Doctor says ‘knock-on effects’ of pandemic chaos could be deadlier than virus
Fears grow over impact of outbreak on healthcare system

Doctor says ‘knock-on effects’ of pandemic chaos could be deadlier than virus

Warning comes amid worries that some patients are petrified to go to hospital for necessary treatment and many will miss important tests

Police officers man a checkpoint at an entrance to the predominantly ultra-Orthodox city of Bnei Brak, which has seen a large number of coronavirus cases, on March 31, 2020. (Gili Yaari/Flash90)
Police officers man a checkpoint at an entrance to the predominantly ultra-Orthodox city of Bnei Brak, which has seen a large number of coronavirus cases, on March 31, 2020. (Gili Yaari/Flash90)

The disruption being wrought on Israeli healthcare by the coronavirus crisis could kill more people than the disease itself, a leading doctor has claimed.

The warning by Anthony Luder, director of the Pediatric Department at Ziv Medical Center in Safed, came as an influential think tank raised alarm bells that the “collateral” effect of the coronavirus crisis could lead to more deaths than the virus, and after a minister said he was worried about people taking their own lives.

“We may have more suicides than deaths from coronavirus,” Defense Minister Naftali Bennett said on Tuesday, suggesting that the economic consequences will push some Israelis to kill themselves if the lockdown is kept in place for too long.

Luder fears that a potentially lethal domino effect of the crisis will be felt in the very health system that is treating coronavirus patients. “It’s entirely plausible that more people will die of the knock-on effects than of coronavirus itself,” he told The Times of Israel.

Dr. Anthony Luder, Director of the Pediatric Department at Ziv Medical Center in Safed. (Screen capture/YouTube)

Luder has witnessed what he considers shocking cases of children’s lives being put in danger because parents are petrified to go to hospital. “We’re starting to see growing numbers of issues where children are sick, being kept at home, and then developing complications that are difficult to treat and dangerous to the child,” he said.

“A kid came in with a burst appendix — the appendix had burst at home. The parents had done nothing because they were frightened to go to an emergency room. By the time he came in, he had a big abscess in his abdomen and needed surgery.” Had the child been quickly hospitalized, Luder said, he may have been treated without surgery, or possibly just a keyhole procedure.

Luder added: “We are starting to accumulate cases like this. We had a kid who was at home for four or five days with meningitis.”

He fears that this is just the start of the “knock on” effect, and expects that some patients with diabetes and other conditions that need managing will see their health spiral out of control as appointments are cancelled. “As this emergency extends to weeks and possibly months, people needing evaluations for chronic conditions — hypertension, epilepsy, diabetes, heart problems and a long list — will not be followed up. These things can cause acute problems and possibly complications that can prove irreversible.

“As time goes on, the risk of people not having routine care gets bigger and bigger.”

Elliot Berry (Courtesy)

Some other doctors think such pessimism is misplaced, however. “I don’t believe in this doom and gloom scenario,” said Elliot Berry, former director of the Hebrew University-Hadassah Braun School of Public Health. “We are well known for being resilient and the medical teams in the HMOs are good, plus we have telemedicine.”

He added: “We have enough trouble with the coronavirus, we don’t have to worry too much about the knock-on effect.”

Berry even voiced optimism that the new reliance on telemedicine would leave a lasting and positive effect on the health system.

But the Taub Institute, a socioeconomic research institute, has just released a bleak report that claims the “collateral” of the crisis will be serious. It raised concerns about Israelis who will miss early diagnosis as hospitals are increasingly canceling routine appointments.

Alex Weinreb. (courtesy)

“If the crisis is stopping us from doing early scans for cancers and heart disease, this could actually have a larger effect than the deaths from coronavirus,” said Alex Weinreb, research director at the Taub Center.

Weinreb stated that Israel is a world leader in minimizing mortality rates from cancer and heart disease. “They claim around 17,000 lives each year and if screening is disrupted we fear a significant increase,” he said.

As non-urgent tests have already been cancelled in many hospitals, and others are expected to follow suit as the crisis deepens, Weinreb said that it will lead to a testing backlog that will take months to clear — and a nation that is lacking in preventative healthcare.

Israelis should gear up for a two year period with higher-than-normal death counts from illnesses that would normally be detected after the coronavirus crisis, Weinreb warned, saying that this spike could easily outweigh the number of deaths from coronavirus.

Orna Blondheim. (Clalit)

Orna Blondheim, who was director-general of HaEmek Medical Center in Afula until five months ago, told The Times of Israel that she is closely following the impact of the coronavirus crisis on screening, and considers it “a concern now —which may become a real worry if it continues.”

She said that her concern increased on Monday, when Health Ministry Director-General Moshe Bar Siman-Tov said that schools are unlikely to resume after Passover. This indicated to her that the current set of restrictions could remain in place for months, which could have major consequences, while “if it remains for a few weeks, the system can overcome the challenge to screening.”

Asked if she thinks that disruption to testing could cost more lives than coronavirus she said: “It’s hard to calculate, but yes.”

Weinreb stressed that he was not downplaying the importance of the fight against coronavirus, but said the state should be careful to find ways to keep other health services run as much as possible and avoid “sacrificing the important accomplishments it has made in other areas.”

Luder stated that his worries lead him to conclude that the lockdown needs to be short-lived. He said: “It’s a little bit too early to end it now, but I would vastly expand testing, and as soon as the figures start flattening out over a week, I would start easing up on the lockdown.”

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