Lockdown, Operations and Staggering Numbers
During the early part of 2020 more than 3.9 billion people in more than 90 countries or territories were asked or ordered to stay at home by their governments. Since then, 10 countries have locked down nationally three times, 16 have locked down nationally twice and 70 have locked down nationally once. 58 countries have either never locked down, have only locked down by region or city or have never reported. The average lockdown period either nationally or regionally was 58 days.
Social distancing became the new thing, along with face masks. Governments introduced travel and movement restrictions for all non-essential travel. Many countries blocked non-essential flight arrivals and as the graphs below show air traffic plummeted compared to the previous year.
Number of flights per day Hong Kong, London & Los Angeles March 2019 compared to March 2020
Travel within major cities across the globe ground to a halt as restrictions on movement and social contact came into force. People in cities like Madrid, Paris, London, Milan, Berlin, and New York were making fewer than one-tenth as many journeys as they did normally, according to data from travel app Citymapper.
One of the few positive effects of the shutdown is that there was a drop in pollution in some parts of the world. This was seen quite clearly over Northern Italy.
Pollution levels over Italy January 2020 comparison to March 2020
The world just stopped and that included healthcare systems.
During that period 2.84x107 or 28,404,603 operations would be cancelled or postponed. So, 2.84x107 really is a big number and represented the estimated number of hospital operations that would be postponed or cancelled globally during the first 12-week peak disruption due to Covid-19 in early 2020(1). That equated to 2.4m operations each week globally. Within that figure there were some startling numbers.
Weekly total operations cancelled during first lockdown
China and the USA estimated they would cancel more than 320,000 operations each week during disruption and a further nine countries would cancel more than 50,000 operations each week.
Most of the cancellations were predicted to take place in Europe and Central Asia, with the cancellation rates probably reflecting where Covid-19 was most prevalent at the time of the survey.
12 Week cancellation rates
The data provided was separated into operations performed for cancer versus those performed for a benign condition. Those specialities that made up less than 5% of operations were put into other. These included breast surgery, cardiac surgery, neurosurgery, thoracic surgery, and vascular surgery. Obstetrics was treated separately.
Unsurprisingly of the 28 million operations that were predicted to be cancelled, 90% would be for benign conditions, 8% for cancer and 2% for obstetrics.
The chart below shows what those percentages really mean in patient numbers.
Predicted cancelled operations during first lockdown
12.5 million benign operations.
6.8 million other operations (including cardiac surgery) were predicted to be cancelled.
6.3 million orthopaedic operations.
2.3 million cancer operations.
The impact of the Covid-19 pandemic will be widely felt in healthcare systems across the world for a long time
Almost 3.5 million people have died from Covid-19. Delayed cancer operations will lead to more people dying. Delayed benign operations will lead to deterioration in individual patients’ conditions, increasing disability and reducing their ability to work. This will lead to lead to substantial costs on society. Behind these numbers are real people whose lives are being damaged or even ended as an indirect result of Covid-19.
There are two worrying take home messages from this article. Firstly, the staggeringly high number of operations cancelled represents just one lockdown. We all know there have been several more throughout 2020 and into 2021 and there may be more. Secondly, healthcare systems will need to increase capacity to clear the backlog of surgery. Sadly, after just one lockdown, even if surgery were increased by 20%, it would take around 10 months to clear the backlog. We have a long way to go.
References:
1. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans COVIDSurg Collaborative. BJS 2020; 107: 1440–1449
Author: Niall Shannon, European Business Manager, Innovgas
This article is based on research and opinion available in the public domain.