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Some things are noticeable by their absence. During these early months of the Covid-19 pandemic, there has not been much talk about the chronic problems of emergency department overcrowding and waiting lists. These issues have been notoriously difficult for various Governments to solve. The inability of the previous Fine Gael majority Government to improve the health services’ capacity deficit was a decisive factor in how people voted in the February election.
The reason overcrowding and waiting lists are seldom mentioned now is not, of course, that they have been solved, but because the arrival of Covid-19 has changed the interaction of patients with the health service. Remote consultations became the norm for general practice and outpatient appointments. Resources were diverted toward a potential surge in severe Covid-19 cases. Elective work was postponed. People also began staying away from hospital because of the fear of contracting the virus.
Now that the new reality brought by the virus has dawned, thoughts are increasingly turning towards non-Covid 19 patients, who still have serious healthcare needs that perhaps are not being met. At the end of March, the Irish Heart Foundation expressed concern that people experiencing symptoms of heart disease and stroke are not presenting at hospital due to concerns about the coronavirus and not wanting to burden the healthcare system.
At the time, Dr Angie Brown, Consultant Cardiologist and Medical Director, Irish Heart Foundation, said: “Since the beginning of this outbreak we have been in constant communication with healthcare professionals in cardiac and stroke services around the country. In recent weeks there has been a marked reduction in heart disease and stroke presentations in Ireland, which we suspect is related to the coronavirus outbreak. We have also heard of cases recently of stroke patients being admitted too late for effective treatment because they were reluctant to go to hospital.”
She advised that anyone experiencing symptoms of a stroke or heart attack should follow the normal protocol and call an ambulance without delay. The same applies throughout the health service. Also in March, the Irish Association of Emergency Medicine (IAEM) said it had concerns that patients, in particular the elderly, may not attend hospital for conditions which genuinely require urgent medical intervention. The IAEM stressed that while facing the undeniable challenge of Covid-19, emergency medicine services will continue to deliver care to the sick and injured as best they can on an ongoing basis.
Is this message getting through to patients, who are also hearing about the continued importance of self-isolation and social distancing? The reluctance of people to attend their GP and hospital is understandable at this extraordinary time. But delays in seeking necessary and timely healthcare can have severe consequences. The focus of the health service has rightly been on the pandemic, but it also needs to put in place a strategy for the post-Covid-19 world, one where we need to live with the virus, in advance of a vaccine being developed. As our columnist Dr Muiris Houston argues in this issue, the Government needs to develop a path for how this might be achieved.
The existing problems of the health service have not disappeared, and are likely to have deepened in many ways because of how resources were channelled towards the pandemic response. The sooner a cohesive and comprehensive plan for non-Covid patients is put in place the better.