The pandemic’s silent crisis: millions of chronic illnesses left in the shadows, undiagnosed and untreated. But here’s the shocking part: while the world focused on COVID-19, a hidden epidemic of missed diagnoses was quietly unfolding, leaving countless lives at risk. When the pandemic struck, healthcare systems globally were thrown into chaos. Hospitals emptied beds, routine check-ups were canceled, and people were urged to stay home unless facing emergencies. In England alone, visits to family doctors and hospital admissions for non-COVID issues plummeted by a third in the early months. Medical staff were reassigned, clinics shut down, and diagnostic tests were put on hold.
Amid this turmoil, the number of new diagnoses for long-term health conditions dropped dramatically, as revealed by our groundbreaking study published in the BMJ. Using anonymized health data from nearly 30 million people in England, my team and I uncovered a startling trend: chronic illnesses were slipping through the cracks.
And this is the part most people miss: the conditions most affected were those relying on routine tests or specialist reviews. For instance, new asthma diagnoses fell by over 30% in the first year, while chronic obstructive pulmonary disease (COPD) diagnoses dropped by more than half. Both conditions depend on breathing tests, which were severely disrupted, creating massive backlogs. Skin conditions like psoriasis and atopic dermatitis also suffered, as patients either delayed seeking care or faced long waits for specialist referrals.
The consequences of delayed diagnoses can be devastating. Take osteoporosis, for example. This common condition weakens bones, leading to severe fractures. Highly effective treatments exist, but they’re typically prescribed only after diagnosis. During the pandemic, new osteoporosis diagnoses fell by a third and took nearly three years to recover, leaving over 50,000 people in England undiagnosed between March 2020 and November 2024.
As the initial chaos subsided, diagnosis rates for many conditions began to rebound—but not all at the same pace. Two conditions stand out: depression and chronic kidney disease. Depression diagnoses dropped by nearly 30% in the first year, partially recovered, and then fell again after 2022. But here’s where it gets controversial: this doesn’t necessarily mean fewer people are struggling with depression. Disability claims for mental health conditions in England doubled between 2020 and 2024, suggesting the opposite.
Why the disconnect? One reason could be the ongoing strain on healthcare services, forcing people to wait longer for diagnoses. Another factor is the shift in how care is accessed. In 2022, England updated its guidelines to recommend talking therapies as the first-line treatment for mild depression, bypassing the need for a formal diagnosis. People can now self-refer for therapy without seeing a doctor, meaning many may never have their condition officially recorded.
Here’s a thought-provoking question: Could changes in disease classification also be at play? While depression diagnoses have fallen, ADHD and autism spectrum disorder diagnoses have soared. Is this a true rise in prevalence, or are overlapping symptoms being reinterpreted?
Chronic kidney disease tells a different story. Diagnosis rates have doubled since 2022, surpassing pre-pandemic levels. Why? One possibility is improved detection, thanks to updated guidelines recommending routine testing for at-risk groups. Another theory is that the pandemic itself may have contributed, either directly through COVID’s impact on kidney function or indirectly through delayed treatment of conditions like diabetes.
The silver lining? Our study shows that we can now detect shifts in disease patterns faster and more comprehensively than ever before. Secure, anonymized analysis of medical records allows researchers to track diagnoses in near real-time, revealing the ripple effects of disruptions and recoveries as they happen. While the findings are sobering, they also highlight a new opportunity: timely data can guide more effective responses to future crises.
But here’s the bigger question: As healthcare systems continue to grapple with the pandemic’s aftermath, how can we ensure that no one is left behind? The pandemic disrupted care, but it also spurred innovations that uncovered patterns once hidden. Now, it’s up to us to act on this knowledge. What do you think? Are we doing enough to address this silent crisis, or is more radical change needed? Share your thoughts in the comments—let’s start a conversation that could shape the future of healthcare.
