There is always a trade-off. Every policy written and enforced has unintended consequences. This is certainly true of public health policy. At its core, public health policy is written for the greater good — more specifically to improve the health of a society. I wonder, as quarantine orders begin to ease across the United States, whether we have met that goal. Or has our societal health suffered in other ways?
One quarantine strategy employed during the COVID-19 outbreak to prevent viral spread is a limited entry strategy. Access to hospitals has been limited, as has access to medical care for other conditions. This was done in an effort to free up resources for those affected by the virus.
As an example, elective surgical cases were suspended. What is an elective case? This was not well defined by those in charge providing the mandate. Is cancer treatment elective? The reality is cancer surgeries have been postponed, and chemotherapy treatments disrupted. Those patients battling cancer who have been delayed or disrupted may have a worse outcome than had their course of treatment been done as scheduled. Also, cancer screenings have been halted. For instance, colonoscopy screenings (to catch signs of colon cancer) have been deemed elective by government officials in times of quarantine.
As another example, the limited entry strategy also only allows “essential” – a word that has lost its meaning during this pandemic – persons into the hospital. Families of the sick and dying have been considered not essential. If death is an inevitable outcome, there has been allowance for “end-of-life” visits. However, not all deaths are so predictable such as to allow for these types of visits. Families are left to hover outside the hospital and unable to provide support to their family member. The mental health and emotional distress burdens of attendant stress have yet to be fully documented, but we can expect long-term consequences.
Even individuals deemed essential may have limited access. Many nurses and doctors work at more than one hospital or health care facility. How can a physician care for the residents of a nursing home and also provide care for her patients in the hospital? What about the nurse who works at more than one hospital? These scenarios are not consistently accounted for under a limited entry strategy.
As a physician, I have seen each of the examples above played out during this pandemic. I could provide anecdotal scenarios which could elicit a visceral response, perhaps even to those who refuse to participate in the simplest way — like wearing a mask. But my point is that the policies like the limited entry policy are not bad policy, but incomplete policy. Just as with a pill we might take to mitigate a disease process, the side effects need to be considered beforehand. This should be so for our public health policy. Now is the time to plan policy for the next pandemic, even as we attempt to fine-tune policy for this one.