My patients are so worried about coronavirus that they’re dying to save the NHS – literally

Like Solomon Grundy, this patient took ill on Thursday and was worse on Friday. I went to her house for a visit (the illness wasn’t Covid-19 related). At the front door, I hung my coat on the fence and took out a plastic apron. The gusts of wind in the front garden flapped the plastic about as I tied the strings about my waist. I put on my mask and gloves and then rang on the doorbell.

"Mum says she would rather die then go back to hospital." I wondered quietly to myself about the care she had previously experienced at hospital. "None of us could see her for seven weeks and now she wants to be with us at home."

I know from her cold hands and feet that she is closing down. I enjoyed meeting her, however brief that meeting was.

She didn't die of Covid though. Given that it doesn't add to our official virus death toll, nobody is really interested. She is a person who elected not to go to hospital and then died. But for me it’s another punch in the stomach.

Because aside from the high numbers of Covid-19 deaths in our country, we also have a high level of excess deaths not caused by Covid-19 - and, worse, we don’t really know why. But judging by what I've seen in general practice, I suspect it might be to do with patients like these electing to not to go to hospital.

The Office for National Statistics (ONS) has published an analysis of our excess deaths. Between 7 March and 1 May this year, we had 130,000 deaths. Of these, 84,000 are usual for the time of year. The additional 46,000 are not, as we all know. Covid-19 accounts for 33,100 of these excess deaths. But what about the rest? What happened to the other 12,900 people?

During March and April, my work in general practice suddenly dropped away. I sat for hours in front of my computer screen, staring vacantly. GPs took turns to be sent home for the day; there just weren’t enough patients to round. It was unprecedented.

Initially bored, I became frustrated and then disconcerted.

A patient bent double with an acute abdomen coming to see me three days later than he should have done was my first obvious delayed presentation. He was trying to "save the NHS".

"Protect the NHS, save lives" is a message so simple and so effective that it has caused problems of its own. It has led to people avoiding their GPs, even though most surgeries have been a fully functioning, Covid-free environment throughout this time. It has led to a 57 per cent drop in attendances at A&E, and it has led to delayed presentations of strokes, heart attacks and many other serious illnesses, with subsequent poorer outcomes.

Further analysis by the ONS of those non-Covid deaths shows that the great majority were in people over the age of 90. Analysis by place of death shows a 60 per cent increase in the number of people dying in care homes, indicating extreme frailty. Furthermore, the number of death certificates with dementia listed as the main cause of death increased by 50 per cent, and of "ill-defined conditions" by 70 per cent. Together these two conditions account for two thirds of the total, suggesting that many of these extra deaths could potentially be due to unrecgonised Covid-19.

But, uncomfortably, there has also been a clear increase in deaths due to asthma and diabetes - and these deaths have been happening at home, not in hospital.

The ONS report suggests a reluctance to seek care could have caused these extra deaths. Were patients reluctant to seek help because they didn’t want to bother the NHS, or because they feared that going to hospital would result in catching Covid-19? Or, like my patient, were they reluctant because they knew they might never be allowed to see their relatives again?

Were they patients who would literally rather die than experience that?

It’s not just adult deaths, stillbirth rates are up too. Maternity patients have been reluctant and fearful to attend hospital, even when they noticed reduced fetal movements - a red flag that every pregnant woman is warned about. St George's Hospital in London alone has found a still birth rate of 9.31/1000 births compared to 2.38/1000 pre pandemic (16 stillbirths compared to 4 stillbirths) which is a tragedy. Importantly, none of these baby’s mothers had symptoms of Covid-19.

Similarly, women in labour have been waiting longer before making the decision to come into hospital, leading to an increase in unplanned out of hospital births or "born before arrival", with consequent poorer outcomes.

I am gutted by these extra deaths. Many doctors, like myself, have been twiddling their thumbs during these months, desperately keen to contribute but wondering where all our patients have gone. To think that people have come to harm when we have had so much capacity to help is terrible.

And it’s not all about death: we've seen plenty of other harms caused by this pandemic in general practice, without focusing on such a crude measure. There's a 70 per cent increase in children being referred for eating disorders since lockdown and school closures, for example.

Thankfully, my general practice lists are mostly back to normal now. Patients are returning. We are all proud of our NHS, and when I say "NHS" I mean not so much the hospitals and the staff so much as our shared collaborative vision - that we all contribute financially to our health system and we are all looked after when we need it; that no one should be left behind.

Let’s have no more excess deaths, adult or newborn, from people trying to "save the NHS". If you need the health service, please use it; it's there for you.

Berenice Langdon is a GP working in south-west London and the author of ​Learning Microbiology through Clinical Consultation​​

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