**1. Introduction**

Covid-19 pandemic caused by SARS-CoV-2 virus hit the world in December 2019 [1, 2]. Because of rapid rise in the cases worldwide it was declared as an international emergency by WHO on 30th January 2020. Social distancing, face mask, hand hygiene became the new norms. Public transport & travel restriction were implemented in most of the countries.

While all the efforts were made to curtail the transmission of the virus and management of those affected by the virus, a lot of routine procedures, treatment appointments were put on halt. Most of the hospitals both public and private were either managing COVID-19 patients or only those with emergency conditions. As a result, lot of patients suffering from diseases other then COVID-19 had to cancel their scheduled appointments indefinitely. Due to the uncertainty neither the doctor nor the patients were sure when will the routine care start again which leads to anxiety, frustration, fear of progression of disease or development of complications related to diseases and depression in many of the patients and health care providers as well.

According to a report published by WHO in June 2020, 94% of the member countries reported that all or some of the ministry of health staff with responsibility for noncommunicable diseases were reassigned the duty for management of Covid-19. As per this report around 53% of the countries disrupted their medical services for hypertension, 49% for diabetes, 63% for rehabilitation services, 42% for cancer and nearly 31% for cardiovascular diseases [3]. Due to the delay in treatment many patients develop anxiety which also manifested as physical symptoms like palpitation, gastrointestinal disturbances, depression, substances abuse. Mental health of such patients waiting for procedures and treatment worsened.

### **2. Non-communicable disease**

Nearly 70% of deaths in the developed nations and 80% in low & middle-income countries occur due to non-communicable disease every year [4].

Non-communicable disease include disease like hypertension, diabetes, coronary artery disease, cancers etc. Patient suffering from such conditions need repeated appointments to adjust their drug dose, check compliance to the drugs, follow improvement in the symptoms and to check for any further progression of the disease. Due to the closing of all non-emergency services during the pandemic resulted all routine appointments were postponed resulting in delayed treatment. Due to this sudden disruption in the existing health care system patients and health care professionals did not get time to discuss and plan their further management. This caused lot of anxiety and distress in many patients suffering from the any of the disease. Many patients experienced mental health problems, sleep disturbances, anxiety, mood disorders to add on to the existing symptoms but had no clue whom to seek clue from.

### **3. Cancer management**

Being diagnosed to have cancer in itself is distressing for a patient and family. The anxiety levels are higher in newly diagnosed cases and new stressor can be difficult to manage for such patients [5–7]. Treatment delay due to COVID-19 pandemic and the fear associated with higher chances of acquiring infection due to week immune system lead to increased psychological issues in many cancer patients [8–10]. Many patients could not travel to hospitals on the scheduled appointments due to travel restriction and many of the hospitals temporarily suspended their services causing delay in treatment. Delayed treatment lead to progression of the disease and raised the mortality rate. A study done by Yingjun ye et al. found that psychological distress was significantly higher in the patient with cancer during COVID 19 as compared to the healthy volunteers [11].

### **4. Fertility treatments**

Infertility i.e. not able to conceive is one of the most distressing diagnosis for a couple and is associated with lot of anxiety, depression and feeling of guilt.

Due to the advancement in the fertility services now many couple see ray of hope. Ovulation induction, intrauterine insemination, in-vitro fertilisation are some of the

#### *Emotional and Psychological Impact of COVID-19 Induced Delay in Treatment... DOI: http://dx.doi.org/10.5772/intechopen.107388*

options which can be opted by the couple as per their medical needs decided after meticulous fertility workup. The whole work-up is itself time demanding and cycle dependent. Cycle cancellation of any reason can be distressing for a couple who is waiting to conceive for long [12, 13]. During the pandemic due to the restrictions and fear of contracting the disease lot of cycles needed to be cancelled and several couples kept waiting for their treatment. Due to the risk of exposure and conservation of resources on March 2020 American Society of reproductive Medicine (ASRM) and many other international societies recommended to suspend all kind of fertility treatments [14]. In a study published in 2020 by Kaur H et al. shows that 50% of the fertility treatment cycles were cancelled due to COVID-19 pandemic and 16.4% of the couples found it extremely upsetting. Around 10.9% experienced sleep disturbances, 14.15 were anxious, 18.4% had mood disturbances and 17.4 had disturbed thoughts [15].
