Covid deaths are down to a trickle, but what about the indirect consequences of the pandemic: deaths that come from people failing to access timely medical treatment for other conditions? Cancer Research UK has estimated what it believes to be the backlog from disturbance to cancer services and the reluctance of some people to seek medical advice over the past year.
Between the start of the pandemic and March of this year, it calculates, 45,000 fewer people started cancer treatment than would have been expected without a pandemic. Looking specifically at cancer screening programmes it estimates that 9,200 fewer people started cancer treatment after referrals from these tests. That was equivalent to a 42 per cent drop. The numbers have started to recover but quite slowly: in March this year, only 3 per cent more people started cancer treatment than under normal March 2019.
It is inevitable that the delay in cancer treatment will result in more deaths over the coming years, though we won’t know for some time just how severe this effect will be. But will this extra toll be the fault of the pandemic itself, of an NHS that was overloaded by Covid patients — or will it be the fault of government messaging? Arguments on this point will no doubt continue to rage, and may never be resolved. Speaking to MPs last November, for example, chief medical officer Chris Whitty firmly put the blame on the pandemic itself: extra cancer deaths, he intimated, should not be treated as victims of lockdown. On the contrary, many have argued, the more overburdened the NHS is with Covid patients, the less capacity it has for other patients.
That is obviously true when put like that. However, hospitals have not spent the entire past year bursting with Covid patients. There was a long period last summer and early autumn when there were few in hospital. Could the NHS not have handled more routine screening appointments during that time?
At the same time, as others have argued, government messaging ever since the beginning of the pandemic has tended to dissuade people from seeking medical attention. The government may not have intended the message 'Stay Home. Protect the NHS' to put people off seeking treatment if they genuinely felt they were ill. But it is inevitable that some people will have taken it as a sign not to bother their GP with small lumps or other symptoms, like bloody stools, that could either be serious or benign.
Many patients have reported that it has become extremely difficult to book an appointment — not least thanks to demands by Matt Hancock, a long-time advocate of telemedicine — that the NHS move to a system where all appointments are online or by phone in the first instance. That has not pleased oncologists such as Karol Sikora, who has warned that many cancers are first spotted as a result of subtle changes in a patient’s appearance — impossible to make over the phone and difficult to make in a Zoom call.
We may never settle on a figure for indirect victims of the pandemic, and arguments as to who or what is to blame for the dramatic fall in cancer treatment over the past year is likely to rage for many years. But to blame it all on the pandemic rather than on the handling of the pandemic seems rather out of place.