Patients Left Behind: Ethical Challenges in Caring for Indirect Victims of the Covid‐19 Pandemic

Abstract

In response to the Covid‐19 pandemic, health care systems worldwide canceled or delayed elective surgeries, outpatient procedures, and clinic appointments. Although such measures may have been necessary to preserve medical resources and to prevent potential exposures early in the pandemic, moving forward, the indirect effects of such an extensive medical shutdown must not outweigh the direct harms of Covid‐19. In this essay, we argue for the reopening of evidence‐based health care with assurance provided to patients about the safety and necessity of high‐value vaccinations, screenings, therapeutics, and procedures. To ensure that virtually all non‐Covid‐related services do not come to a halt again, health care systems and physician practices must preemptively increase their capacity, secure adequate personal protective equipment to safeguard health care personnel, and develop a measured approach to reclosing such routine health care, should it become necessary in the future.

Ethics in Emergency Times: The Case of COVID-19

“…This increase in "indirect mortality" may have many different causes 18 [68] and the figures, which are in any case impressive 19 (see also [69][70][71]) are not easy to work out, because both short-term and long-term outcomes need considering. The fact remains that a pandemic such as that prompted by SARS-CoV-2 unavoidably entails the risk of some patients' being "left behind" [72], precisely because the healthcare system cannot work as it does in normal times.…”

Covid-19

“…Procedures such as hysterectomies, cancer biopsies, and knee replacements if delayed can have a devastating impact on quality of life and outcomes. 8…”

“…The Office for National Statistics reported the highest death rate in England and Wales since the year 2000. There were 6082 more deaths than the 5-year average, and only 3475 of these deaths were related to COVID-19, 8 raising more alarm that an increased number of deaths were occurring unrelated to COVID-19 because of the strain on the health care system due and public resistance to see medical attention because of concerns for contracting COVID-19.…”

“…The health care system is faced with a fine balance to treat not only those with COVID-19 but also those with non-COVID-19-related medical needs. 8 Ensuring that by focusing on treating and preventing COVID-19, we are not worsening morbidity and mortality for those with non-COVID-19-related medical needs. We must equitably care for both COVID-19-and non-COVID-19-related patients.…”

“…Short-term limitations may be needed as cases of COVID-19 increase; however, medicine does not know yet the evidence-based risk benefit of short-term closings and if this is needed on an individual basis or as a population. 8 In an online interview, 11 Tom Lindquist, the CEO of Allina Health-Aeta, advises that besides reaching out to media interviews and recording podcasts encouraging at-risk populations to seek care and encourage patients to return to routine care, they are Pieper making efforts to make sure at-risk patients feel safe for their visit. They are sending convenience packages to seniors that include thermometers, masks, and hand sanitizer to help them feel safe to visit a clinic if they need or prefer this option over a virtual visit.…”