Patients return to doctors' offices in large numbers as pandemic eases

NEW YORK, April 6 (UPI) -- With the worst of the Omicron surge in the COVID-19 pandemic fading in much of the country, people in the United States are returning to doctors' offices, hospitals and clinics for in-person exams, cancer screenings and other medical services, healthcare providers said.

However, because of the crush, some patients find it difficult to secure appointments quickly. Moreover, healthcare facilities that have had staff departures during the pandemic because of burnout and other factors are overwhelmed, the providers said.

"I am still seeing some patients who are hesitant to come in for a routine health screening, but those who are coming back are seeing longer wait times," said Dr. Subhankar Chakraborty, a gastroenterologist at the Ohio State University Comprehensive Cancer Center in Columbus.

"There definitely is a lot of backlog," he said.

By the end of last year, gastroenterologists nationally were performing, on average, up to 20,000 colonoscopies per month for colon cancer screening, or close to pre-pandemic levels, according to a report from healthcare data organization Epic Research.

By contrast, in the first months of 2020, at the height of the COVID-19 pandemic in the United States, gastroenterologists across the country were performing fewer than 5,000 colonoscopies per month, Epic estimates.

Similar trends were seen in breast and cervical cancer screenings.

In addition, this year, 153.2 million adults in the United States, or about 58% of the population, are expected to see their primary care doctors at least once, according to data from research firm Insider Intelligence.

This is up significantly from the recent low of 144.4 million in 2020, when many people were limiting "non-essential" activities because of the pandemic, the firm reports.

Demand for appointments with specialists has also "bounced back," though it remains "a couple of percentage points" below pre-pandemic levels, said Dr. Ateev Mehrotra, an associate professor of healthcare policy and medicine at Harvard Medical School in Boston.

One of the areas hit hardest by this "pent-up demand" for care has been mental health, in which patients are "waiting weeks or even months" for appointments to see providers, said Mehrotra, who has researched trends in healthcare use since the beginning of the pandemic.

This is particularly significant given the rise in mental health problems, such as anxiety and depression, seen nationally since the start of the pandemic, Mehrotra said.

Telemedicine tells the story

A key indicator of the return to in-person medical visits is the usage of its "replacement" -- telemedicine, according to Mehrotra's colleague at Harvard, Dr. Mara A. Schonberg.

Telemedicine, in which patients connect with clinicians via telephone or online video conferencing, replaced as many as 1 billion in-person healthcare visits in 2020, estimates say.

That year marked the beginning of the COVID-19 pandemic, and many non-essential healthcare services, or those not involving life-threatening issues, were curtailed across the country to limit the spread of the virus.

A survey released early in 2021 found that nearly 70% of adults in the United States were nervous about attending in-person medical appointments when COVID-19 infection rates were high in their local areas.

Telemedicine accounts for about 20% of all primary care doctor visits across the country now and appears to have "stabilized" at that figure, said Schonberg, who is director of research in shared decision-making in medicine at Harvard Medical School.

However, that's down from nearly 40% of all medical appointments in 2020, according to the Centers for Disease Control and Prevention.

That said, telemedicine is not a perfect substitute for in-person medical visits, as it does not allow for thorough physical exams, collection of samples for testing, routine vaccinations and screening for certain diseases, such as cancers, experts said.

In addition, not everyone has access to the technology needed to use telemedicine, particularly older adults and those living in poverty, as well as those who are non-English speakers, Schonberg said.

COVID-19 care declines

Because tests cannot be performed online, the United States saw dramatic declines in screenings for various forms of cancer during the two-plus years of the COVID-19 pandemic, research suggests.

However, studies indicate people with severe mental illness across the country also experienced care disruptions, particularly during the first half of 2020, when much of the United States was under "stay-at-home" orders to limit the spread of the virus.

People even were reluctant to seek emergency medical care during the height of the pandemic, with one study estimating a more than 40% drop in ER visits across the country.

It's the decline in cancer screenings, though, that may have the most serious downstream effects, said Ohio State's Chakraborty.

Rates for mammograms, which are used to screen for breast cancer, fell to 1% of expected volume nationally in April 2020 before rebounding to 90% of pre-pandemic levels one year later, research indicates.

Screenings were down at more than 80% of the more than 700 cancer centers in the United States through the end of 2021, a recent analysis found.

In 2020, the National Cancer Institute estimated that an additional 10,000 people nationally could die of breast and colon cancers, two of the most deadly forms of the disease, because of missed screenings.

Across the country, colon cancer screenings fell by about 80% during the pandemic, which lead to as many as 20,000 additional cases of the disease that could have been prevented or detected in earlier stages, Chakraborty said

Some estimates suggest that as many as 4 million colonoscopies were missed or postponed due to the pandemic, he added.

As many as 10% of the patients in these missed colonoscopies would have been found to have precancerous polyps, meaning some 400,000 early-stage cancers went undiagnosed, Chakraborty said.

"Even though patients are coming back, it will take us some time to catch up," he said.

To address the shortfall in colonoscopies, at least somewhat, the Ohio State University Comprehensive Cancer Center has launched a program to distribute free at-home stool tests to people living in poverty in the Columbus area.

These tests can be used by those at "average risk" for colon cancer and, if they test positive, it is recommended they come in for an in-person colonoscopy, he said.

Although these at-home tests can serve as an alternative for some patients, now is arguably the time to come in for in-person screenings, given that COVID-19 infection rates are low and "we have effective vaccines" against the virus, Chakraborty said.

Those who opt to do so should be fully vaccinated, including with a booster dose, and wear a face covering throughout their appointment, he said.

"Right now, it's safe for patients to come in for in-person exams and routine health screenings," Chakraborty said.

That could change as new outbreaks of COVID-19 emerge, but cancer screenings for those at high risk for the disease should not be delayed, he said.

Meeting the new demand

After struggling to cope with the influx of returning patients since the latter part of 2021, healthcare facilities are beginning to catch up, said Dr. Michelle Medina, associate chief of clinical operations with Cleveland Clinic Community Health.

Patients seeking appointments with specialist physicians at Cleveland Clinic, which operates facilities throughout its home state of Ohio, as well as in Florida, Nevada and West Virginia, can secure them within two weeks or so, on average, said Medina, who also is a pediatrician.

For primary care doctors, wait times for appointments are down to less than one week, with most patients able to book needed care within 24 to 48 hours, she said.

Still, demand for care has rebounded, but not yet returned to pre-pandemic levels, Medina said.

Patient traffic at hospitals nationally remains about 5% lower than it had been in February 2020, before the COVID-19 pandemic hit, based on data from healthcare consulting firm Kaufman Hall's National Hospital Flash Report.

"As the pandemic has started to turn, we're seeing people's confidence in feeling safe to return for in-person appointments starting to rise," Medina said. "Whether that continues if we start to see new outbreaks across the country, we just don't know."