Organizations representing people with chronic illnesses in Canada are worried about the potential impact another surge of COVID-19 cases would have on the health-care system.
These groups say the pandemic has created delays in diagnosis, which could cause further strain on the system later on.
"It's a significant concern and one that we don't even understand yet," said Kelly Cull, director of advocacy with the Canadian Cancer Society.
"As provinces and territories begin this process of resuming services, we know that there is going to be a significant backlog within the health-care system for patients who have potentially gone untreated and who are hopeful that their cancer hasn't spread."
Seema Nagpal, vice-president of science and policy at Diabetes Canada, said many people were unable to seek care at the height of the pandemic — and there is concern another surge could reduce access to services again.
"Those things have consequences, obviously," Nagpal said.
One of those consequences, Nagpal said, is increased rates of diabetes complications in the future, such as kidney and nerve damage, heart attack and stroke.
"If patients are struggling with their diabetes management right now, that could be long-term consequences for individuals and for society, because obviously those types of things can be quite costly to our health-care system," said Dr. Jill Trinacty, an endocrinologist based in Ottawa.
She said she heard from patients this spring who were struggling to exercise because of gym closures and who were making food choices based on emotion more often.
First wave offered 'invaluable insight'
Carla Adams, spokesperson for the Nova Scotia Health Authority, said the province has since reintroduced or increased programs that were slowed or suspended due to the pandemic.
"We are making progress in many areas including surgery, diagnostic imaging and lab services, as examples," Adams said.
"We acknowledge that this has been a difficult time for many Nova Scotians who have experienced delays in their care."
Adams also said the first wave of COVID-19 offered the health authority "invaluable insight" for any potential second wave.
"We need to have the right resources, providers, equipment and protocols in place to effectively contain the spread of COVID-19 while enhancing and maintaining the highest level of services possible for patients and families," she said.
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A recent patient survey of people with Type 2 diabetes suggests that 89 per cent of people struggled to access health-care professionals during the pandemic, and one-fourth of those patients say they found it challenging to manage their blood glucose levels, which can lead to complications.
The survey was done by Novo Nordisk Canada, a pharmaceutical company that specializes in diabetes care medications and devices, including insulin manufacturing. The online survey was done for six days in May and included 551 Canadians.
Poor blood sugar control can also lead to hospitalizations for short-term complications, such as adverse reactions to high blood sugars or seizures related to low blood sugars.
"These are things that may get delayed and missed when people have delays in accessing care," Nagpal said.
Meanwhile, the Canadian Cancer Society is urging governments to prioritize resuming early detection screening, particularly for breast, cervical and colorectal cancer.
"If you're diagnosed at an earlier stage, your outcomes are likely to be better than if you were diagnosed at an earlier stage, so detection and screening is a critical part of this conversation," Cull said.
Call also said there needs to be a comprehensive plan for a potential surge in cases, which would ensure the health-care system has supplies, space and resources to deliver cancer care safely.
People with chronic illness are also more likely to have adverse complications from COVID-19, such as hospital admission, needing to be ventilated or even death.
While Nagpal said the health-care system adapted as best as it could during the pandemic, doing visits over the phone or online, she is unsure everyone was able to benefit from those changes.
That includes people in more vulnerable situations who may not have internet access or who do not have flexible workplaces to accommodate appointment times.
"I'm not sure that everybody was able to adapt and accommodate during the pandemic, it wasn't equal across all people living with diabetes that's for sure," Nagpal said.
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