And that is ‘quite a lot’, says lead researcher Ardine de Wit. ‘I think this is intense’, also responds health economist Xander Koolman (VU Amsterdam), after perusing the report.

Over the past two years, hundreds of thousands of non-emergency surgeries have been suspended. This is because due to corona there were too few staff, beds and stuff available, because patients themselves canceled for fear of contamination. At the end of 2021, a total of 305 thousand fewer operations had been performed in the Netherlands than would have been the case without corona – almost one sixth of the total. Which calculates the RIVMin a report published Monday .

And that’s just ‘one piece of the puzzle’, the report says. For example, according to the Dutch Healthcare Authority, tens of thousands of urgent operations have also been canceled: these are now not taken into account by RIVM. Health damage that may arise later, for example as a result of bankruptcies of unfinished courses, was not taken into account either.

That does not mean that the drug was worse than the ailment and that hospitals should leave corona patients to their fate, study leader De Wit. ‘We don’t know the alternative. Even then there would have been enormous additional damage to health.’

Regular care in crisis situations

Nevertheless, the figures sharpen the discussion as to which patients deserve priority in a crisis, according to the RIVM. For example, 63 thousand eye operations were postponed, and 32 thousand knee and hip operations: interventions with significant health gains. there were at least a thousand corrections of drooping eyelids, four thousand removals of benign moles and 30 thousand treatments for varicose veins. These interventions cause fewer problems if men postpone them.

De Wit says it carefully. ‘Our most important ones underline the importance of continuing regular care in crisis situations as much as possible. Look for ways to forgo as many operations as possible, make regional agreements, look at possibilities to divide the family, look abroad, make use of private clinics. At the same time, we say: look again at the health effects of various interventions. And prioritize the operations with the greatest health effects.’

Giving priority to the greatest need

A sound study, according to health economist Eline van den Broek-Altenburg, who conducts research herself into side effects of the corona crisis. ‘My first reaction is really: wow. It has turned out that we have postponed almost a sixth of our care, with all the damage that entails. And that’s just the non-acute concern, so in reality it’s more likely to be around a third,” she expects. “I like that quite a bit.”

This leads to a question of conscience, says Van den Broek: ‘Do you still think that the guiding principle should be that the patient with the greatest need comes first, now that it appears that you have lost so much health? If you start talking about deferred care, you quickly say: we don’t want to help people who are choking at the gate. But that’s not the issue. What is it about: how do you make decisions about scarce resources?’

The figures from RIVM suggest that it could help to give fitter people priority, given the same circumstances. A partial calculation showed that the damage suffered would be much smaller – 151 thousand lost healthy years – if men assume patients who gain a lot of health from surgery. When men have lost natural life years. ‘That is really a lot’, notes De Wit.

Catch-up care and excess mortality

Koolman, who studies how calculations are made, thinks that the RIVM’s own calculations are too high for exactly that reason. “What we conclude from our conversations is that during the corona crisis, doctors are already giving priority to patients who benefit most from surgery.” That will have dampened the number of healthy years, he thinks.

In the meantime, RIVM does not expect that suffering can be eliminated. Even if men lost 5 percent during the years, they would still have a thousand healthy lives for years by 2026, the calculators estimate. also, lack of and overstrained and sick employees.

The RIVM figures did not show that the missed operations also cost lives. Although there are anecdotal cases, for example of patients who died of a small aneurysm (weak spot in the vein) that harmless leeks broke earlier than expected.

Another research team, from CBS and RIVM, recently announced that about three thousand Dutch people more than usual died at the end of last year. The reason is unknown, but delayed care is one of the possible causes.