Industry Voices—Mapping the ripple effects of a pandemic: We have to measure more than just COVID-19

A woman rides a bus while wearing a face mask
It will be critical to continue monitoring not only the direct impacts of the novel coronavirus but also the effects of delayed diagnoses and treatments on morbidity and mortality, says Komodo Health's Arif Nathoo, M.D. (alvarez/Getty)

Even at the height of its surge, COVID-19 never became the leading cause of death in the U.S. Accounting for excess deaths, COVID-19 still trailed behind heart disease and cancer as the top U.S. killer throughout April.

That’s important when you consider the fact that many Americans are still delaying or deferring important care for fear of exposure to COVID-19.

While COVID-19 continues to wreak havoc on our population, the public health response to it has caused widespread ripple effects that will reverberate throughout healthcare for years to come.


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For that reason, when it comes to understanding the real-world population health impact of COVID-19, tracking the novel coronavirus itself is just the beginning. There are dozens of related variables that need to be accounted for—and mapped—before we can truly understand the scale of the challenge.

Plummeting medical tests

Recent trends in patient access to the healthcare system paint a dire picture of just how far these ripple effects have already spread. Emergency room visits, preventive screenings and cancer care all have plummeted during March and April, and no one knows when, or if, these missing months will be reabsorbed by the healthcare system.

For example, by tracking real-world patient encounters, we recently found (PDF) that routine testing for diabetes and cholesterol were down roughly 65% during the height of shelter-in-place guidelines.

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Worse, care for cancer patients is also on the decline. By mid-April, colonoscopies had dropped by nearly 90%, according to our analysis (PDF), and diagnoses for colorectal cancer, the second-leading cause of cancer deaths, had declined by 32%. Colorectal cancer survival rates have improved dramatically since the 1970s, but the pandemic appears to threaten that progress.

Additionally, different regions of the country have been impacted unevenly. The sharpest declines in screening occurred in COVD-19 “hot spots” such as New York state, where HbA1c tests declined 82%—and more than 90% in Manhattan.

This is critical information that will affect everything from routine care interventions to federal funding for Medicare to clinical trial recruitment, but it’s just the first step.

Telehealth haves and have-nots

Another ripple effect of COVID-19 that will need to be monitored closely is the widespread growth in telehealth utilization. Amid this void in care, telehealth has emerged as the unsung hero.

According to our data, the number of healthcare providers now offering telehealth services to their patients is more than six times higher today than it was before COVID-19. In New York, the number of doctors now offering telehealth is 10.7 times higher than it was pre-pandemic. And these trends are increasing by thousands of providers every week.

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That should be good news. For many years, telehealth has been limited by dated technology, poor reimbursement and a lack of physician willingness.

But patients have been eager for virtual alternatives to the hourlong wait for a 10-minute visit. Now, COVID-19 is forcing a shift to telehealth, and some physicians are reporting that the technology is actually helping them get closer to patients than they could with a face-to-face visit.

But there’s also a darker side to the telehealth revolution: Not everyone has access to virtual care. Our research has found that U.S. counties with the highest median income were 37% more likely to benefit from telehealth than those in lower-income counties. Yet it’s clear there is a crucial role for technology to support our population’s care needs.

Here again, detailed tracking of real-world patient data to spot nascent trends and anomalies before they blossom into full-fledged public health emergencies will be a critical component of the post-COVID-19 healthcare recovery effort.

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Defining the 'new normal'

As we slowly emerge from the first phase of this pandemic, these trends in patient care present several new questions and challenges, including how best to monitor our health, bridge the digital divide and close gaps in care that may have inadvertently been created by our efforts to stop COVID-19.


With a historic acceleration toward a digital future in medicine, we have an opportunity to better use data and technology to bridge the divide and address the real gaps in care, all while creating a better consumer experience in today’s digital age.

Beyond COVID-19, if we want to prepare for what’s still to come, we need to start digging deep on real-world, real-time patient data to understand how behaviors are changing and how that might affect everything we thought we knew about healthcare before the pandemic.

Arif Nathoo, M.D., is co-founder and CEO of Komodo Health.

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