The second pandemic has already begun

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One in three patients missed their doctor’s visit last year. This is setting us up for our next health crisis, and nobody is talking about it.

The Economist Intelligence Unit (disclaimer: I have consulted for the EIU), reckons that doctor’s visits in TT were down by 80 per cent during the three months of lockdown in 2020, and down by 20 per cent for the rest of 2020 and up to now. Until a vaccine arrives, a recovery of the market is unlikely anytime soon.

Huge numbers of patients with chronic diseases have fallen off the map in both the public and private sectors. Given that in TT, almost all our health problems are from chronic diseases requiring constant follow-up (one in two die from heart disease or diabetes alone), this means that we are setting ourselves up for an almighty disaster in the coming years.

Only regular check-ups and blood tests can pick up early signs of chronic conditions. A colleague of mine just buried his cousin – dead of a heart attack in his thirties. Another family friend (and owner of a pharmaceutical distributor) died of a massive and totally preventable heart attack because he was always reluctant to go to a doctor – despite himself employing them.

Diabetes finishes most everyone else off.

Let’s assume that tens or even hundreds of thousands of people have put off their care. Thousands of them are living with deadly risks.

It may take a year or two to start seeing the effects of all this delayed care, but when they arrive, they will be slow and devastating. Not forgetting the mental health crisis, with the pandemic driving everyone stir crazy and preventing mental health patients from receiving care.

Doctors' and others' pockets are being drained – with ripple effects to the rest of the economy. Assuming between 1,200-1,500 doctors in private practice, a back-of-the-envelope estimate tells us that private healthcare industry revenue fell by more than $890 million in 2020. When patients stay home that means fewer referrals, resulting in a knock-on effect.

What is causing all this? First, patients are afraid to visit doctors in person in case they catch covid19.

Second, many doctors themselves, particularly older, more vulnerable ones, have limited their visiting hours and shuttered their practices part time, for the same reason.

Third, the economic shock of covid19 (estimated at more than $9 billion last year by the government) has meant that fewer people can afford medical fees, with many of the newly unemployed having lost insurance coverage for their families.

Many people who have any kind of symptom associated with covid19 are also afraid to tell their doctors, choosing instead either to stay home and isolate or say nothing. Revealingly, several pharmaceutical distributors told me that antibiotics sales have plunged – no one wants to report flu-like symptoms – often the sign of a bacterial infection.

So what are our options if we are to prevent this new pandemic? According to the US Centers for Disease Control: “If care were avoided because of concern about SARS-CoV-2 exposure or if there were closures or limited options for in-person services, providing accessible telehealth or in-home health care could address some care needs.”

Telehealth, whether over video or phone visits, can diagnose about 70 per cent of symptoms, but many patients are still wary. We need to help them overcome this distrust, or they risk far worse fates.

Telehealth is not the answer to everything. But there’s no question at all that doing a video consultation is better than not going to a doctor at all. There’s a reason that globally more than a billion telehealth consultations were made in 2020. We need to speed up.

Some tech-savvy doctors, like psychiatrist Dr Ian Hypolite and family practitioner Dr Alexandra Ames have already employed telehealth in their practice, while new platforms like Checkup are enabling doctors to roll out remote consultations. More must step up, or their patients will be left behind.

Likewise, insurers need to step in to support patients to access telehealth. The reason they are doing so internationally is because they know that if they don’t do this now, expensive and tragic emergency room visits will skyrocket in the next few years.

There are no easy answers. The fastest answer is still to order more vaccines. In the meantime, the public sector should come together with the Medical Association and private sector to set up an inter-disciplinary task force to manage this now, or we will be living with the fallout for years.

Kiran Mathur Mohammed is a social entrepreneur, economist, and businessman. He is a former banker, and a graduate of the University of Edinburgh.