The collapse in non-COVID care

With the world fighting a pandemic, demand for healthcare has plummeted in the UK and elsewhere.

This counter-intuitive trend was partly deliberate: dentists were shut, non-urgent care and operations were cancelled in most hospitals, and around 30,000 beds were emptied to prepare for coronavirus patients. But the drop in patient numbers across the NHS was also faster than anyone expected. In April, when the UK was in full lockdown, NHS England saw its lowest-ever attendance figures for accident and emergency – a full 57% lower than a year earlier – while Public Health England reports that cancer referrals from GPs have fallen by 80% in some areas. Telemedicine has filled some of the gap, but not all.

The UK is not alone. In the US the collapse in non-coronavirus care is causing chaos in the private healthcare sector. In the first quarter of 2020 overall US GDP contracted by 4.8%, but the recession was led by an 18% year-on-year fall in healthcare services. By April, the impact was being felt in the jobs markets, with employment in the healthcare sector falling by 1.4 million during the month, according to the US Bureau of Labor Statistics. Dentists accounted for over half a million of these. The pattern was mirrored in China, where consumer expenditure on healthcare declined by 10.2% year-on-year in the first quarter, outpacing the 9.2% drop in total consumer spending.

These conflicting trends in the healthcare sector have been echoed in pharmaceuticals. While most of the big global pharmaceutical companies have managed to avoid a hit to their revenues or their share prices, amid the mayhem affecting other sectors, a few have not. Merck & Co (US) issued a profit warning in April, saying that it had been affected by the drop in GP care. Johnson & Johnson also cut its guidance, dented partly by the fall in consumer healthcare. Medtech companies focused on cardiovascular care, such as Boston Scientific, have also fared badly.

Social distancing measures, lockdowns and government priorities are partly to blame for the fall in non-coronavirus care. But so too is patients’ fear of contracting the virus, and their worries about placing an additional burden on healthcare workers. For that reason, getting patients to come back as the lockdowns ease will require huge amounts of reassurance. Since mid April senior NHS doctors have been exhorting people not to ignore potentially dangerous symptoms such as chest pains, and not to avoid routine vaccinations, stressing the non-coronavirus care has been carefully separated from the coronavirus wards. On May 14 NHS England published a roadmap for the restarting of routine operations, outlining how safety measures will work.

One danger, however, is that once patients do start to return, they will cause yet another crunch in NHS services. Medefer, a provider of virtual NHS healthcare, forecasts that the waiting list for NHS treatment will swell from a record 4.4 million people in February 2020 to 7.2 million by the end of September. And getting through the backlog will be made even more difficult by the need for stringent safety measures. Surgeons and anaesthetists report that, thanks to the need to don personal protective equipment (PPE), routine operations are taking up to four times as long as usual, and are exhausting to perform. As a result, the number that can be done each day has plummeted. Even more worrying are reports of shortages of certain drugs needed for non-coronavirus care, including anaesthetics.

As a result, the end of the coronavirus crisis will be far from the end of the healthcare crisis. Nor will it be the end of the death toll. Research from University College London and Data-Can, a cancer data hub, suggests that delays in treatment and diagnosis of cancer could lead to almost 18,000 extra cancer deaths over the next 12 months.