‘We Must Reverse The Delays In Seeking Care’

“In Bermuda, a decline in annual health examinations and preventive care, which reduce the risk of disease, was also evident during this current pandemic,” Minister of Health Kim Wilson said, adding that “we must reverse the delays in seeking care that may have become normalised over the past two years.”

Speaking in the House of Assembly today [May 20], the Minister said, “Although we continue to contend with variants of concern, the world is in a different place than it was in early 2020. Certainly, Bermuda is. As of 14 May 2022, 74.4% of our population is fully vaccinated, and we are learning to live safely with Covid-19.

“A part of ‘living safely with Covid’ involves adjusting to a new normal, including reaffirming our commitment to living a healthier life – something data suggests we have put on the back burner.

“Health professionals in general, have noticed a reduction in the number of people seeking health care during the pandemic. A 2021 study conducted by the Urban Institute in the US found that more than one in ten adults elected to delay or not seek at least one type of care. A similar percentage of parents delayed or declined to pursue care for their children as well. The Health Foundation, based in the UK, found that 6 million so-called ‘missing patients’ did not seek treatment in 2020.

“In Bermuda, a decline in annual health examinations and preventive care, which reduce the risk of disease, was also evident during this current pandemic.

“Compared with the pre-Covid fiscal year of 2018/2019, Bermuda has experienced a drop in annual check-ups with new patients. In the 18- to 39-year-old demographic, new patient preventive care check-ups plunged an average of 24% between 2019/20 and 2021/22. For those between the ages 40 and 64 years old, there was a 14% decline on average in new patient check-ups, while 65-year-olds have remained diligent.

“We must reverse the delays in seeking care that may have become normalised over the past two years. Young adults need to introduce themselves to annual health checks and make them a habit. Children need to be up to date with their schedule of vaccinations to prevent and reduce the spread of disease. All of us benefit from preventive screenings that can detect disease early when treatment can be more effective.

“Additionally, the Ministry of Health strongly urges those in the community with known risk factors – obesity, heart disease, hypertension, relevant family history – to reach out to their GP or the Hamilton Health Clinic for an appointment.

“It would be extremely remiss not to recognise Covid-19 has had, arguably, a more significant impact on our mental health.

“The Mid-Atlantic Wellness Institute [MWI] indicates the now prolonged nature of the pandemic has led to many challenges for the Bermuda community. In addition to the fear of being exposed to COVID-19 or the ramifications of infection, MWI has also seen some older adults experience loneliness at having reduced family contact and missing out on events and celebrations.

“Many client presentations to Community Mental Health Services have been related to Covid, with anxiety or depression due to job loss or economic instability a factor. The thread of the impact of Covid, whether health-related, economic or simply exhaustion due to the length of the pandemic, is woven into many mental health reviews. ”

The Minister’s full statement follows below:

Mr Speaker, Honourable Members, on 30 January 2020, the World Health Organisation [WHO] declared the novel coronavirus outbreak a ‘public health emergency of international concern’, and by 11 March 2020, the WHO had confirmed COVID-19 as a global pandemic.

At that point, health systems around the world were already beginning to grapple with thousands of severely ill patients and hundreds of extraordinarily sad deaths. To this day, many health systems continue to experience enormous pressure brought on by successive waves of coronavirus variants such as Alpha, Beta, Delta and Omicron.

Mr Speaker, here in Bermuda the Government took immediate steps to ensure our health system, including the island’s only acute care hospital, would be capable of coping with the anticipated high levels of sick individuals and hospital admissions. Our safety measures included ‘stay at home’ orders, remote learning and remote working, curfews and restrictions on group activities.

The Ministry of Health’s Pandemic Response Unit, the Bermuda Hospitals Board, and the island’s medical profession and medical laboratories responded admirably without hesitation to support and care for the more than 14,000 positive cases recorded since the beginning of the pandemic.

Mr Speaker, although we continue to contend with variants of concern, the world is in a different place than it was in early 2020. Certainly, Bermuda is. As of 14 May 2022, 74.4% of our population is fully vaccinated, and we are learning to live safely with COVID-19.

A part of ‘living safely with Covid’ involves adjusting to a new normal, including reaffirming our commitment to living a healthier life – something data suggests we have put on the back burner.

Mr Speaker, health professionals in general, have noticed a reduction in the number of people seeking health care during the pandemic. A 2021 study conducted by the Urban Institute in the US found that more than one in ten adults elected to delay or not seek at least one type of care. A similar percentage of parents delayed or declined to pursue care for their children as well. The Health Foundation, based in the UK, found that 6 million so-called ‘missing patients’ did not seek treatment in 2020.

In Bermuda, a decline in annual health examinations and preventive care, which reduce the risk of disease, was also evident during this current pandemic.

Mr Speaker, compared with the pre-covid fiscal year of 2018/2019, Bermuda has experienced a drop in annual check-ups with new patients. In the 18- to 39-year-old demographic, new patient preventive care check-ups plunged an average of 24% between 2019/20 and 2021/22. For those between the ages 40 and 64 years old, there was a 14% decline on average in new patient check-ups, while 65-year-olds have remained diligent.

Mr Speaker, a slide in diligence is apparent with mammograms as well, where there was an average decrease of 7% in screenings over the same period. This is disturbing in view of the fact that, for the first time in 2020, the WHO identified breast cancer as the most common cancer worldwide.

These are just two examples in Bermuda.

According to the Urban Institute study, the common cause for the reluctance to seek health care is due to concerns about patients’ exposure to the coronavirus. This is understandable.

However, Mr Speaker, we must reverse the delays in seeking care that may have become normalised over the past two years. Young adults need to introduce themselves to annual health checks and make them a habit. Children need to be up to date with their schedule of vaccinations to prevent and reduce the spread of disease. All of us benefit from preventive screenings that can detect disease early when treatment can be more effective.

Additionally, the Ministry of Health strongly urges those in the community with known risk factors – obesity, heart disease, hypertension, relevant family history – to reach out to their GP or the Hamilton Health Clinic for an appointment.

Yes, Mr Speaker, the coronavirus is still here in our community, so the concerns are real, but face masks are required in all health care facilities. Also, these facilities have established very stringent cleaning processes and work hard to avoid overcrowded waiting rooms. Preventive care is essential, and it is critical that we resume good health routines.

Mr Speaker, it would be extremely remiss not to recognise COVID-19 has had, arguably, a more significant impact on our mental health.

In a scientific brief issued in March of this year, the WHO indicated a global increase in anxiety and depression of 25%. The main driver for this has been unprecedented stress, which has never before been experienced to this degree and for this duration, along with social isolation due to the pandemic.

The Mid-Atlantic Wellness Institute [MWI] indicates the now prolonged nature of the pandemic has led to many challenges for the Bermuda community. In addition to the fear of being exposed to COVID-19 or the ramifications of infection, MWI has also seen some older adults experience loneliness at having reduced family contact and missing out on events and celebrations.

For the front-line workers, burnout and exhaustion have become a genuine concern.

Mr Speaker, in Bermuda, many client presentations to Community Mental Health Services have been related to Covid, with anxiety or depression due to job loss or economic instability a factor. The thread of the impact of Covid, whether health-related, economic or simply exhaustion due to the length of the pandemic, is woven into many mental health reviews. Persons known to the mental health services required ongoing support, while some have undergone a deterioration in their pre-existing mental health issues.

Mr Speaker, members of the extended Bermuda community, have lost people close to them, and having lost close relatives and friends, the inability to travel for funerals and memorial services was a further stressor. MWI has seen a number of in-patient admissions related to COVID-19; some with psychotic symptoms following the contraction of COVID-19, having never been involved with mental health services before, and others developing obsessional thoughts due to fear of Covid exposure. There have also been more serious cases of depression, in part due to changes in work circumstances, loss of loved ones or inability to pay bills.

Mr Speaker, families had to pivot, balancing work with childcare and teaching during remote learning, and for essential workers, this was particularly challenging.

In particular, children have had a difficult journey, having spent significant amounts of time at home, which has doubled as a school space, with extracurricular activities and typical social interactions paused, resulting in less social contact. Social anxiety has been observed in the adolescent group, and there are some reports of school refusal with the return to in-person classes following protracted periods of remote learning.

Further, Mr Speaker, MWI has seen high levels of in-patient admissions to Child and Adolescent Services [CAS] with this ongoing pandemic. In 2019 there were 25 admissions to CAS; already in 2022, there have been 39 admissions to date, perhaps reflecting a worrying trend.

Mr Speaker, discharges from in-patient care are difficult to achieve and can be drawn out. It is acknowledged that there remains a need for a diversity of housing options within our community; we welcome the efforts being made in this regard.

The delivery of care for those with mental health disorders required agility on the part of MWI due to the inability to safely complete face- to-face reviews as a result of the pandemic disaster alert levels within the Bermuda Hospitals Board [BHB]. Not all patients requiring support had access to digital means to allow for virtual reviews. Nonetheless, MWI continued to be responsive to high acuity situations and be flexible depending upon their need – and for that, the MWI team must be commended.

Mr Speaker, more recently, MWI has shifted back to more typical face to face reviews with the development of BHB’s integration initiatives, which include satellite clinics being held at the Lamb Foggo Urgent Care Centre as part of the Integrated Healthcare Clinic, and the Hamilton Health Clinic on Victoria Street. These are examples of providing care closer to home and continuing work to lessen the stigma associated with mental health and enhance access to care.

Mr Speaker, BHB has supported the development of the MWI Directorate Plan, reflecting a commitment to mental health. Globally, there is a shared concern among mental health professionals that the tidal wave for mental health may be coming, with unknown end-points, due to the pandemic. There is a continued need to be flexible and incorporate care tailored to specific needs as each individual’s journey over this extraordinary time is different.

So, how do we manage mental health during this ongoing pandemic?

There is a directory of service providers available to assist at helpingservices.bm/directory which can be used for general health and, also, filtered for ‘health – mental’.

As the WHO stated, ‘no health without mental health’; therefore, it is vitally important we value ourselves and prioritise self-care.

Mr Speaker, with that in mind, MWI offers these tips for all of us to follow now.

• First of all, be gentle with yourself. We have been living through unprecedented times, and there is no right way to respond to the stressors we have been facing. Experiencing a degree of anxiety is normal.

• Take a break from the news. We can sometimes feel bombarded by negative news and images, so disconnecting and doing something else can be a good distraction.

• Reconnect with previous interests to instil a degree of normalcy.

• Take care of yourself. Try to eat a balanced healthy diet, exercise, lessen your alcohol intake, and avoid alcohol and other substances as a ‘go-to’ if feeling stressed.

• Prioritise sleep.

• Try to maintain connections with others – family and friends.

• Focus on what you can control instead of worrying excessively over things you cannot control. And, avoid spending too much time on social media.

•  Practicing mindfulness can be beneficial; this can be a simple addition to your day.

• Practice gratitude. Pause and reflect on what we remain grateful for along with reminding ourselves what might be going well, despite the pandemic.

• Take things at your own pace; what works for some may not work for others.

Finally, take a look around. We are living on an island of exceptional beauty. Absorbing the vibrant colours of the ocean and getting out into nature can be very restorative for mental health.

Reflecting on the journey we have been on, let us be kinder to ourselves and to one another; it can positively impact our own mental health.

Thank you, Mr Speaker.

You can find more information on the links below from our dedicated website BermudaCovid.com, which is the most comprehensive resource and historic record available of Bermuda’s handling of the pandemic.

• All Charts: Vaccine, testing & more here
• Timelines: Dates of major developments here
• Test results: Chart of testing stats here
• Vaccine: Data covering vaccinations here
• Dedicated website: BermudaCovid.com

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