Side effect of the pandemic: neglected health. Health screenings, pediatric vaccinations, and needed treatments were delayed during the pandemic as people fearing exposure to COVID-19 avoided health care settings. A study at Kaiser Permanente in Southern California found a decline in childhood vaccine administration among nearly 1 million members ages zero to 18 years during "stay-at-home" periods in 2020, compared with the same months in 2019-and the decline persisted in older children during reopening in summer 2020. Cancer screenings such as mammograms, Pap tests, and colonoscopies also decreased, perhaps permitting early, more treatable cancers to go undetected. The postponement of 800 lung cancer screening appointments at the University of Cincinnati resulted in an increase in lung cancer nodules suspicious for cancer when screening resumed. The pandemic also brought an increase worldwide in tuberculosis deaths for the first time in more than a decade, due to disruption in access to services and reallocation of resources to COVID-19 efforts. Similarly, U.S. drug overdose deaths spiked. Monthly deaths rose 50% between February and May 2020 although they returned to prepandemic levels in early 2021.

Telehealth use soared during the pandemic. More than one in four Medicare beneficiaries surveyed received medical care by telehealth between the summer and fall of 2020. Two-thirds, or 64%, reported that their provider offers telehealth, up from 18% before the pandemic. The use of telehealth also skyrocketed during the pandemic among privately insured patients. Telehealth visits in 2020 among 37 million Blue Cross and Blue Shield members accounted for 23.6% of all health care visits, compared with 0.3% in 2019.

Age as a factor in crisis rationing of care. In areas overwhelmed by patients with COVID-19, beds-especially ICU beds-are in short supply. Health care professionals have been asked to decide who will receive treatment. Arizona and Idaho have already enacted "crisis standards of care," based on their state's pandemic preparedness plan (PPP) specifying how scarce resources are to be prioritized. According to a study in Chest, in a significant number of states the determinant is age. Researchers identified 35 published state PPPs developed or updated during the pandemic. A full 60% of plans, 21 of 35, involved rationing by age in some capacity, such as by considering short-term expected life-years, actual life expectancy based on age, or an age cutoff.

First malaria vaccine to tackle disease. The World Health Organization has recommended widespread use of a new malaria vaccine for children in sub-Saharan Africa and other regions with moderate to high malaria transmission. The vaccine, called RTS,S/AS01, was developed after 30 years of research and tested for two years in a pilot program in Ghana, Kenya, and Malawi. It is the first vaccine to demonstrate reductions in malaria, decreasing deadly severe disease by 30%.-Joan Zolot, PA