MADRID — COVID-19 is killing people even without the virus.

Spain's Lung Cancer Group, a research body, believes lung cancer will have killed 1,300 people more in the country in 2020 than predictive models had anticipated before the pandemic struck. Between January and April this year, lockdowns and diverted healthcare resources meant 30% fewer initial oncology consultations than during those months in 2019.

This is just one of the many pathologies with significantly worse data for what many are calling a "covidization" of healthcare. It means that a near-exclusive focus on the coronavirus is impeding treatments, diagnoses and research in many other illnesses.

Covidization is a term coined by Madhukar Pai, a tuberculosis researcher at Montreal's McGill University to describe the pandemic's distorting effect on resource allocation, prioritization and media attention in fighting other pathologies. Data appear to have confirmed his opinion. Since April this year, the European Commission has devoted 137 million euros to research on the coronavirus, or twice all the monies spent in 2018 on tuberculosis, malaria and AIDS. Many researchers have felt the impact of changed priorities first-hand.

In a debate organized by the National Center for Oncological Research, Doctor Luis Paz-Ares, head of Medical Oncology at the 12 October University Hospital in Madrid, said that for months, hospital research has been devoted almost entirely to the coronavirus. "We have had to delay clinical trials, and at certain times the number of diagnoses dropped by as much as half," he said. "We must recover the lost ground."

The Spanish Anti-Cancer Society has gauged just how much ground was lost, revealing in a recent webinar that new cancer diagnoses have fallen by 20-25%, 36.5% of treatments had to be interrupted, 44% of surgeries were canceled or delayed, and 17% of radiotherapy treatments interrupted.

The medical review The Lancet has published a report in June on the impact of this diversion of resources to cancer survival rates in the United Kingdom. For the first time in recent history, cancer patients saw a drop in their chances of being cured, based on data for 32,583 patients with breast, colon, esophagus and lung tumors.

Five-year mortality from breast cancer is estimated to have increased by 7-9%, 15% for colon cancer, 5% for lung cancer and 6% for esophagus. The study concludes that this significant rise in expected cancer deaths for the pandemic can be rectified with ambitious mitigation policies.

AIDS is another illness affected by this change of paradigm. The Lancet's latest editorial made it clear: the pandemic has strained healthcare systems the world over, and in regions where AIDS is most prevalent, it is causing important interruptions in diagnosis and treatment. This could raise HIV mortality rates by 10% over five years.

A "day against breast cancer" event in Malaga, Spain — Photo: Lorenzo Carnero/ZUMA

The HIV Modelling Consortium estimates that sub-Saharan Africa will see 296,000 more deaths from AIDS in 2021 than previously expected. UNAIDS believes in turn that a six-month interruption for six months in HIV mother-to-child transmission prevention programs can mean a 40% rise in child infection rates in the poorest countries.

Yet UNAIDS mitigated its pessimistic prognoses in recent weeks, stating that novel transport and distribution systems for therapies and medical attention may cut HIV transmission and mortality rates early in 2021.

It's the biggest impact on life expectancy since the 1918 pandemic and World War II.

The pandemic has also had an impact on assisted fertility treatments in Spain. The state of emergency decree on March 14, 2020 paralyzed the activities of all fertility centers, where only treatments already begun could be completed. Embryo transfers and new patients were blocked until centers were reopened a month later.

Joaquín Rueda, professor of cell biology at the Miguel Hernández University in Elche says the country expects "between 4,000 and 8,000 fewer births from assisted reproduction than last year."

In July, Science magazine published a projection of the effects of the pandemic on life expectancy and birth rates. In parts of northern Italy worst hit by the virus, life expectancy is expected to fall between 1.1 and 2.5 years in women, and around 3.5 years in men. This is the biggest impact on life expectancy in those regions since the 1918 pandemic and World War II.

The evolution of birth rates differs however in line with the wealth of countries. As Professor Rueda explains, countries with higher living standards have seen accelerated changes in the work-domestic life balance during the pandemic, reduced family incomes and economic uncertainty, and the aforementioned paralysis in fertility treatments. These will lead to a net fall in birth rates next year. In poorer countries however, reduced access to contraception are already yielding more births. Thus, says Rueda: "the big demographic gap between the rich world and the poor world will grow due to the pandemic."


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