How the pandemic has affected primary healthcare around the world
The new coronavirus has affected people’s health in more ways than one. In this Special Feature, we look at what the pandemic has meant for primary healthcare access in countries around the world.
Over the past few weeks, Medical News Today have investigated the many ways in which the coronavirus pandemic has affected — directly or indirectly — the lives of people all around the globe.
In one feature, we spoke about how restrictive measures put in place to curb the spread of the virus have taken a toll on people’s daily lives and their mental health.
A follow-up presented our readers’ and contributors’ best strategies for coping with this crisis and explained, with reference to scientific studies, why these strategies actually work to boost people’s sense of well-being.
In this Special Feature, we turn to another way in which the COVID-19 pandemic has affected countries all over the world: its impact on primary healthcare.
The World Health Organization (WHO) define primary healthcare as "a whole-of-society approach to health and well-being centered on the needs and preferences of individuals, families, and communities."
"Primary healthcare," the WHO explain, "ensures people receive comprehensive care — ranging from promotion and prevention to treatment, rehabilitation, and palliative care — as close as feasible to people’s everyday environment."
Access to healthcare is a fundamental human right, but the strain that the COVID-19 pandemic has placed on healthcare systems everywhere has, in turn, affected many people’s primary care provision.
Due to fears relating to the spread of the new coronavirus, healthcare providers around the world have been minimizing in-person contact with their patients.
This has affected prenatal care, a crucial aspect of ensuring that pregnant women and developing babies stay healthy throughout pregnancy.
The Office on Women’s Health at the Department of Health & Human Services advise frequent checkups and screenings for pregnant women. They note that these should include one checkup per month during weeks 4–28 of the pregnancy, two per month during weeks 28–36, and weekly checkups from then on until the birth.
However, the pandemic has jeopardized these regular prenatal visits to the obstetrician or even made them impossible.
U.S.-based obstetricians have reportedly either switched to less frequent in-person appointments or turned to telemedicine completely.
Specialists argue that telemedicine is more convenient and safe, allowing pregnant women to receive the support they need without placing themselves at risk by attending clinic appointments in person during the pandemic.
However, pregnant women may have fear for other reasons. For example, what happens if they contract SARS-CoV-2, the new coronavirus? What will the birthing experience be like during the pandemic?
Expectant parents worried about delivery
In the U.S., the Centers for Disease Control and Prevention (CDC) say that some doctors may find it necessary to separate the woman and child immediately after birth if they suspect that the woman may have contracted SARS-CoV-2.
"The determination of whether or not to separate a mother with known or suspected COVID-19 and her infant should be made on a case-by-case basis using shared decision-making between the mother and the clinical team," the CDC advise.
There is also a concern that partners, who would usually provide reassurance and support during the delivery, may not have permission to enter the delivery room or visit in the maternity unit.
The CDC advise that visitors can still enter these areas during labor and delivery, but only if they show no symptoms of COVID-19 and wear appropriate personal protective equipment.
In the United Kingdom, some hospitals have banned all in-person visits to maternity wards in this period, and in Germany, some hospitals are reportedly banning partners from entering the delivery room.
Throughout Europe, hospitals appear to be making independent calls about who gets to stay and support the woman during labor, and who is allowed to visit after birth, leading to additional worries and uncertainties among expectant parents.
"Women have to give birth alone without the support of their partners or doulas — that caused a huge argument here," Juuli, from Estonia, told MNT.
"There were rumors that our partners wouldn’t be allowed in the maternity ward," Alexandra, who lives in Belgium, also confided. Alexandra was expecting her second child, who was born shortly after Belgium announced the start of lockdown measures in the middle of March.
"It turned out that they were only that — [unfounded] rumors. The only drawback was that I had to wear that pesky face mask when they placed my baby on my chest for the first time [after birth]. I couldn’t even see him."
– Alexandra, Belgium
Canceled doctor’s appointments
The cancellation of prenatal checkups, or their transfer to a telemedicine approach, was part of a much larger effect on primary care.
Since the WHO declared the SARS-CoV-2 outbreak a pandemic, there has been a widespread concern that, for the time being, it would be unsafe to attend regular appointments at clinics or hospitals.
Around the world, doctors’ offices have closed their doors, and many have switched to telemedicine, following their country’s guidelines.
For instance, in the U.S., the CDC recommend that "healthcare systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in healthcare settings."
In the U.K., the National Health Service (NHS) also recommend that people seeking medical advice should take the online route or phone their doctor or the NHS helpline. People should only attend a doctor’s office in person, the NHS say, if the doctor has expressly asked them to do so due to serious concerns.
But the cancellation of a significant number of planned elective surgeries during the pandemic has left many people in the U.K. fearing for their long-term health and feeling like "collateral damage."
A recent article in the BMJ said that, according to current reports, the new coronavirus does not explain a "staggering number" of community deaths in the U.K. So, if COVID-19 did not cause them, what happened?
According to David Spiegelhalter, Chair of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, many of these deaths might have been avoided had those individuals been able to access hospital care.
In France, where more than 27,000 people have died due to COVID-19, the severity of the situation has called for a serious overhaul of the healthcare system.
Diana, from France, commended the reaction of the healthcare system in the country. She told MNT that the system there was able to reorganize so as to relieve pressure from overtaxed hospitals, sending patients from crowded hospitals across the country to those that had more available resources.
Other European countries have fared less well, however.
"Lots of people are waiting on their scheduled medical [appointments] that [have] now been postponed for obvious reasons, but they are hoping to open up the scheduled appointments for those who need [them] soon," Juuli, from Estonia, told us.
Missed vaccines could lead to other outbreaks
And while healthcare organizations such as the CDC continue to stress the importance of immunizing children against other viruses, they also note that the number of children receiving their vaccines has dropped significantly of late.
This could, in part, result from lockdown measures and stay-at-home policies, but it is also likely to be due to the aforementioned cancellations of and delays in primary care appointments.
Sacha Deshmukh, Executive Director of UNICEF U.K., has warned that "up to 117 million children could miss out on vaccines due to the global pandemic."
"Millions of children missing out on routine vaccines is an alarm bell and risks further outbreaks of life threatening diseases like measles."
– Sacha Deshmukh, UNICEF U.K.
Mihai, a contributor reaching out to MNT from Romania, said that he and his spouse were concerned about their young son’s missed immunizations.
"We are […] [anxious] about [our son’s] vaccination because our family physician has postponed the appointment. […] Only now have they started to book in new vaccination appointments," he told us.
According to a briefing from the WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, a recent WHO report suggests that "the rate of progress [in healthcare worldwide] is too slow to meet the Sustainable Development Goals and will be further thrown off track by COVID-19."
The Sustainable Development Goals are an extensive agenda that the United Nations (UN) have adopted with the aim of curbing poverty and other deprivations — including in the realm of healthcare — globally by 2030.
"[T]he world has not done enough to deliver on the promise of health for all," the WHO Director-General warns.
"The pandemic has made it crystal clear that we are one world that has more in common with each other than we’d ever dare to believe," he goes on to say.
"The best defense against disease outbreaks and other health threats is preparedness, which includes investing in building strong health systems and primary health care. […] If we don’t invest in both, we will face not just health consequences but the social, economic, and political fallout that we’re already experiencing in this pandemic."
– Dr. Tedros Adhanom Ghebreyesus