Evidence of the COVID-19 care deficit

December 17, 2020

Dear Members:

As we settle into a new phase of restrictions to check the spread COVID-19, I wanted to write to you about the impact of the pandemic on patient care and the health care system. While the arrival of vaccines in Alberta is truly encouraging, we face a long road back to whatever the new normal will be. I wrote in my last letter that a care deficit has been created since the pandemic arrived, and it is worsening. Diseases and conditions are going undiagnosed and many treatments are being delayed. This has implications for the health of Albertans and will tax the system at a time when we are least equipped to deal with it. This care deficit has the potential to be a second pandemic of its own.

The AMA’s online community albertapatients.ca, has over 13,000 patient members who interact with us regularly to provide their perspectives and advice. We surveyed our panel in November and more than 4,300 patients responded (view the full results). When we compare the results to our June survey, a number of issues are apparent; there are three that I thought should be highlighted.

There has been a decline in the sense of well-being

• Even compared to June, a growing number of patients are feeling a deterioration in their own mental and physical health.
• It is deeply concerning that:
  • 44% say their physical health is worse now than before the COVID-19 outbreak began (33%* worse than June).
  • 64% feel their mental health has declined (21%* worse than June).
• Those under 45 years of age are far more likely to sense a decline, particularly with respect to mental health, where a staggering 70% feel worse now than before the pandemic.
• Patients experiencing a decline indicate that they are not eating, exercising or sleeping as well as they should. They also feel a sense of isolation and anxiety about the virus as well as the financial impacts that are upon them.

A care deficit is building:

Disruptions in patient care were reported by 59% of patients:

• 34% say they have avoided or delayed visits to their family physician.
• 21% have put off specialist visits.
• 20% have been unable to access lab and diagnostic services in a timely fashion.
• 37% of patients who have had health care disruptions report that these have contributed to a decline in their health.

Impacts of COVID-19 are not being felt in an equitable manner:

• 41% of women report being negatively impacted versus 34% of men.
• 41% of patients with chronic conditions, and 48% of family members of patients with chronic conditions, reported worsened health versus 28% of those without chronic conditions.
• Individuals with lower incomes are more likely to report worsened health:
  • 48% of patients earning under $40,000/year have been impacted versus 39% in those earning over $100,000.

There is no quick solution to all of this. The physical, mental and economic health of Albertans are inseparable, but a balance must be struck between the effects of COVID-19 and the effects of restrictive public health measures. Overwhelming our health services and diverting resources from urgent and elective care to patients who are ill with COVID-19, will only continue to increase the care deficit we are already facing. The latest restrictions, as difficult as they are for individuals and businesses, are a critical part in our response to the pandemic. It will be weeks now before we can observe the impact, but we are all hopeful that they will limit the loss of life and allow the health care system to continue to function. The sooner we can control community spread, the quicker our economy and health care system will recover. I continue to implore everyone to follow public health guidance, to live within the restrictions and to stay as safe as they can. We cannot afford more cases, illness and death. Everyone must do their part, as hard as this will be over the holidays.

Because it can never be said too many times, thank you to every physician and every one of our allied health colleagues for all that you have done and are doing in this crisis. Providing care everywhere has been a challenge, but this has been especially true in the community. Keeping our community practices open and viable through this is essential as most of the care for COVID-19 patients takes place in the community. These community practices are also key in reducing the growing care deficit. We continue to advocate for better support.

As we all draw a deep breath before facing the weeks ahead, I wish you wellness and safety. Please set an example with the restrictions yourselves as we call on Albertans to do the same. The care deficit expands with every new COVID-19 hospitalization and it is our duty to do all we can to slow it down.

While we live in a society where everyone is allowed to express their view, when it comes to physicians and public commentary, the bar is necessarily high. I would caution those who may use their status as physicians to spread misinformation or promote unproven therapies. Let us behave in the professional manner that society expects of us and put our trust in those with content expertise: our specialists in public health.

As always, I remind members that the AMA's Physician and Family Support Program is ready to assist you 24/7/365. Call 1-877-767-4637. If you missed this short video in my last letter, you can review it now for a reminder of the support available.

Your comments are welcome in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org
• Comment publicly below on this President’s Letter (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member).

Sincerely,

Paul E. Boucher, MD, FRCPC
President, Alberta Medical Association

*Please note there were typographic errors in the email version of this letter sent to members. This online version contains the correct statistics for these two figures.