According to projections from the Centers for Disease Control and Prevention, the number of new cancer cases in the United States between 2010 and the end of 2020 will have gone up about 24% in men and about 21% in women. That shakes out to about 1 million new cancer cases per year for men and 900,000 for women. The CDC goes on to say that, while rates for many cancers are decreasing or stabilizing, the number of new cancer cases and deaths is anticipated to continue to increase. While such a reminder would normally be of great concern, it is obscured by more pressing concerns of the moment.
As outlined in a recent Time magazine report, in Boston’s Dana-Farber Cancer Institute, about 1,000 new patients came in for treatment consultations each week before the pandemic hit. When the COVID-19 lockdown was imposed in Massachusetts, the number of consultations quickly decreased. As restrictions have been lifted, the hospital is said to be back to about 800 consultations per week, using a mixture of telemedicine and in-person appointments. That still leaves about 200 folks who are not getting the important screenings they would during prepandemic times. And fewer screenings translates to fewer cancer diagnoses.
Such are the unintended consequences of the need for hospitals to delay nonurgent medical appointments to deal with the escalating pandemic. As noted by Time, it has led to a roughly 80% drop in routine cancer screening appointments nationwide. “According to one estimate, the number of weekly diagnoses for breast, colorectal, lung, pancreatic, gastric and esophageal cancers dropped by about half during the pandemic,” Jamie Ducharme and Emily Barone report. This includes individuals who do not even know they have the disease yet and whose life might be saved by early detection.
Within this group, I am sure there are those who understand the benefits of such checkups but have run into a barrier in acting on this need. “I know I need to get in and see a doctor,” some might say. “Right now we are consumed by the agonizing choice of whether to send our children to school and, if not, how to manage remote learning,” they might add.
It is such stressful decisions that accounts for one-third of Americans experiencing high levels of psychological distress during the COVID-19 outbreak, according to a Pew Research Center report. It seems like so many choices we are making today involve deciding between troubling, unpleasant alternatives.
“We know more about the virus than we did five months ago, but still not enough to feel any choice is right,” the Chicago Tribune’s Alison Bowen writes. “It’s this constant risk/benefit analysis that we’re doing in our heads,” Vaile Wright, senior director of Health Care Innovation at the American Psychological Association, tells Bowen.
Sound familiar? Well, welcome to the world of crisis and “decision fatigue,” where COVID-19 applies added weight and stress to decisions small and large.
“Anecdotal evidence indicates that alcohol relapses, drug overdoses, and suicides are on the rise,” writes Michael Pittaro in Psychology Today. “Unchecked mental health issues are exacerbated by the uncertainty of what each new day will bring … We do not have any prior experiences for our coping and resiliency skills to summon with memory recall, so we are essentially navigating through unchartered waters,” he adds.
In such an environment, how does one make the right decisions? “There are many knowable parameters in the equation,” writes Elisabeth Rosenthal, editor-in-chief of Kaiser Health News. She goes on to say that these factors include your health or the prevalence of cases where you live, as well as the safety precautions being taken anyplace you want to visit. “But the final answer may depend on your individual risk tolerance for exposure to infectious disease,” she adds. “Most Americans alive today have never before had to make that self-assessment.”
“When our bodies remain in crisis mode — which has been five months for most of us — (stress hormones) cortisol and adrenaline can wreak havoc on our physical and mental wellbeing because the threat remains very real and pervasive on a global scale,” writes Pittaro.
“We are actually dealing with two contagions: the virus and the emotions generated from the virus,” he continues. “Negative emotions are just as contagious as the virus and can lead to ‘allostatic load,’ which refers to the outcomes associated with extreme wear and tear on our bodies, minds, and emotions.” With the onset of allostatic overload, “Hypervigilance now turns into irritation, rage, or despair.” This can lead to burnout, which is also “the stage when people are more likely to engage in risky behaviors that are detrimental to themselves or others.”
“For the foreseeable future, we will be living in a world with some level of the coronavirus out there,” writes Rosenthal. “So if we want to get out of our bunkers, we all need to take stock of our risk tolerance. … these decisions do not mean ignoring the data and infectious disease specialists’ recommendations.”
“When the virus pandemic subsides and life returns to ‘somewhat’ normal, the next big challenge will be to flatten the mental health curve,” concludes Pittaro.
“In those places where governments, businesses and administrators have set the stage properly,” says Rosenthal, “we can — with sensible precautions — begin to live again.”