Fear and the Law of Unintended Consequences

Photo by Martha Dominguez de Gouveia on Unsplash

One of the most important costs of our pandemic policies — and the resultant media amplification of them –– that emphasize risk and the need to stay home are the myriad medical needs unrelated to Covid that have been unattended to. In short, people have been afraid to go to the doctor because they’re frightened of contracting Covid. More worryingly, many have been afraid to take their kids to the hospital.

An article in JAMA Pediatrics published last month showed that pediatric hospital admissions in 2020 fell by as much as an extraordinary 45%, compared to the median rates over the previous decade. One inpatient survey cited in the study found that greater than one-third of parents delayed seeking medical care for their child because of fears surrounding Covid-19.

A number of studies have shown that these delays have led to grave harm, including death. Just a sampling: Children with acute-onset of type 1 diabetes, and children with with acute-onset leukaemia, with dramatic symptoms, were nevertheless delayed in coming to the hospital. The parents of a child who couldn’t move his bowels for a week were told it was mere constipation by their pediatrician over the phone, but once in the emergency room doctors discovered a large abdominal tumor. In a small Italian study, the parents of these children with delayed treatment all said they avoided coming to the hospital out of a fear of contracting Covid. A Massachusetts study saw that a spike in pediatric patients with delayed treatment for appendicitis led to a significant increase in serious complications.

Regarding patients with heart disease, the JAMA study noted, “it is unclear whether reductions in admission rates represent purely elective surgical delays or the possibility of decreased recognition of congenital heart disease because of decreased contact with health care.”

In conclusion, the authors wrote:

Together, these findings are worrisome, although not definitive, in that unmet health care needs may be accumulating in the pediatric population as a result of decreased health care interactions.

The authors suggest that, in part, the drop in hospital admissions may have had to do with kids not getting as sick this past year because they weren’t interacting as much with others. And since children weren’t as physically active, the likelihood of broken bones and other kinds of accidents went down as well. (Presumably the pandemic has represented a quieter time for pediatric orthopedists.) But these two factors don’t account for the entirety of the drop in admissions since there are of course many other ailments that afflict children beyond infectious diseases and trauma.

The delay of pediatric care is part of a larger concern for the broader population. As a Lancet paper notes, emergency treatment for stroke went down in early 2020 and UK nursing homes saw an increase in deaths related to coronary syndrome, strokes, and heart failure. Cancer cases in German hospitals decreased, and in England chemotherapy appointments fell by 60%.

But as tragic as any missed diagnosis or missed treatment for an adult is, it is of course far worse in the case of children. Therefore, the JAMA Pediatrics study is intriguing and important. Yet it’s received zero coverage in major media. I can’t help but wonder if part of the reason this study, and similar ones, haven’t received much exposure is that they complicate the Manichean narrative of “stay home.” They force parents to conduct their own risk analysis, and to question whether staying home is always the wisest choice.

It’s too soon to grasp the full scope of how many children have suffered medical problems, and even died, as a result of missed care during the pandemic. And perhaps those numbers will never be able to be teased out precisely. What is certain, however, is that fear and simplistic narratives carry their own risks.

Author of INVISIBLES. Forthcoming: AN ABUNDANCE OF CAUTION (2022), and MERELY PLAYERS (2023?). I write for @NYMag @TheAtlantic @NYTimes @Wired

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