Chronic disease wave looms post-pandemic

STEVEN ROSS JOHNSON  April 20, 2021 03:47 PM

COVID-19 vaccinations have brought heightened hope for the end of the current health crisis, but healthcare experts worry the pandemic may have created an even greater and longer-lasting challenge for millions of individuals with preventable chronic health conditions.

Currently, 6 in 10 adults in the U.S. have at least one chronic disease, while 4 in 10 have two or more, according to the Centers for Disease Control and Prevention.

The safety protocols instituted to slow the spread of COVID-19 also disrupted access to many non-emergency, routine care services for months. That's led to a reported rise in patients showing signs of more advanced preventable chronic diseases because they were not managed or controlled at earlier stages.

Dr. Nirav Vakharia, an internal medicine and geriatrics specialist at Cleveland Clinic, has seen patients present more markers of chronic disease control, like blood pressure readings, blood-sugar measurements and medication adherence since the beginning of the pandemic. Those health declines could be attributed to patients delaying seeking care, which he felt was likely due to their fears of contracting COVID-19 at a healthcare facility.

A Centers for Disease Control and Prevention study released last September found 32% of U.S. adults by last June reporting they avoided routine medical care due to concerns over COVID-19, while 12% of adults delayed seeking urgent or emergency care.

Earlier this month, former Food and Drug Administration Commissioner Dr. Robert Califf warned in the American Heart Association's science journal Circulation that the country needed to take action now to avoid what he described will be "…an enormous wave of death and disability due to common chronic diseases" after the pandemic.

Cleveland Clinic late last year increased its community outreach efforts to help patients better understand why it was important to engage in certain aspects of their care. Stressing the importance of patients undergoing preventive screenings has been a focal point of the campaign's message.

While part of the health system's effort has been to assuage patients' safety concerns about visiting their facilities, Vakharia acknowledged a sizable portion would likely remain away for the foreseeable future. In response, the health system has promoted the use of in-home screening tests for conditions like colorectal cancer.

Like many other providers, Cleveland Clinic has also increased its use of remote tools like telehealth, remote patient monitoring, and phone apps to help patients manage their chronic diseases from home without the need of an in-person visit.

"Those are a lot of the really, dare I say, positive developments in terms of how healthcare has flexed to meet the patients' concerns during the pandemic," Vakharia said.

While the clinic's outreach may alleviate some of the losses in patient volume experienced during the pandemic, Vakharia was concerned it may not be enough to reverse current trends, which could result in more missed opportunities to detect and treat cancer or heart disease at earlier stages.

"Instead of a polyp found during a colonoscopy that can be taken out and the cancer can be avoided altogether, patients are now presenting with stage 2, stage 3or stage 4 cancer," Vakharia said.

Delayed care aside, another concern involves the long-term health outcomes for older patients and individuals with serious underlying medical conditions who contracted COVID-19. Such higher-risk patients are more likely to experience serious longer-term health effects as a result of having COVID, like heart and lung damage and blood clots, all of which will require ongoing monitoring.

Evidence has pointed to an increase in individuals engaging in risky health behaviors during the pandemic like overeating, physical inactivity, drug and alcohol use, and smoking, which some say is likely the result of increases in stress and anxiety levels, will likely lead to a increase of cases of cancer, diabetes and heart disease.

Calls to state-run smoking cessation hotlines declined by more than 190,000, or 27%, in 2020 compared with 2019, according to a recent report by the advocacy group the North American Quitline Consortium, while cigarette sales increased by 1% after annual declines of up to 5% since 2015.

"Things like diabetes and hypertension require continuous care, and so to the extent that care has been delayed, there may be more uncontrolled diabetes, more uncontrolled hypertension that we're seeing in our communities," said Dr. Susan Kansagra, board president of the National Association of Chronic Disease Directors.

The focus on more acute immediate care needs at many healthcare facilities during the pandemic has reduced the availability of chronic disease care activities. Patients have had less access to preventive resources like screenings to identify the early onset of chronic diseases, while consultations, support staff and resources needed to help patients better self-manage their health conditions have been less available as well during the ongoing emergency.

Dr. Richard Freeman, regional chief clinical officer for Chicago area-based Loyola Medicine, said the pandemic's first surge in March 2020 forced the health system to scramble to set up a new telehealth platform in matter of a few weeks while figuring out whole new processes for seeing patients.

During that emergency period he said he was sure there were patients with chronic diseases whose conditions worsened, which likely led to some who got severely sick and some who died because they weren't able to access their regular pattern of care or chose not to our of fear of contracting COVID-19.

Freeman said more fail-safes were put in place by the time the health system experienced its most recent COVID surge in November. Telehealth services were fully operational, which allowed clinicians to check on of their higher-risk patients. Soon after, clinical staff began checking in on at-risk patients and scheduling follow-up visits either in-person or virtually.

Freeman believes the changes will allow the health system to better handle a potentially steep rise in demand for previously delayed elective surgeries and diagnostic procedures after more people are vaccinated.

"We're going to be in a better place as we come out of this last surge than we were at the end of the first surge," Freeman said.

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