Cancer patients are far from alone in the fear that coronavirus will kill thousands of people with chronic conditions
In the six years since Jane Dabner’s breast cancer diagnosis, she’s been through it with dignity and good humor. The 57-year-old says that despite tumors that have “ popped up everywhere, ” most recently in her skull, she continues to live a fulfilling life – thanks to advanced medications administered every three weeks at the Clatterbridge Cancer Center on the Wirral.
And since the mother of two – who lives in nearby Bebington – recently became a grandmother for the first time, she plans to visit her little grandson as soon as the block is lifted. She says she “still has a lot to live”. Or she hoped – until her future looked very uncertain.
Jane, it seems, was considered collateral damage in the battle against Covid-19 – one of thousands of patients across the NHS said their life-prolonging treatments would be canceled or postponed until after the crisis was over. And of course nobody knows when that will be.
“It really feels like there are a large number of patients who cannot be cured,” says Jane. “But we’re not ready to be written off yet.”
Casualty of the Crisis: Jane Dabner, who had canceled her cancer treatment. The mother of two – who recently became a grandmother for the first time – says she has ‘a lot of life left’
Jane, as it becomes painfully clear, is not alone. Across the country, a new growing health crisis is developing – the true magnitude of which may not be felt for months or years to come.
In cancer care alone, 2,300 tumors are missed every week as the number of referred patients for emergency hospital appointments plummets by 75 percent, according to Cancer Research UK. Procrastination and cancellation also affect those awaiting heart surgery, organ transplants, and patients on dialysis for kidney failure, The Mail on Sunday has learned.
In many cases, decisions are made because treatments for these conditions can suppress the immune system, making patients more vulnerable to coronavirus.
But NHS Trusts are also forced to divert resources to the frontline, re-deploying doctors of all specialties and transforming hospital wards into makeshift Covid-19 wards.
Patients who are most at risk for the virus from pre-existing diseases have been told to ‘shield’ – to exercise a strict social distance by staying home at all times and avoiding any personal contact. Still, there are increasing concerns. While self-isolation can protect them from the ravages of the virus, there can be a brutal payoff as many can worsen their condition. And some, experts say, could die from this.
Professor Stephen Powis, medical director of NHS England, confirmed a 50 percent drop in people going to A&E in April yesterday – which is equivalent to a million fewer patients.
When asked if people had already died after not being treated quickly enough, he said, “That’s our concern, of course – it’s that people will suffer damage if they don’t go to the hospital.”
He added that it was important to start reintroducing routine surgery now that the Covid-19 numbers were starting to drop, but warned that it would take “a little bit of time.”
Harry Whitehorn, an 11-year-old pneumonia patient, who was taken to Salisbury Hospital “because it was too late” when NHS 111 called an ambulance
Indeed, perhaps a worrying trend of non-Covid-19 fatalities has already started.
Data released by the Office for National Statistics for the week to April 10 revealed a shocking spike in deaths, reaching 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.
In the previous week, 43 percent of excess deaths did not have Covid-19 on the death certificate, which Professor Sir David Spiegelhalter, a risk expert at Cambridge University, said he was upset and shocked. “How much is collateral damage from the lockdown?” Asked Sir David. “We just don’t know.” However, the place of death may be an indication, he says.
Due to the lack of community testing, many of those who die of Covid-19 at home, in nursing homes or in hospices may not be registered as victims of the virus. Indeed, analysis of the ONS figures shows that 70 percent of additional deaths in care homes and at home are not labeled as Covid-19, meaning underreporting can be a problem.
Significantly, however, the number of non-Covid hospital deaths has fallen by 27 percent, closely corresponding to a 29 percent drop in hospital admissions in March. In other words, some of these deaths may be patients with other diseases that have not been treated.
Sir David said, “It is not clear how many of these non-Covid excess deaths are underdiagnosed and how much collateral damage. But a clear shift in non-covidal deaths from hospital to community points to a substantial impact of the current blockage 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 it turns out that these deaths are not directly related to coronavirus, but instead are a sad side effect of lockdown, what should we gain protecting people from coronavirus can be lost. ‘
Professor Chris Whitty, Chief Medical Officer for England, pictured during a daily coronavirus media briefing on Downing Street. Officials urge everyone to continue using the NHS
Justin Stebbing, a professor of cancer medicine at Imperial College London, admitted that most oncologists had to make “heartbreaking decisions” about which patients should be given priority, 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 forced to make a choice – the risk of dying from the virus or the cancer.”
Guidance from the National Institute for Health and Care Excellence (NICE) recommends cancer centers prioritize patients most likely to survive, but Prof. Stebbing said individual centers and regions also drew up their own guidelines based on how well they were able to continue to give treatment. He said one of his patients at Charing Cross Hospital in central London, a 37-year-old woman with advanced breast cancer, would die ‘within weeks’ if her treatment was discontinued. While her care would continue, he said, similar patients in other hospitals might face stopping theirs.
The picture for other circumstances is equally worrying. Thousands of joint replacement, hernia and cataract surgeries have been canceled to clear hospital beds, and transplant centers perform only the most urgent cases.
Meanwhile, NHS England has said that only 60 percent of acute hospital beds are occupied, compared to 90 percent a year ago.
Specialist in intensive care, Dr. Ron Daniels, founder of The UK Sepsis Trust, said: “Normally I would expect at least one patient to be referred to us with sepsis every day [a life-threatening condition resulting from an infection].
Thousands of joint replacement, hernia and cataract operations have been canceled to release hospital beds amid the coronavirus pandemic (hospital ward file photo)
“I haven’t had one in recent weeks, and that’s alarming – where are those patients?” The number of heart attacks treated in England alone fell by half in March – from 300 a day to just 150. This doesn’t mean fewer people are having heart attacks, but fewer are going to hospital.
Cardiologist Dr. Ramzi Khamis, a fellow of the British Heart Foundation, said the number of patients who entered his heart attack center at the Imperial College Healthcare NHS Trust in London had halved and many who had “significantly delayed” sought help. He said, “We want to emphasize that we have the staff, equipment and resources to treat heart attacks. Delays in treatment put lives at risk and will put more pressure on the NHS, no less. ”
The same is true for stroke care, where speed of treatment is often the difference between life and death. Stroke specialist Dr. Paul Davies of the North Cumbria Integrated Care NHS Foundation Trust said that the number of patients admitted to a stroke clinic in recent weeks across the country was “significantly less” than usual.
He added, “Our major concern is that there are those with stroke symptoms, such as limbs or paralysis of the face on one side of the body, confusion and speech problems, who are too afraid to come to the hospital because of COVID-19.’
But without treatment, many would be at risk for a “ potentially larger stroke, ” he said – and it can be deadly.
GPs across the country report seeing half of the number of patients they would normally get, which means that a whole host of symptoms – from small to possible red flags for more serious illness – aren’t picked up. Screening for breast, cervical and colon cancer has been suspended.
Sarah Woolnough of Cancer Research UK said the “stay at home” message had “unintended consequences.” She added, “The danger is that the treatment will be delayed for too long [a cancer] becomes unusable. ‘
Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, has already warned that sick children have died from hospitalization delays.
A pediatric nurse in intensive care said, “Everyone says this: the children they see are generally sicker than before because parents don’t like to go to health care.”
GPs across the country report seeing half the number of patients they would normally have, meaning a whole host of symptoms aren’t picked up (file photo)
All experts urge parents to “listen to their instincts” and seek medical attention for unusual symptoms. But for many, like Katy Whitehorn, it’s a confusing time. Her son Harry, 11, became extremely ill with what turned out to be bacterial pneumonia, but not sure where to go for help, she eventually took him to the hospital “because it would be too late.”
Katy, 40, who lives near Salisbury, Wiltshire, said, “On the one hand, I didn’t want to tax the NHS if it’s been stretched too long, and on the other, I thought we would get corona virus if we Hospital.’
Harry was taken to Salisbury District Hospital when NHS 111 called an ambulance. “Everyone has done their job so kindly and I can’t thank them enough,” says Katy. “But many parents I’ve spoken to still don’t know what to do in a crisis.”
After all, these are not normal times. And this in itself can save psychological problems, not just in people with a history of anxiety or depression. Mental Health Charity Young Minds surveyed more than 2,000 youth with a history of mental illness and found that 83 percent believed the pandemic had made their condition worse.
And an article in the medical journal The Lancet last week suggested that school closings may worsen mental illness in children, adding that there may also be “significant adjustment difficulties when school resumes.”
There is no sign (yet) of returning to normal, but officials are urging everyone to continue using the NHS. Professor Chris Whitty, the Chief Medical Officer for England, said, “I would like to encourage people, if they have other medical emergencies, that the NHS is open for business.”
Green shoots appear. Some hospitals that have had fewer Covid-19 patients than expected send relocated staff back to work. And after the MoS intervened, Clatterbridge Cancer Center told Jane Dabner on Friday that she will now receive her treatment. It said decisions to slow down were “never taken lightly.”
The big hope is that others will also receive good news. Otherwise, the coronavirus may have peaked, but a cascade of longer-term problems can still overwhelm the NHS.
Questions and Answers with Dr. Ellie Cannon: Can Disinfectant Treat Covid, And Will Diet Protect Me?
Q President Trump suggested that scientists were investigating whether the use of disinfectants in the body could treat corona. Is there anything in it?
A At a really bizarre press conference, Donald Trump first seemed to suggest that we could use UV light and then disinfectant in patients with coronavirus.
One possible reason he said this is that laboratory studies have shown that both disinfectant and UV kill the virus.
This would be useful for surfaces, hospitals and for mass disinfection.
What this does not mean is that there is some evidence that it would be safe or effective for use on or in the human body – both are dangerous.
Most household disinfectants in this country are bleach-based or contain other chemicals that, even at diluted levels, are toxic and potentially deadly if ingested, let alone injected.
During a really bizarre press conference, Donald Trump first seemed to suggest that we could use UV light and then disinfectant in patients with coronavirus (file photo)
Likewise, UV light, although used in a very controlled way for psoriasis, it damages cells and causes cancer.
There is no evidence that they have ever been used to treat a respiratory infection such as Covid-19.
Once the virus has infected the human body, it lives in cells, so it is quite unlikely that a shining light would have an effect on the body.
Trump also said that the arrival of summer would kill the disease, because the virus is destroyed by heat.
In fact, the latest evidence suggests that you need to heat this coronavirus to temperatures above 56C to deal damage, which the kibosh puts on that theory as well.
Needless to say, any attempt to raise body temperature to something close to this level would be deadly.
Q I have read that being overweight can make corona worse. Should I go on a diet?
A It appears to be true that among patients with severe Covid-19 in hospitals, a significant number are overweight or obese.
But it is by no means clear whether obesity is only the cause of more severe symptoms. We do know that diabetes, high blood pressure and heart disease lead to worse results and these conditions are more common in overweight people. But if you are overweight and have no other conditions, are you at greater risk? We just don’t know.
Q What can I do to strengthen my immune system and better protect myself against the virus?
A The honest answer to this is not much. Our immune system is a whole catalog of proteins, glands and organs in the body that all work together to protect us from viruses.
The whole system works well if we are generally in good health. That is why eating well, sleeping well and exercising are all important.
The less we sleep or exercise and the worse our diet, the more likely we are to get sick in general. I see it all the time: When my patients ignore one of these areas, they get more infections. If your diet lacks a good range and fruits and vegetables, it may be worth supplementing it with vitamins, especially A, D and C, as well as the minerals iron and zinc.
Stress also seems to weaken our immune system. Mindfulness, exercise, and regular conversations with supportive friends will help reduce stress and maintain a good immune system.
Q What about vitamin D supplements? Are they going to help protect me?
Vitamin D is actually a hormone produced by the skin in response to sunlight.
It is very difficult to get adequate amounts in the diet because it is found in such low concentrations in foods.
It plays a variety of roles in the body, from supporting bone and muscle health to use within the immune system.
All adults in the UK are advised to take supplements during the winter months as there isn’t enough sunshine to make the vitamin in our skin.
During lockdown, since we are all out much less than usual, it would also be advisable – but now that it’s spring, you only need 20 minutes in a T-shirt outside to get a daily dose.
If you can’t figure it out, a supplement may still be a good idea.
But there is no evidence that if you take vitamin D, you are less likely to suffer from the infection.