The extended shutdowns related to the COVID-19 pandemic are creating “a mass casualty incident” that could negatively impact the health of all Americans for years to come, according to a letter to the White House signed by more than 600 American physicians, including one Oklahoma City orthopedic surgeon.

Dr. Mark Kowalski said Americans may be paying for the extended shutdowns for some time as unrelated health issues that are not being treated now continue to emerge.

The letter notes that “we are alarmed by what appears to be the lack of consideration for the future health of our patients. The downstream health effects … are being massively underestimated and underreported.”

Perhaps worst of all, liquor sales have risen from 300 to 600 percent, the letter noted, suggesting that issues surrounding addiction may lie years in the future. Calls to suicide hotlines—and by extension suicides that are not prevented—have also risen dramatically.

“I’m sure there is increased drinking going on,” Dr. Kowalski said. “We won’t see it right away, but we’ll see it in a few months.”

As an orthopedic surgeon, Dr. Kowalski said he mostly had to confront the moratorium on elective surgeries, which included patients forced to wait for pain-relieving procedures. He noted that physicians in other specialties faced other unique challenges.

Dr. Kowalski’s concerns were buttressed by a recent article in The Hill by, among others, Scott W. Atlas, a physician and senior fellow at Stanford University’s Hoover Institution. The shutdown, Dr. Atlas and his coauthors suggested, has already cost lives due to “delayed and foregone health care.”

Atlas says emergency evaluations of strokes have declined 40 percent since the shutdown began. As many as half of cancer patients undergoing chemotherapy are missing treatments. Perhaps most tellingly, “two-thirds to three-fourths of routine cancer screenings are not happening because of shutdown policies and fear among the population.” Those screenings usually detect as many as 150,000 new cases of cancer each month in the United States—cancers that could be curable with early treatment that is now being delayed.

Those missed or delayed treatments are costing some 8,000 additional deaths each month in addition to those lost to COVID-19, the authors state. The impact may be long-term; Atlas suggests that half or more of children due routine vaccinations are not receiving them on time.

“That is going to be an issue when children go back to school,” Dr. Kowalski said. “If kids don’t have their immunizations up to date they won’t be able to enroll.”

He noted that the suspension of many of the most common cancer screenings—especially mammograms, colonoscopies, and prostate antigen blood tests—are certain to allow many undetected cancers to progress.

Asked how he would have handled the pandemic, Dr. Kowalski said, “I probably would have had the shutdown early but lifted it sooner.” That decision would have been supported by findings that mortality and severe illness from the virus have been almost entirely confined to the elderly and those in poor health.

He also noted that another long-term impact on health care may emerge as millions of Americans who have lost their jobs find themselves with no health insurance.