The cost of deferred care: We cannot pause our healthcare system

As a public health researcher, I join everyone in worrying about the Coronavirus. With what we know so far, it is safe to claim that this could be the most alarming health crisis of our generation to date. In less than few months, this pandemic became the number one health priority globally, and more importantly, locally. But as the situation continues to unfold in Jordan, and as we enter the sixth week of a nation-wide lockdown, my worry about the health of millions of Jordanians continues to grow. Albeit there have been much deeply appreciated efforts by officials in the country to maintain healthcare for other health situations unrelated to the coronavirus, the situation continues to be far from normal.

With this virus as a healthcare priority around the world, those with chronic illnesses, including cancer, are left feeling unsettled. Patients, those with worrying illnesses far before the times of coronavirus, have come a long way in their independent battles to be left uncared for during these times. Their worry is multifold. On the one hand, many of these patients suffer from diseases that put their immune system at stake, and hence cannot afford the slightest exposure to a hospital, a clinic or any other medical facility. Additionally, these patients may be worried that their doctors, whether their primary care physicians or oncologists, are too busy battling the coronavirus. With the madness surrounding this pandemic, such patients may be left out feeling that their illness, which is their top concern prior to and during these times, is the least of their physician’s concerns. This reality could be extremely worrying. Research has repeatedly shown that chronic illness patients with low access to healthcare have significantly different trajectories to health outcomes compared to those who are able to access care. In the case of a lockdown, the majority, if not all, of chronic illness patients are experiencing barriers to healthcare, which is ultimately affecting their mental health too, setting another barrier to recovery.

The lockdown also imposes health risks to the healthy. Expecting the population to adhere to its typical diet during the times of lockdown is unthinkable, and physical activity patterns are bound to be drastically changing. With these lifestyle changes, we are not solely worrying about cardiovascular disease or obesity outcomes. Health research consistently showed that those who lead a physically active life and eat healthy are more equipped to fight diseases. In fact, in a study looking at immune response following influenza vaccine, individuals who reported moderate physical activity in the past leading to their vaccine injection demonstrated enhanced immune response against influenza compared to those who were not physically active.

Furthermore, it would be no surprise to see mental health issues fueling as the economy continues to be held captive of this crisis. Financial and social stressors will continue to arise and trouble people. Happiness and stress are associated with an adverse set of health outcomes, including those that influence our immune response. Remaining happy and minimizing stress is not just important during normal times, but also should be a priority and a key weapon in our fight against the coronavirus. The message should be clear: a nation whose people are healthier, more physically active and mentally at peace is a nation that is more prepared to combat diseases. As we continue in a state of lockdown, it is very likely that many physical and mental health outcomes, including those associated with our immune response, will be severely affected.

At the current time, and as there continues to be no alternative for policy makers besides the lockdown, it is important that we begin preparing for what will follow. As more time passes in lockdown, the burden of deferred care continues to increase. Policies should be put in place to ensure the accessibility of healthcare for those most vulnerable. The needs of those with chronic illnesses cannot be neglected for long. If you are a patient, seek care –your primary physician or oncologist should not be too busy to care for you. Healthcare facilities around the country must be accessible to such patients despite the pandemic. It is paramount to address the barriers to healthcare access that have emerged during these unusual times. And if you are a physician, encourage your patients to seek care and foster an environment that leads them to express their concerns safely. Be there for those who are at-risk. We know your plates are full given the coronavirus struggle, and the nation applauds your commitment to fighting this pandemic, but your chronically ill patients may need you now more than ever, even if they do not voice their concerns directly.

People’s illnesses and health status will not give them a time off due to the Coronavirus pandemic. Hence, our healthcare system cannot be toned down while we fight a pandemic. There is no policy without its drawbacks. With every decision made, there are negative side-effects that must be accounted for. And the side-effects of a lockdown imposed for more than a month could be profoundly heavy. We must remember that not everyone has the luxury of staying at home for long periods of time by choice. Many people need to seek care. While they can withstand avoiding seeking treatment for some time, to join forces in our fight against the Coronavirus, the cost of deferred care may be an expensive one. A second pandemic may hit us after this one, one that is hidden and underlying in our society as we speak today. We must prepare accordingly.

Yazan Ahmad Al-Ajlouni is a Public Health Researcher at The University of Cambridge in the UK and at the Columbia University Mailman School of Public Health in New York City. He has over a dozen peer-reviewed publications in the field of public health, in addition to co-authoring four book chapters focusing on Neighborhood and Geo-Spatial Health. He contributed this article to The Jordan Times