Dr. Tochi Iroku-Malize, chairwoman of family medicine for Northwell Health and for the Zucker School of Medicine at Hofstra/Northwell., on Thursday talked about some of the reasons people may have been afraid to go to the doctor during the coronavirus pandemic, which may have led to a death toll higher than originally believed. Credit: Barry Sloan

The true U.S. death toll linked to COVID-19 is likely far higher than the nearly 550,000 in official counts, because of heart attacks and other medical emergencies in people who shunned care because of a fear of contracting the coronavirus, medical experts said.

The effects may be seen for years to come, as some who skipped annual checkups, cancer screenings and diabetes assessments become sicker than they would have if they hadn’t forgone medical appointments, said Dr. Wayne A.I. Frederick, president of Howard University in Washington, D.C., and a professor of surgery.

"There will be more deaths as a result indirectly of what COVID did in preventing people from getting the care that they should have gotten," Frederick said.

139% Increase in deaths from coronary artery disease in New York City. It was 44% in the rest of the state. Source: Journal of the American College of Cardiology

Deaths traced to coronary artery disease — which can lead to heart attacks — jumped 139% in New York City and 44% in the rest of the state from March 18 to June 2, 2020, compared with the same period in 2019, according to a paper published in January in the Journal of the American College of Cardiology.

Nationwide, there were more than 225,000 "excess deaths" — the difference between the actual number of deaths and the number expected, based on trends — between March and July 2020, according to a research letter published in October in the Journal of the American Medical Association. Most were from COVID-19, but 33% of those nationwide, and 22% in New York, were attributed to a cause other than COVID-19, researchers estimated.

Town clerks on Long Island counted big increases in deaths during the pandemic.

In Hempstead Town, the number of deaths spiked 47% between the 12 months ending February 2020 and the year ending February 2021, from 3,505 to 5,151, while in Brookhaven Town they rose 30%, from 3,111 to 4,033, officials in the two towns said. Numbers exclude some incorporated villages.

But it’s unclear how much of the increase was due to people who died of causes other than COVID-19, because the state compiles that data, they said. State health department spokesman Jeffrey Hammond said 2019 and 2020 mortality data is still being finalized.

Frederick worried that "we may see some sliding back" in recent improvements in life expectancy for some cancers because of the pandemic. The full effect won’t be known for years, as cancer develops in people, he said.

"How quickly people come back into the system and get more regular checkups will impact that," he said.

Survey: 38% of Americans missed appointments

A Prevent Cancer Foundation survey released in January found that 38% of Americans missed, postponed or canceled routine medical appointments because of COVID-19, and an Epic Health Research Network examination of electronic health records found that between mid-March and mid-June, screenings for three types of cancer dropped by about two-thirds.

Between mid-March and mid-June 2020. There was a: 63% drop in breast cancer screenings 64% drop in colon cancer screenings 67% drop in cervical cancer screenings. Source: Epic Health Research Network examination of electronic health records 

During the spring, people heard about hospitals crowded with COVID-19 patients and the rising death toll and "they were afraid to go to the hospital or doctor’s office," said Dr. Tochi Iroku-Malize, chairwoman of family medicine for Northwell Health and for the Zucker School of Medicine at Hofstra/Northwell.

"Even though they had symptoms that would require them to go to the hospital, some people tended to wait until it was really unbearable before they arrived at the hospital," she said.

In addition, in the early weeks of the pandemic, doctors had "really pushed the patients to stay away" except in urgent cases, to avoid overwhelming hospitals, Frederick said.

Some people have remained fearful of coming in for checkups, because they hear about surges in cases and the more contagious virus variants that are spreading, he said. That is leading to conditions that are "untreated and unchecked," which could lead to a poorer prognosis, he said.

10,000 How many more people may die from breast and colorectal cancers alone over the next 10 years, because of delayed diagnoses, according to the National Cancer Institute estimates. Source: National Cancer Institute director Norman E. Sharpless writing in Science

Frederick said the biggest impact of missed checkups and screenings will be on Black and Latino people, who, according to the Centers for Disease Control and Prevention, are twice as likely to die of COVID-19 as whites.

The pandemic magnified the existing problem of less access to preventive screenings, and regular health care in general, among Black and Latino people, who have higher rates of certain medical conditions, he said.

"There could be a health care crisis that adversely affects African Americans over the next few years," he said.

Life expectancy drops during pandemic

Life expectancy dropped by 2.7 years, to 72, for non-Hispanic Black Americans in the first half of 2020 because of COVID-19, widening the gap with non-Hispanic whites, whose life expectancy fell 0.8 years, to 78, according to a February CDC report that showed the biggest drop in life expectancy in decades. Hispanic life expectancy fell nearly 1.9 years, to 79.9.

Checkups and screenings for cancer, diabetes, high blood pressure and other conditions, and the monitoring of people who have medical conditions, are critical, Iroku-Malize said.

"All of these illnesses have complications if you don’t keep them under control," she said. "Now we’re playing catchup in the ambulatory world, in the primary care world, trying to make sure those whose conditions were not under good control during the pandemic — we’re trying to get them back under control. And some of these complications are things you can’t reverse."

Northwell has been combing patient records and contacting those who haven’t had regular checkups, screenings or other appointments to encourage them to come in, Iroku-Malize said.

The pandemic also has exacted a toll on mental health. More than 40% of Americans reported symptoms of anxiety disorder or depressive disorder in January, compared with 11% in the first half of 2019, according to a Kaiser Family Foundation analysis of federal data.

18% Increase in drug overdose deaths in the 12 months ending May 2020 compared with the 12 months ending in June 2019. Source: CDC

Drug overdose deaths increased more than 18% in the 12 months ending May 2020 compared with the 12 months ending June 2019, according to provisional CDC data.

"We call those deaths of despair," said Jeffrey Reynolds, president and CEO of the Mineola-based Family and Children's Association.

Data on suicides during the pandemic is incomplete, but Reynolds is expecting it will show an increase.

COVID-19 meant that people were isolated from in-person contact with mental health professionals and friends and had difficulty coping, he said.

"Some people turned to drugs or alcohol to make it all go away," said Reynolds, who predicted that rates of problem drinking are "going to be off the charts."

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