For example, is anyone tracking (or modeling) deaths due not to COVID-19 per se but because people do not have access to regular medical services (e.g., dialysis, chemotherapy) to address their existing conditions, because medical services are all maxed out, and/or because of travel restrictions, and/or because supply chains may have been disrupted, etc.? I've started compiling readings on this issue on https://www.zotero.org/groups/2479192/the_world_after_covid-19/collections/GJUZXQ25
This is a complex issue.
For example, an unfortunate adverse effect of social distancing for the Covid-19 pandemic has arisen. There has been a dramatic fall in the number of blood donors in Saudi Arabia a result of social isolation during the Covid-19 Pandemic. Supplies of blood are being depleted. This is likely to be a global phenomenon
If insufficient blood of the correct type is available a woman may die as a result of not being transfused blood for severe acute bleeding following delivery of a child, for example. This will be most challenging for patients with rare blood group
Patients may die as a result of not being transfused blood severe acute bleeding due to stress ulceration, for example. If the patient has severe or critical Covid-19, the cause of death is actually the Covid-19 but it is likely to be coded as GI tract bleeding.
Another important factor to consider when trying to interpret variation in mortality rates between countries is differences in cultural interpretation of quality of life. This impacts the social and medical ethics and the delivery, limitation and withdrawal of life sustaining therapies.
In many Western cultures quality of life is valued far more than quantity of life. In those setting limitation and even withdrawal of life sustaining therapies are a common mode of death.
In many Eastern cultures quantity of life is valued more than quality of life. In these settings treatment limitations and withdrawals of therapy are rare. Admission to intensive therapy units and prolonged organ support are common. Mode of death is often cardiac arrest.
These differences are magnified when there are limited resources particularly in Western countries. The social and medical acceptance of treatment limitations is increased; this may significantly increase case fatality rates.
Article Checklist Proformas to Guide and Document the Assessment of ...
The availability of healthcare in general and specifically critical care will affect case fatality. In China and Italy where large numbers of healthcare professionals were infected the capacity to deliver healthcare was substantially reduced.
So, as the COVID 19 pandemic progresses we will need to upskill colleagues to facilitate the assessment and treatment of critically ill patients with and without COVID 19. This may be achieved by face-to-face education sessions. However this is very labour intensive and may result in spread of COVID 19 amongst healthcare professionals.
An alternative approach would be to use standardised checklist proformas for the assessment of critically ill patients (see link below).
Article Checklist Proformas to Guide and Document the Assessment of ...
Thank you for such thoughtful replies, Rajkumar Rajendram. These are precisely the kinds of complex scenarios I had in mind.
Article Making informed decisions and balancing risk-benefit ratios ...
This brief letter discusses the points outlined below
The availability of healthcare in general and specifically critical care will affect case fatality. In China and Italy where large numbers of healthcare professionals were infected the capacity to deliver healthcare was substantially reduced.
This has created a situation in the developed world that occurs routinely in the developing world. The ever-increasing demand for critical care in developing countries is similar to that of the developed world. However, the availability of resources is very different. In a typical intensive therapy unit (ITU) in a public hospital in Bangladesh resources are scarce and the demand for beds is high. There is always a very long ‘waiting list’ of outliers throughout the hospital. In this context the process of making informed decisions and balancing risk-benefit ratios is often straightforward; when there are no resources available, patients cannot receive advanced organ support. However, decision making is usually several orders of magnitude more complex than this. As a result, decisions that could be considered abhorrent and unethical in the developed world are made routinely.
These decisions are now being made in developed countries where the capacity for healthcare systems to provide organ support in intensive care units is exceeded. As a result excess deaths are occurring.
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This is complex but transparency in the recorded data should show this.
Yes, it is important to accurately estimate the collateral damage caused by SARS-CoV-2 coronavirus causing Covid-19 disease, i.e. deaths not due to SARS-CoV-2 Coronavirus itself, but due to the lack of access to various services that have been limited because of home quarantine. this issue is important to more accurately estimate the direct negative effects of a pandemic.
Regards,
Dariusz Prokopowicz
Not sure if it helps, but I would suggest to add to your collection some of the paper that Dymitri has written:
Ivanov, D., 2020. Predicting the impacts of epidemic outbreaks on global supply chains: A simulation-based analysis on the coronavirus outbreak (COVID-19/SARS-CoV-2) case. Transportation Research Part E: Logistics and Transportation Review, 136, p.101922.
A very important issue, please go on with the recording. Good initiative.
This is excellent. Also have a look at:
https://www.cebm.net/covid-19/covid-collateral-damage-in-scotland/
also
Collateral damage: the impact on cancer outcomes of the COVID-19 pandemic
Amit Sud, Michael E. Jones, John Broggio, Chey Loveday, Bethany Torr, Alice Garrett, David L. Nicol, Shaman Jhanji, Stephen A. Boyce, Phillip Ward, Jonathan M. Handy, Nadia Yousaf, James Larkin, Yae-Eun Suh, Stephen Scott, Paul D.P. Pharoah, Charles Swanton, Christopher Abbosh, Matthew Williams, Georgios Lyratzopoulos, Richard Houlston, Clare Turnbull
medRxiv 2020.04.21.20073833; doi: https://doi.org/10.1101/2020.04.21.20073833
Economical models estimate that the economical damage caused by this pandemic is around 80 trillion USD.