Dr. Saphier explains what's behind new COVD numbers as spikes test reopening plans
Dr. Nicole Saphier breaks down the state of the coronavirus pandemic and explains what's causing new cases
Around 3 a.m. one day in April an ambulance was called to the home of a young family in New Jersey who were doing their best to say safe during the COVID-19 pandemic.
Let’s go back a couple weeks to when Executive Order No. 109 was announced in New Jersey. It directed the suspension of all elective surgeries and invasive procedures performed on adults beginning on March 27. This was an unprecedented move that most in our generations had not seen before and is now happening again in areas of the country with increasing new cases.
After seeing the tragedies occurring in Italy, I knew that lives would be saved if we did what we could to make sure Americans had enough hospital beds, ventilators and personnel available to prepare for the influx of critical patients that were soon to come. Yet, the concept of something being “elective” in health care was quite elusive, outside of the obvious purely cosmetic plastic surgeries.
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What our health care system (mainly the administrators with nominal clinical experience) did not do correctly was assume that every case outside of arriving in the emergency department was an elective procedure and they took the decision-making away from the doctors and patients. Not only were the plastic surgeries canceled, but other interventions such as cancer screenings and preventive surgeries were halted.
The reason for the 3 a.m. phone call in April was a brain aneurysm rupture in a young woman who was at home with her husband and two young boys. The aneurysm had initially been discovered incidentally a month earlier during a brain imaging she obtained for an ancillary reason.
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The risk of death in a person with a brain aneurysm that ruptures ranges from 70 to 80 percent, so the goal is to identify the aneurysm before it ruptures. In the case of the young woman, the risk of rupture of her aneurysm given the size was about 40 percent over the next five years. It didn’t constitute an “emergency,” in the sense that she wasn’t dying in that moment, but she did die three weeks later from her aneurysm rupturing.
That was the phone call first responders received – someone was dying from a ruptured aneurysm and needed immediate medical attention. This is not uncommon. A brain aneurysm ruptures every 18 minutes and most people never even know they have one.
This woman was lucky enough to have found it before it ruptured and had ensured treatment to prevent it from rupturing. However, because of the executive order trying to make room for COVID patients, her “elective” procedure to treat her aneurysm was canceled despite persistent rebutting. After it ruptured, she laid in an ICU bed for two weeks before succumbing to the devastating brain injury.
Ultimately, the cancellation of her “elective” procedure, which would have been performed outpatient and not required a hospital bed, resulted in delayed care that necessitated an ICU bed and ultimately death in this young mother.
As cases of SARS-CoV-2 ramped up in late March, hospitals, health systems and even private practices dramatically reduced inpatient and nonemergency services to prepare for an influx of COVID-19 patients. Unfortunately, more selectivity and thought should have gone into this decision.
Our shutdown of medical care is the double edge sword no one wanted and we are seeing the ramifications of such efforts.
Rather than stopping medical care, indoor social gatherings should have been targeted first to decrease spread. Now, as we are seeing a continuation of the first wave in various regions of our country, I caution our leaders and the American public to avoid repeating our mistakes.
A Kaiser Family Foundation poll found that 48 percent of Americans said they or a family member canceled or delayed medical care because of the pandemic, and 11 percent said the person’s condition worsened as a result of the delayed care.
With a rise in cases, the media is reporting less hospital availability in some areas. However, in Houston and Austin, less than 15 percent of the hospital beds are filled with COVID-19 patients. Many patients are people needing inpatient hospitalization because they delayed care to the point where they now require more intensive treatment.
Additionally, hospitals are testing all patients in the hospital for COVID-19 regardless of the presenting reason, which may artificially inflate the number reported as COVID-related hospitalizations. This was a common criticism in the New York City area, which promulgated fear and gave a false sense of reality regarding the situation.
While the rise in new cases is concerning, we should take a moment and praise the American people for using the knowledge gained in the last several months and doing what they can to protect the most susceptible: the elderly and those with chronic medical conditions. The average age of those testing positive and being hospitalized is significantly less now than what occurred even a month ago, which is why the death rate has not mirrored what we saw previously. This is incredible news and something we should be proud of as our elderly seem to be more protected. While we remain vigilant in protecting the vulnerable as we re-open, let’s also remember to take care of ourselves in the interim.
The harsh reality is, Americans tend to lead unhealthier lives than our global counterparts mainly in terms of obesity, heart disease and diabetes. Since many of us avoided or delayed routine medical care during this time, hospital systems are now caring for patients whose flaring chronic illnesses now require hospitalization and even ICU treatment.
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Our shutdown of medical care is the double edge sword no one wanted and we are seeing the ramifications of such efforts.
People died because they avoided care or their care was involuntarily delayed, and now our health system is being tested as it tries to fix the damage done in the midst of fighting a pandemic with limited treatment options and no available vaccine.
From cancer to COVID19, early diagnosis and treatment are key to survival and lessening the societal burden of advanced disease. What may be easily treated as an outpatient requires a hospital bed if you delay care. Get your mammogram, check your blood pressure and make sure you have ample refills of any medication. These simple actions will help keep our hospital beds available for the most urgent cases. If our goal is to ensure ample hospital and ICU beds while also trying to keep our economy open, we need to live our healthiest lives to ensure there is a safety net when needed.
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The virus thrives in enclosed spaces with prolonged exposure and activity trackers are telling us that congregating in bars and nightclubs is spreading the disease. If canceling happy hour means we can avoid shutting down medical services and the entire economy again, we should do it. Let’s focus on long-term goals rather than giving in to short-term joys that will do little other than transmit a virus that has already killed more than 120,000 Americans in a little over three months.
No single legislation, medication or vaccine will get us out of this crisis. Rather it will be our own behaviors that ensure adequate hospital availability and lessen the spread of the virus among the elderly. I am doing my part. Are you doing yours?