We read with interest the recent paper by Einstein et al. (1). During the coronavirus disease 2019 pandemic, a rapid reduction in cardiovascular diagnostic procedures was observed globally with a potential impact in the care of millions of patients. From the early stages of the crisis, concerns have been raised about the very real potential for “collateral casualties” of the pandemic: people who never contracted severe acute respiratory syndrome coronavirus 2 but died from noninfectious causes sooner than they would have under normal circumstances.
Similarly, the impact of the pandemic on the endoscopic procedures and its effect on gastrointestinal cancer detection was recently investigated in a large retrospective study from 15 endoscopic units in the Netherlands (2). In a country proud of its national screening program, Latinga et al. (2) found that gastroscopies decreased by a staggering 57% and colonoscopies by 45%, with a subsequent reduction in the number of gastrointestinal cancers detected. Similar disappointing results were seen in a national study in the United Kingdom (3). Early in the United Kingdom’s response to the pandemic, endoscopy activity reduced to just 5% of normal activity, and 10 weeks later activity had increased to only 20% of pre-pandemic levels. Endoscopic cancer detection decreased by 58%, and colorectal cancer detection by 72% (3). Of course, this is going to have far-reaching consequences in terms of future cancer survival.
This is only the tip of the iceberg; the total number of collateral casualties will eventually be higher than the coronavirus disease 2019 deaths. The speed of recovery of diagnostic activities across the board will determine the scale of the collateral damage. The time is ripe for a collective overview of all aspects of the pandemic’s impact on current health care delivery and the roll-out of telemedicine solutions.
Footnotes
Dr. A. Koulaouzidis is codirector of iCERV and cofounder of AJM Medicaps; has received honoraria from Dr. Falk Pharma UK, and Jinshan; has received travel support from Jinshan, Dr. Falk (UK), and Aquilant; has been in advisory board meetings for Tilots, Dr. Falk Pharma (UK), and Ankon; and has served as a consultant for Jinshan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Kim A. Eagle, MD, served as Guest Associate Editor for this paper. Athena Poppas, MD, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.
References
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