opinion: covid-19 is causing deadly delays in diagnoses

the incidence of brain cancer in children in canada is  three in 100,000 . brain cancers are treatable when they are localized but prognosis worsens and they become less treatable as they grow larger, spread throughout the brain and in some cases metastasize through the cerebrospinal fluid down the spine and around the brain. they are aggressive, as  brain cancers are the second most common cause of childhood cancers after leukemia but the most common cause of childhood cancer mortality .

very often in the last year or so, i have seen children for the first time when they have already reached the end stage of brain cancer. these are children whose illness is dreadfully apparent. they are children whose  lives we could have saved if they had been diagnosed even six months earlier .

i know why that didn’t happen: the covid-19 pandemic, and  its effects on our health-care system  and its patients. sometimes families were too reluctant to take their children to see their family physicians, or regular care was only accessible through online appointments, where so much less information is available to the clinician. this includes the  vital observations that can only come from a physical examination .

virtual visits
seeing a patient on a screen is nothing like examining a child in person. there are cues we get from muscle tone, eye clarity and subtleties in breathing, for example,  that when taken together with other information can flag serious problems in time for us to treat them .

sadly, i’m certain that  these preventable deaths are happening throughout the health-care system , among children and adults alike. patients have delayed seeking diagnosis and treatment because they were more afraid of the virus than of whatever else was happening.

my colleagues talk about adult patients who skipped diagnostic procedures like colonoscopies, ignored chest pains or failed to investigate other serious concerns . people suffering from other conditions have become the collateral damage caused by the ongoing pandemic.

health care after the pandemic
as we appear to be emerging from the worst stages of the pandemic, i am bracing myself to see more children with advanced terminal cancer, knowing they could have lived if not for this well-meaning but misguided approach.

since the spring of 2020, though, it’s almost as if there were no other health problem but covid-19. while in the foreground we’ve been assiduously washing our hands, wearing our masks, keeping our distance and getting our vaccines,  the drumbeat of other serious health problems has continued as steadily as ever .

even in health care, i think too many were too ready to pinch off in-person contact with patients in family doctors’ offices, community clinics, in imaging and other diagnostic services, all of which are vital conduits for  earlier diagnosis of symptoms that patients can’t identify themselves .

future pandemics
i dread what my colleagues and i have yet to discover as  more patients emerge from covid-19’s fearsome shadow . there will be months, even years of catching up as we try to care for people with advanced illnesses and conditions, while new cases of the diseases and conditions that usually keep our system full continue to develop.

we will  likely see more pandemics , and sooner than we’d like. when they come, i hope we will face them with  the needs of all patients in mind .

sheila singh is a professor of surgery, neurosurgeon, scientist, and director of the cancer research centre at mcmaster university.