Non- COVID fatalities in the COVID era: A paradigm shift in the face of a pandemic- lessons learnt (or not)

Abstract

Introduction The rapid spread of the coronavirus pandemic and the associated high morbidity and mortality led to sudden lock down, forcing the elderly and others in the high risk group into isolation. Elective health care services including diagnostics, therapeutics and elective surgical services were put on hold, leading to delays seriously affecting cancer and non-cancer related services. In spite of lessons learnt during the first wave, similar issues have persisted during the second wave, increasing the pressure on an already fragile infrastructure. Methods Information related to surgical patients admitted since lock down (March to August 2020) as an emergency was collected on a structured proforma and analysed. Data was gathered from prospectively kept patient admission lists and Electronic Discharge summaries. All the patients who were directly or indirectly affected with poor outcomes including delayed diagnosis and treatment were identified and included in the analysis. Results A total of 185 patients were admitted as an emergency during this period. Of these Eight patients admitted under surgical care were included in the study. Four out of eight patients were diagnosed with advanced cancer and the remainder presented with complications of benign pathologies. Of the four patients with advanced cancer, three patients had advanced colorectal and the fourth had advanced ovarian cancer. All four patients either presented late or had delayed access to investigations. Three out four patients with benign disease presented with complications due to cancellation of elective and semi urgent services. One patient who was COVID positive and presented with bowel perforation died after a prolonged hospital stay. Conclusion There is definite evidence of unfavourable patient outcomes in non COVID patients as a result of the COVID pandemic. As COVID is unlikely to whither down in the very near future and highs and lows are expected, rapid and safe reintroduction of elective health care services affected by COVID is the call of the hour. In addition, more efforts should be directed towards increasing awareness amongst patients regarding the importance of reporting red flag symptoms and encouraging them to access health care services.

Colorectal cancer in patients with SARS-CoV-2: a systematic review and meta-analysis

“…Few studies were made within multi-countries ( n = 3) [ 9 , 12 , 51 ]. The majority of the studies were single centre [ 11 , 16 , 23 , 25 , 27 , 28 , 30 – 35 , 44 – 50 , 52 , 54 , 55 , 58 , 59 , 61 – 63 , 65 – 69 , 71 , 72 , 74 – 76 , 78 , 80 , 82 – 84 ] and only 25 studies were multi-centre [ 8 – 10 , 12 – 17 , 26 , 29 , 36 , 43 , 51 , 53 , 56 , 57 , 60 , 64 , 70 , 73 , 77 , 79 , 81 , 85 ]. The median NOS score for these studies was 6 (range, 5–7).…”

“…3 . In the hospital-acquired SARS-CoV-2 infected patients, subgroup analysis showed a significant difference in the rates between all patients (Europe, multi-countries, Asia and America) [ 9 , 10 , 25 – 28 , 30 , 31 , 35 , 36 , 47 , 51 , 53 , 56 , 57 , 60 , 61 , 65 , 68 , 69 , 72 , 74 , 77 , 79 , 80 , 83 , 85 ]; and Europe only patients [1.1% (95% CI 0.5 to 1.6, n = 178, 12 studies, I 2 = 91%)] [ 10 , 25 – 27 , 35 , 47 , 53 , 56 , 60 , 61 , 77 , 79 ]; multi-countries only patients [4.7% (95% CI 3.6 to 5.9, n = 212, 2 studies, I 2 = 90%)] [ 9 , 51 ]; Asia only patients [0.7% (95% CI 0.0 to 1.4, n = 32, 9 studies, I 2 = 69%)] [ 28 , 31 , 36 , 57 , 65 , 68 , 74 , 83 , 85 ]; and America only patients [2.3% (95% CI 0.9 to 3.6, n = 32, 4 studies, I 2 = 10%)] [ 30 , 69 , 72 , 80 ], respectively; Fig. 4 .…”

“…The median patient age ranged from 51.6 years to 80 years across studies. There was an increased male predominance in CRC patients diagnosed with SARS-CoV-2 in most of the studies [ n = 2243, 66.7%] [ 9 , 11 , 14 , 16 , 17 , 25 , 27 , 28 , 30 , 32 – 35 , 47 , 52 – 59 , 61 , 62 , 71 , 72 , 74 , 75 , 77 , 81 – 85 ] and majority of the patients belonged to White (Caucasian) ( n = 262, 7.8%), Hispanic ( n = 156, 4.6%) and Asian ( n = 153, 4.5%) ethnicity [ 11 , 13 – 17 , 25 – 34 , 36 , 43 , 44 , 46 – 50 , 52 – 55 , 57 – 61 , 67 , 70 – 73 , 75 – 78 , 80 , 81 , 83 – 85 ]. Most patients were diagnosed for CRC through symptoms, endoscopy, radiological imaging, biopsies and tumor markers [ 8 – 10 , 12 – 14 , 16 , 17 , 23 , 25 – 36 , 43 , 44 , 46 – 56 , 58 – 61 , 65 – 77 ...…”

Fear of COVID-19 leading to late presenting myocardial infarction complicated by cardiogenic shock due to ventricular septal rupture

“…An observational prospective study enrolling a total of 185 patients has shown that 50% of the acute surgical cases who tested negative for the COVID-19 experienced service delay in healthcare and presented late with stage IV cancer as underlying aetiology. 14 …”

“…In terms of non-COVID-19 non-cardiac emergencies, delayed care seeking due to disruption in the healthcare utilisation has resulted in increased morbidity and mortality. An observational prospective study enrolling a total of 185 patients has shown that 50% of the acute surgical cases who tested negative for the COVID-19 experienced service delay in healthcare and presented late with stage IV cancer as underlying aetiology 14…”