Covid-19 delays raise mental stress of patients with other conditions

People forced to wait for non-urgent procedures experience higher levels of anxiety and depression, doctors say

Hospitals have been forced to focus on Covid-19 cases, creating a backlog in the treatment of other patients. Silvia Razgova / The National

Months after the birth of her firstborn through fertility treatment, Sabrina Ware had earmarked early 2020 to begin the IVF treatment that would hopefully enable her to conceive a second child – and complete her family.

An Australian expatriate in Oman, Ms Ware, 39, had given birth to a daughter in June 2019, and, hoping to have two children close in age, had scheduled to meet local fertility experts in Muscat.

Then Covid-19 hit. Worldwide, millions of routine treatments and non-urgent elective operations – from IVF to bariatric surgery to hip replacements – were cancelled or postponed. The measures were implemented in many countries to safeguard public health and manage cases of Covid-19.

In Oman, Ms Ware’s plan to start a cycle of IVF was put on hold.

"With my first child I had to undergo fertility treatment to get pregnant so I knew with number two I would need to go down that route again,” she said. "The plan was to begin the process early in 2020 but when Covid-19 hit and we were getting hundreds of cases per day I began to get anxious at the thought of sitting in a clinic with other people and interacting with a doctor who would be in close contact with several patients.

"I was not only afraid of contracting it, but I was also afraid of getting pregnant and then contracting it and that affecting the baby.”

Ms Ware, an executive director in public relations, said she heard "horror stories" of mothers with coronavirus giving birth and then being separated from their newborns.

“I decided to wait until I felt confident the end of Covid-19 was in sight – but months have passed and we still have no idea when that could be. “

Ms Ware said putting her dreams on hold have caused a mental toll.

"Trying to conceive when you have fertility challenges is stressful enough as it is, so this just added another level of stress and anxiety,” she said.

The patients had the worry of delayed surgeries possibly leading to poor outcomes and longer suffering

Her case is by no means unique. While many countries now have begun dealing with the backlog and resumed scheduling non-urgent operations, the period of uncertainty for patients has left a mental strain, says Dr Amaka Kate Uzu, a consultant in family medicine at Bareen International Hospital at MBZ City, Abu Dhabi.

"Having a health problem naturally creates anxiety, but knowing an appropriate procedure will help resolve this problem and improve their health, gives patients some level of relief and hope,” she said. "With the current pandemic, this understandably has caused a lot of delays in patients having life-changing procedures, which has now led to increased anxiety, depression, fear, uncertainties and a general decline in their mental and physical health.”

In Jordan, the pandemic affected the ability of the Medecins Sans Frontieres (MSF) reconstructive surgery hospital in Amman to treat victims of violence in the Middle East.

By March the hospital, which normally treats patients from Iraq, Yemen, Gaza and Syria, had stopped receiving admissions from outside Jordan and was performing emergency surgeries only, said Rasheed Fakhri, a surgical co-ordinator at the facility.

About 400 patients waiting for surgery were told that the team could only provide online consultation.

"The concerns for these delayed surgeries were shared between the patients themselves and the treating team,” said Mr Fakhri. "The patients had the worry of delayed surgeries possibly leading to poor outcomes and longer suffering.”

This led many patients to manifest "depression, anxiety, or aggressive behaviours", he said.

The World Health Organisation was unable to provide regional data for how many routine operations had been cancelled or delayed due to the pandemic. However, in the UK, the Royal College of Surgeons of England surveyed nearly 1,000 members in September and found just 14 per cent were able to treat the same number of patients as before the pandemic while 48 per cent said planned operations were currently running at just 50-80 per cent of 2019 levels.

In May, CovidSurg Collaborative researchers, using data from surgeons in 359 hospitals across 71 countries, estimated that the pandemic may have led to more than 28 million cancelled or postponed operations.

Some patients have faced the stress of testing positive for the coronavirus in addition to cancelled or postponed treatments.

Filipino national Mary Jane, a 39-year-old mother of two, was diagnosed as Covid-19 positive in May while undergoing treatment for breast cancer.

A manager at an amusement centre in Abu Dhabi, the 11-year resident of the UAE had already completed 15 cycles of chemotherapy.

She had to postpone treatment for over a month while she recovered from the virus and completed mandatory home quarantine.

While she went through a cycle of "mixed emotions”, Mary Jane is now focusing on becoming cancer-free.

"As a single earner in the family – my husband is a stay-at-home dad – I have no choice but to stay strong and make myself get better.”