The need for chronic disease management and prevention does not disappear during a pandemic. As I am a gastroenterologist and colon cancer researcher, the irony of cancelling procedures meant to detect colorectal cancer at an early stage during Colon Cancer Awareness Month was not lost on me. Infusion centers where patients receive treatment for rheumatoid arthritis; radiology centers that perform mammograms to detect breast cancer; and offices that perform cardiac echocardiograms to diagnose heart diseases are closing. A federal waiver though Medicare that covers telehealth visits now allows patients with chronic conditions to receive medical care without traveling to a clinic. But this does not address the need for outpatient surgeries and procedures that often accompany medical management.
Closure of outpatient facilities will lead to more emergency room visits as growing numbers of patients with unchecked symptoms require urgent care. Outpatient clinics triage patients into high and low risk of poor medical outcomes and decrease emergency room traffic by helping low-risk patients manage their symptoms at home. But without this triage and management, these patients are more likely to show up to emergency departments critically ill and medically unstable. Together, this will defeat the purpose of the CMS recommendation, which is meant to decrease hospital volumes, preserve protective patient equipment and conserve the medical workforce to treat those diagnosed with COVID-19.
Colorectal cancer is just one of many preventable diseases impacted by the new policy. Screening colonoscopies, the most common test used to detect and prevent colorectal cancers in the United States, are now delayed. Nearly 23 million adults aged 50 to 75 are past due for screening and an estimated 53,000 Americans will die from colorectal cancer this year. To address this problem, the National Colorectal Cancer Round Table, a coalition established by the American Cancer Society (ACS) and the Centers for Disease Control and Prevention (CDC), launched its “80% in Every Community” campaign, aimed at substantially reducing colorectal cancer as a major public health problem. The CMS recommendation to postpone screening colonoscopies during the COVID-19 pandemic, which could last 18 months, makes achieving this goal even more challenging.
Our COVID-19 response is not complete without identifying and, to the extent possible, mitigating the unintended consequences these strategies will have on public health. In the midst of a pandemic, we cannot and should not abandon chronic disease management or disease prevention. As businesses find new creative ways to fulfill their missions and deliver services to their patrons, so too should government and medical leaders. Now is the time for ingenuity, because failure to prevent and manage chronic medical conditions will lead to other public health crises long after COVID-19 is contained.