The healthcare sector has faced many challenges during the coronavirus pandemic. In addition to taking care of infected patients, and, now the vaccination roll-out, the scope and accessibility of healthcare services have also become a significant problem. In order to determine the causes and extent of the situation, a team of researchers at Vilnius University (VU) carried out the study “The impact of the COVID-19 pandemic on human and public health and on the functioning of the healthcare system: case study of vascular diseases.”
The researchers of the study team assessed the impact of the first lockdown on the provision of healthcare services to patients with cardiovascular diseases in both inpatient and outpatient settings, the potential economic and social damage caused by the lockdown, and the experiences of the population and the employees of the healthcare system in the country. Based on the study data, the researchers have provided detailed recommendations and possible solutions.
Far fewer people used healthcare services
According to the study, in March-June 2020, there was a decrease in the total number of outpatient visits (-39 %) and patients (-22 %) with the lowest figure for visits recorded in April 2020. Prof. Giedrius Davidavičius, the project supervisor, maintains that the group of patients who did not contact or receive a timely consultancy from a cardiologist due to chest pain or shortness of breath, and for whom no differential diagnosis was performed with the purpose of determining the disease is of great concern.
“This means that fewer new cases of cardiovascular diseases, such as a coronary heart disease, diseases that cause shortness of breath, arrhythmias, cerebral ischemia, etc. have been identified, patients have not received the treatment they require in time in order to improve their well-being or to reduce the risk of adverse cardiac events,” Prof. Davidavičius commented the study results.
As noted by Prof. Davidavičius, during the lockdown, there was a significant decrease in the number of inpatient treatment services (-35%) and rehabilitation services (-49%): “The biggest reduction was seen in the number of cardiac surgery cases: after cardiac surgery, patients are usually treated in an intensive care unit for an average 3-5 days, therefore with patients hospitalized with COVID-19, cardiac surgery was almost entirely suspended”.
According to the professor, the restrictions, which were introduced, were only partially responsible for the decrease in healthcare services. According to the study data, during the entire three-month period of the first lockdown patients had difficulty contacting their general practitioner or specialist physicians. Patients avoided contacting healthcare facilities not only for scheduled healthcare services, but also for emergency medical assistance, for example in the cases of acute myocardial infarction or stroke.
“Because of the fear of becoming infected at a healthcare facility, patients opted to postpone their visits for a later date. Data show that media coverage had a significant impact on this view. News feed, various publications online, etc., where healthcare facilities were referred to as the sources of infection, caused a direct response from patients – there was an increase in requests to postpone appointments,” Prof. Davidavičius said.
Although healthcare facilities gradually increased the scope of scheduled healthcare services following the lifting of the lockdown, the number of visits to outpatient healthcare facilities and the number of patients treated in hospitals remained lower than in 2019 for several months. According to the professor, several factors contributed to this.
“First of all, it was due to the enhanced procedures – COVID-19 test, ventilation of premises after each patient; second – reduced number of medical personnel and hospital beds available, because some staff were redeployed to treat COVID-19 patients, and some hospital beds, especially in intensive care units, were reserved or used for the treatment of COVID-19 patients. Finally, there was the prevailing fear of becoming infected with coronavirus at a healthcare facility”, Prof. Davidavičius said.
According to the professor, analysis of the mortality rate due to vascular system diseases in March-October 2019 and 2020, showed an increase of 11% during the first lockdown and an increase of 14% in the subsequent phases of lockdown. There was also an increase in the number of home deaths due to cardiovascular diseases.
Suggested modern solutions
Based on the final findings of the study, researchers have provided research-based conclusions and recommendations that could contribute to mitigating the effects of the coronavirus pandemic. The researchers recommend that scheduled outpatient and inpatient cardiology services be maintained during the pandemic and that outpatient and inpatient services provided by general practitioners and cardiologists be maintained to the greatest possible extent.
“This is essential in identifying new cases of cardiovascular diseases and assessing patient risks. It is also necessary to ensure the functioning of tertiary care services during the pandemic by directing patients with COVID-19 to designated backup hospitals. It is equally important to continue diagnostic and treatment procedures, cardiac surgery and catheter-based interventions. The latter procedure is based on minimal intervention, so the patient is hospitalized for a short time,” Prof. Davidavičius commented.
In the light of the study results, the researchers recommend retaining scheduled visits for patients who are seeing a cardiologist for the first time due to new chest pain, shortness of breath, fainting or other condition, and due to the deterioration in their cardiovascular condition in various regions of the country during the pandemic, the researchers also recommend promoting the introduction of new technologies into the clinical practice of cardiologists and telecardiology services, which would allow diagnostics and monitoring of conditions remotely.
“It would also be appropriate to regularly disseminate information via public media about emergency medical assistance at healthcare facilities so that patients would seek medical assistance immediately. The dedicated centres provide emergency medical assistance 24/7 to all patients across Lithuania,” Prof. Davidavičius noted. Professor believes that it is particularly important to emphasize the symptoms of acute myocardial infarction and stroke and the message that these conditions must be treated in a hospital, not at home, due to damage to the heart muscle and high risk of death.
“At a time of high risk, it is very important to improve the information system so that patients who require medication therapy do not avoid visiting their doctor. It is important that training and professional development of cardiovascular nursing specialists is ongoing and not just during the lockdown,” the project leader asserted.
Prof. Davidavičius points out that it is important to continue the project, to collect more data, and to analyse the effects of the second lockdown. During the second lockdown, unlike during the first lockdown, the healthcare system has been reformed, the provision of scheduled services has not been suspended, but only restricted to a certain extent due to the high incidence of COVID-19 cases.
“It is likely that with the improvement in the epidemiological situation we will see a surge in the numbers of patients who, for various reasons, were unable to access medical services. The health of a significant portion of these patients will have deteriorated due to disrupted chronic disease control and will therefore require not only a visit, but also medication therapy and, in some cases, more intensive care and treatment. Therefore, it is important to monitor the situation and to prepare for an increased flow of patients,” Prof. Davidavičius concluded.
The implementation of the project “The impact of the COVID-19 pandemic on human and public health and on the functioning of the healthcare system: case study of vascular diseases” was funded by the Research Council of Lithuania, Contract No. S-COV-20-27.
Project researchers: Supervisor and principal investigator Senior Researcher Prof. Dr Giedrius Davidavičius, Senior Researcher Prof. Dr J. Čelutkienė, Researcher Dr R. Gurevičius, and Junior Researcher P. Budrys. Researchers – Senior Researcher Prof. Dr P. Šerpytis, Dr G. Černiauskas; Junior Researchers K. Čerlinskaitė, V. Bajoras, and M. Lizaitis, and specialists R. Višinskienė and R. Buivydas.