Patients with a range of serious conditions avoided seeking healthcare during the 2020 lockdown, new research has found.
Some wrongly believed health services were overwhelmed and didn't want to add to the workload, while others were afraid of heading out in case they were exposed to the virus, doctors and nurses told researchers from the University of Otago.
A new paper published in the New Zealand Medical Journal on Friday outlines how unprepared not just parts of the health sector were for the dramatic change in how they operate, but patients too.
New Zealand abruptly locked down in March 2020 after modelling showed an uncontrolled outbreak of COVID-19 would easily overwhelm the health and potentially leave tens of thousands of Kiwis dead. It was a success, the rapid and strict measures wiping out that particular outbreak. New Zealand emerged from 2020 as the only country in the OECD to have had fewer deaths than in a normal year.
But in early 2020, no one knew that was how it was going to play out. Some doctors spoken to in the new study reported " dramatic decline in workload, attributed to patients mistakenly believing that medical services were overwhelmed".
"Respondents commented that patients appeared to be minimising or tolerating their symptoms, considering them too minor to justify seeking care."
The elderly, told to stay home because of the additional risk COVID-19 posed to them (this was before conditions like long COVID were known about), were perhaps too careful, health professionals said.
"Elderly particularly had great fear, especially with security guards on the gates of villages, felt it was too dangerous or they weren't allowed to leave the village even for essential health," one nurse said.
Others who couldn't do phone consults easily - such as the hard of hearing or people with limited English skills - reportedly "just sat on their medical problems and left chronic conditions untreated", a GP said.
Some people made unemployed or on reduced incomes avoided seeking help for reasons of cost, the interviews - conducted over 16 weeks from May 2020 - revealed. Others were mistakenly led to believe the emphasis on phone consultations was because they were too busy to see clients in-person.
Not all healthcare professionals found their workload reduced though, some reporting more time spent dealing with clients whose specialist care had been cancelled or postponed - hospitals expecting a surge of COVID-19 patients - or triaging patients suffering respiratory illness.
"We are assessing patients who would normally be at home managing themselves, which is just taking up valuable GP time," said one doctor. "It is preventing us spending time with the patients and catching up on non-COVID work."
Some doctors and nurses in primary care reported being frustrated by cancellations and postponements in secondary care, since the predicted surge of COVID patients - at least when compared with what happened overseas - didn't happen.
"Several patients have been 'returned to primary care' who were previously sitting on a waiting list for some kind of interventions - almost all from surgical disciplines," said one GP.
"Many patients' needs were compromised by keeping hospitals 'ready'," added a nurse.
A "considerable number" of patients suffering cardiovascular events and cancers weren't seen as quickly as they should have, some doctors said, because they "either presented late or had refused emergency admission to hospital in fear of being exposed to COVID-19".
Some conditions were initially misdiagnosed - sometimes as COVID-19 - during phone consultations "when it would have been obvious in an in-person consultation".
As the lockdown lifted, many GPs reported becoming overwhelmed.
"Patients have stored up their health concerns and are now coming in with long complex lists they are expecting us to deal with in a single consult as they can only afford to pay for a single consult," said one.
The study's authors conclude by saying it's clear New Zealand's "under-funded" health system would have been "severely compromised" in the event of a larger outbreak.
"These experiences have highlighted a number of ways to minimise future delayed care from pandemic disruption, including reducing barriers to patients seeking care and improving integration and relationships across the health system."
The current outbreak has seen a greater number of cases in a shorter space of time, but fewer deaths than last year's thanks to improved treatments and vaccines.
