On March 18, 2020 hospitals and doctors were asked by the Centers for Medicaid and Medicare Services (CMS) to refrain from performing routine preventive medicine and elective procedures.  The reason was there was great concern the healthcare system would be stretched beyond its capacity in efforts to deal with the novel coronavirus and preventing that from occurring was a top national priority.  But doing this created not only severe financial problems for hospitals, doctors’ offices, and other facets of our healthcare system, it added more damage to the economy and will cause health problems for many of our citizens.

An April 27 Modern Healthcare article, “Oncologists Anticipate Worse Cancer Diagnoses After COVID-19” reported, “Although cancer centers have kept up essential treatments and surgeries for patients during the COVID-19 pandemic, routine preventive screenings such as mammograms and colonoscopies were by and large put off.  Now as states look to ease stay-at-home restrictions, leaders at cancer centers are anticipating their clinics will see an influx of new cancer diagnoses and potentially worse prognoses.”

Other “elective” procedures have been delayed.  An April 24 Modern Healthcare discussed a CIGNA study, which showed a rapid decline in hospitalization for serious conditions the past few months.  CIGNA’s Head of Data and Analytics Dr. Saif Rathore said, "What we found was that there is – concerningly – care deferral.  This is not just about heart attacks missing, or appendicitis cases missing. This runs the gamut to things like (transient ischemic attacks), which are early manifestations of stroke, GI bleeds, seizures, and atrial fibrillation."  One cardiologist, Dr. John Puskas at Mount Sinai Morningside noted that there is a 70 percent to 90 percent decline in acute coronary events at New York City hospitals.  He said there are 200 unaccounted deaths each day in metro NY, in addition to deaths of COVID-19 patients.  He suspects patients are having heart problems and are not seeking care, either recovering at home or dying.

Not only are these patients not being seen, which raises health concerns, healthcare facilities are not receiving income for performing medical procedures.  The April 20 Fierce Healthcare reported that health facilities are facing “financial strain due to a loss of revenue from the cancellation of elective procedures.  The lack of revenue from such surgeries, in addition to low patient volume overall, has sparked a cash crisis for U.S. hospitals.  Some major healthcare systems such as Tenet, Trinity Health and Detroit Medical Center have had to furlough workers due to the lack of cash.”

But it is not just financially strapped healthcare facilities and people that may be delaying elective healthcare that is a serious problem.  According to the National Bureau of Statistics, the number of unemployed individuals increased from 1.4 million to 7.1 million in March, although the number is likely greater.  This will lead to a host of other health concerns.

Suicide rates are known to go up in a time of unemployment.  Glenn Sullivan, Ph.D., wrote in the March 2020 Psychology Today that after “the stock market crash of 1929, the suicide rate skyrocketed 50% to 18.1 per 100,000.  The suicide rate over the next decade of economic depression (1930-1940) stayed at a terribly high 15.4 per 100,000, until the national emergency of World War II, when it declined significantly.”  He said that suicide rate was about 13.1 per 100,000 between 2008-2018.  He said if the suicide rate jumps as it did during the stock market crash, then the rate could jump to 16.6 percent per 100,000 and 2021 could see more than 54,000 deaths by suicide.

Drug use also increases during high unemployment according to the National Bureau of Economic Research.  With every percent increase in unemployment in any given county, there is a 3.6 percent increase in opioid-related deaths and a 7.0 percent increase in emergency room visits due to an opioid overdose.  There is a similar increase in all drug-related deaths of 3.3 percent.

A May 2017 HealthManagement.org discussed a study of patients with heart failure and found that unemployed patients have a 50 percent higher risk of death.  The lead author of the study, Dr. Rasmus Roerth, explained that, “the ability to hold a job plays a very important role in the overall well-being and performance status of an individual.  Being unemployed is also associated with an increased risk of depression, mental health problems, and suicide.”

The Federal Reserve is predicting the nation will lose 47 million jobs that will result in an unemployment rate of 32.1 percent.  That number is frightening and could cause long-term damage to our nation.  It is why governors and many elected Washington representatives understand the necessity of getting America back to work.  Governors are opening businesses in their states by reviewing the data and conditions in their state and following the White House Task Coronavirus Force guidelines to determine how to safely and swiftly move forward.  More serology antibody testing will help them understand the extent of the coronavirus’s penetration into their population, particularly the percent that were asymptomatic, and will assist them with their decisions.  Governors will open their states in different ways and doing so is not a bad thing.  The different approaches will help us to understand SARS-CoV-2 better and help prepare all of us on what to do should it re-appear.