Side effects of COVID crisis impacting health system

Specialists can’t get to Cayman amid global travel shutdown

Cayman's healthcare system rose to the challenges posed by COVID-19 but long term system reforms are recommended.

Cayman has made giant strides in ‘healthcare security’

The aftershocks of the COVID-19 pandemic and the measures taken to fight it are causing a wave of secondary health impacts across the Cayman Islands.

While the territory has escaped the worst consequences of the virus itself, the lockdown, border closure and subsequent rise in unemployment have resulted in serious side-effects for the healthcare system.

Multiple overseas specialists have been unable to fly into Grand Cayman, because of travel restrictions, leaving some patients in limbo as they wait for surgeries.

Meanwhile travel to the US and Canada for medical care has become more complex, further limiting patient options.

Screening and diagnostic tests for certain cancers have also dropped dramatically – firstly because of the lockdown and now because of a rise in the number of people going without health insurance after losing jobs or businesses.

Cancer fears

Though most of these secondary impacts do not involve immediate life or death situations, the Cancer Society is warning of a possible surge in advanced cancers in 2021.

Operations manager Jennifer Weber said, “During COVID, the hospitals did the right thing and stopped all screening and non urgent procedures. People didn’t get mammograms, pap tests, colonoscopies and other diagnostic tests that help lead to early diagnosis.

“Unfortunately, we may see an increase in advanced cancers as a result of this.”

Five key concerns

  1. Specialists can’t get to Cayman. Travel restrictions in Cayman and overseas have made it difficult if not impossible for visiting specialists to get to Cayman, limiting options for patients needing some surgeries.
  2. Patients wary of travelling. In extreme situations it is possible for Cayman Islands residents to go to the US for medical care but vulnerable patients are often concerned about travelling to an area where the virus is rife.
  3. Cancer screenings dropped as non-essential medical services shut down during lockdown leading to fears of a possible surge in late-stage cancers in 2021.
  4. Children missed wellness checks for the same reason, meaning some paediatric concerns may not have been highlighted as quickly as possible.
  5. Underinsurance. The unemployment impacts of the virus have left an increasing number of people without health insurance.

Those concerns are reinforced by a July 2020 paper published in UK medical journal, the Lancet, which examined data from the National Health Service cancer registry and assessed the likely impact of delays in diagnosis on survival outcomes.

“Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK,” the paper concluded, recommending urgent policy interventions to clear a backlog in routine diagnostic services.

Unlike in the UK, where all cancers are recorded in a national database, Cayman’s cancer registry is voluntary and requires patients to opt in by submitting their information.

Similar patterns are discernible in the local data, however.

“We had a period of a few months where nobody was registered at all,” said Amanda Nicholson, the Cancer Registrar.

“We would love to believe that is because people weren’t getting cancer but that is unlikely to be the case. People weren’t going in to get screened as they would ordinarily have done because of the lockdown.”

That trend may have lingered even as medical clinics and hospitals began to reopen for normal services in the summer, warns Weber.

She said the cost of doctor’s visits or diagnostic tests for people who are uninsured or under-insured was still putting people off.

Right now, unemployment and under-insurance is a key concern for the charity.

“We have people coming to us with cancer who have no job so they have zero income and no insurance,” she said.

The Cancer Society had the majority of its fundraisers cancelled in 2020, reducing its coffers at a time when it is needed most.

“I can absolutely say the numbers have gone up, the amount of work we have needed to do for each patient has gone up and the amount we need to spend has gone up,” she said.

The Stride Against Cancer is a chance both to replenish the charity’s funds and reinforce its key public health message for people to get screened.

Weber added “Early detection is key. If you didn’t see your doctor in 2020, make an appointment.”

Children also missed checks

Andrew Vincent, director of Integra Healthcare family medicine, pediatrics and dermatology clinic at Grand Pavilion voiced similar concerns around late diagnoses.

He said the lockdown had led to delayed identification of skin malignancies. The inability to perform “well child checks” – recommended health screenings for young children – also resulted in late identification of pediatric complaints, Vincent warned.

He added, “Additionally, we know of patients who would have accessed care and elective procedures off island who have put off that care because of both concerns for safety with travelling to Miami and the challenges presented with quarantine.”

Waiting lists for surgeries

Compounding those concerns, is the inability to get specialists to Cayman.

Cayman Orthopedic Group, which has a roster of 10 surgeons who visit Cayman periodically to treat serious injuries, has been forced to suspend surgeries because of the travel restrictions.

Resident doctor Frank Smith still sees patients, but for consultations only.

“We have desperately been trying to get active surgeons here for eight months but have run into road blocks at every level,” he said.

Dr. Smith said the clinic now has a team of surgeons from the UK, who have been vaccinated, and are on standby to come to Cayman as soon as government relaxes quarantine restrictions. He said he hoped swift action could be taken to allow “vaccinated vital workers” to visit the island as soon as possible.

In the meantime, both the practice and its patients are suffering.

Practice manager Fay Frederick said some patients have been waiting since March for surgeries.

“Some have gone to other facilities both here and abroad because they have been unable to wait due to discomfort and pain which has impacted their lives,” she said.

“This interruption of service has been devastating to both the practice and patients.”
Vincent said many practices across Cayman had been similarly impacted.

“The Cayman Islands have been reliant on a number of visiting specialists who travel here up to four times per annum and who have busy clinics and patient lists.

“These specialists have not been able to come and that has reduced capacity to below what we had. We have seen this acutely in dermatology.”

Telemedicine impact

The Health Services Authority has also been unable to bring in specialists.

Deputy Medical Director Courtney Cummings said state-of-the-art medical technology had helped reduce the impact for patients.

The Health Services Authority robot nicknamed Sally has helped patients connect with overseas specialists despite the travel shutdown.

A telemedicine robot – nicknamed Sally and equipped with high-definition cameras – has allowed for overseas experts to perform detailed examinations in many specialties, including dermatology, at the Cayman Islands Hospital.

Cummings said telemedicine had been utilised throughout the pandemic and beyond across multiple specialties.

Dr. Delroy Jefferson, medical director for the Health Services Authority, acknowledged there had been a drop in screening and diagnostic tests as a result of the decision to shut down elective surgeries and consults during the lockdown. He said this action was recommended by the Centers for Disease Control and Prevention, and other agencies to protect healthcare resources and prevent the spread of the virus at the height of the pandemic.

Clearing the backlog

Jefferson said the hospital is now dealing with a backlog of patients presenting for preventative healthcare services.

“There was a deficit of patients seen. However, once services resumed there was an upsurge of patients who attended the various screening clinics. Presently, all services have resumed, the numbers have returned to normal and we continue to encourage the public to get screened.”

Dr. Yaron Rado, chairman of Doctors Hospital, reported similar phenomenon.

“We stopped doing elective surgeries in March. People did have to postpone a mammogram or a colonoscopy for six months but we are now seeing a lot more work in that area than we used to. We are working off the backlog.”

Health City is also reporting an uptick in people seeking preventative care, according to its director of business development Shomari Scott.

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  1. I have a friend who is a general surgeon who comes to the island 3-4 times a year when needed. He is retired back home and is willing to quarantine and then stay on the island and work for 3-4 months to help. He can not arrange to get here.