergence of the Omicron strain, saved countless lives. But what is also an unavoidable truth is that every move in these “unprecedented times” has come with a trade-off. Namely, we have traded some of our overall health as a nation for safety from the worst of COVID.

When we think about how lockdowns and restrictions have impacted people, our first thought will often be the negative effect on mental health. Mental health is absolutely an integral part of overall welfare and even influences physical health, make no mistake. But perhaps some of the reasons that mental health has taken centre stage in many discussions about lockdowns is because it can be directly linked to the tangible impacts of restrictions – loss of employment, social isolation, general uncertainty and incessant fearmongering and statistic-reporting from media. The impact of mental troubles from COVID and lockdowns can be reliably measured even at the present – see Figure 1 below for illustration of the increase in number of mental health services accessed from 2019-2021. But can the same be said for other types of health services?

Figure 1: Quantity of MBS mental health services accessed across 2019-2021 [1]

Countless politicians claimed that Australia locked down to protect vulnerable populations such as immunocompromised people and the elderly. It is clear at least that Australia’s sometimes-criticised policies have led to us faring significantly better (25 cumulative deaths per 100,000 as of 28/03/2022 [2]) compared to the US (295 cumulative deaths per 100,000 [2]). But – and I mean this in the absolute least-antivaxxer-conspiracy-theorist way possible – lockdowns and Covid restrictions have negatively impacted regular healthcare access in ways that potentially couldn’t have been predicted. A conventional benefit/cost analysis with health in mind obviously yields that it was better to lock down, again there is no question of that, however, we cannot forget about the hidden, tricky-to-quantify health costs that we accepted as a trade-off.

Potentially the most common example of this problem is the issue with dental care during the pandemic. Early on, dentists were restricted from providing many treatments due to the obvious risks of Covid transmission posed by that setting. While dental care is rarely immediately essential, it is still a very important aspect of healthcare that requires regular preventative treatment and screening, and this is something that was surely disrupted by restrictions and lockdowns. The cancellation of dental treatment surely led to countless small issues turning into big ones, and their costs of treatment increasing accordingly. For a more pressing example, cancer screening programs and cancer diagnosis were also reduced by the pandemic. Again, smaller, and potentially easily treatable issues that would have been dealt with earlier in an “ordinary” time, have potentially been able to grow into life-threatening, expensive diseases. Cancer Council Victoria predicts that over 2,000 patients had their cancer diagnoses missed during 2020, and that some cancer-diagnosing procedures were reduced in quantity by up to 18% [3].

Patient demand for healthcare has also been affected in unique ways since the pandemic, and after restrictions have lifted. The aforementioned increase in mental health services rendered has been reflected in even more people waiting to see someone for help, with psychiatry/psychology clinics being inundated by demand throughout the entire duration of the pandemic. This is an ongoing problem that has long-term costs such as worsening welfare and needing even more treatment to recover. Longer wait times have affected other areas of healthcare, as patients who endured the disruptions all attempt to access the health services at once. On the contrary, healthcare providers fear for patients who are reluctant to visit a doctor or even the emergency room due to fear of catching Covid or feeling that their issue isn’t pressing enough to put further strain on the healthcare system. Yet again, this dilemma leads to those people being worse off in the long-term due to putting off seeking help for their symptoms, or even literally dying from their concerns about seeking treatment. …

To reiterate for probably the fourth time, the net benefit of the lockdowns is abundantly clear. If people can’t find enough empathy in themselves to feel concerned about protecting vulnerable members of our population, then they should at least be thankful that they were mostly spared from the more-devastating effects of the earlier strains of Covid. Despite the concerns detailed above, we’re certainly doing better than some other nations in terms of health. Like every aspect of policy impacted by the pandemic, it is impossible to please everyone and prioritise everything, or know everything.

Health is a sensitive topic with no “right answer” when it comes to making tricky decisions that play with people’s welfare and lives. If there is any silver lining to this situation, it is that authorities are better utilised to deal with this sort of thing in future…not that we hope this ever happens again. Health authorities should continue to monitor and analyse the ongoing and long-term costs of pandemic healthcare disruption, and strongly encourage patients to return to normalcy with their demand for health services. And, if you, the reader, gain nothing else from this, at least think about whether you’re up to date with routine healthcare since the pandemic, so you can minimise your own health costs.

By Elise Williams

References:

[1] Australian Institute of Health and Welfare (2021). Mental Health Services in Australia. Retrieved from: https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/mental-health-impact-of-covid-19

[2] World Health Organisation (2022). WHO Coronavirus (COVID-19) Dashboard. Retrieved from: https://covid19.who.int/table

[3] Cancer Council Victoria (2021). More than 2,500 cancer diagnoses slip through the COVID-19 pandemic cracks in Victoria, sparking fears of a possible ‘cancer spike’ to come. Retrieved from: https://www.cancervic.org.au/about/media-releases/2021-media-releases/march-2021/more-cancer-diagnoses-slip-through-the-covid-19-cracks.html

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