Hippocrates in Danger: COVID-19 and the Missed Care Epidemic

“Wait,” the nurse says, poking her head through the curtain into my room in the ER, “I haven’t told them yet.” My heart drops and my teeth start to chatter; this must mean my chest and back pain weren’t as benign as I’d thought. 

“Well,” the doctor who had been cut off by the nurse, a pulmonologist, says, “your CT scan shows pulmonary emboli in both lungs.”

The next moments are a flurry of nasal swabs to see which Intensive Care Unit (ICU) I am to be admitted to—COVID-positive or negative—and to determine whether or not my mother will be able to see me at all. My chest is tight, with both pain and panic. What if my test comes back a false positive and I have to be put on a floor with COVID patients and then I catch it there? It’s practically impossible that I have the virus, I tell myself, since I have scarcely left the house for four months. Will all that hard work be wasted because of blood clots and a test?

Thankfully, the test comes back negative, so I can turn my worry elsewhere. Two nights later, I am discharged with a prescription for blood thinners and the instructions to wait while the infarcted tissue in my lungs scars over and heals. But the scariest part of the whole ordeal comes to me days later, when I am well rested enough and the pain has dulled enough for me to consider: I almost didn’t go in. 

I cried the whole way to urgent care, then to the ER when they referred me, not from pain but from fear of contracting COVID-19 at those places. And I was far from alone in my fear. A KFF Health Tracking poll in May 2020 found that 48% of American adults postponed or skipped medical care due to the coronavirus outbreak. Emergency departments across the country have seen visits halved since early March of this year. Heart attack and stroke teams nationwide have noted a 40-60% reduction in admissions for heart attacks during the pandemic, not because Americans are suddenly getting healthier, but because they are scared. Scared that they have COVID-19 and won’t be able to see family, or scared that they’ll come away from the hospital or the ER or the doctor’s office with an infection. 

But even Americans who may want to go in, who have weighed the risks and determined it to be worth it, may not be able to receive the treatment they need. Elective surgeries in many states have only just opened up in recent months, and even then, the backlog of cases is huge—three months at best. 

“Elective” in medicine has a very different meaning than it does in common parlance. It does not necessarily mean something you freely chose to have done but could live without, but rather any procedure that is scheduled ahead of time. Therefore, “elective” is not synonymous with “non-essential.” But unfortunately, when COVID-19 surges, it is treated as such. Around the country, postponing or cancelling elective surgeries is the first line of defense in ensuring hospitals don’t exceed ICU capacity. Elective procedures account for an estimated 91% of surgeries in the U.S., so the decision to preserve space makes sense, but it comes at an undeniable cost. Elective procedures range anywhere from the removal of a malignant tumor to injections that treat debilitating migraines. The effects of their postponement range anywhere from an inability to perform daily tasks out of pain to disease progression and death. Affected also are preventive procedures such as cancer screenings, which declined by 90% from February to April of 2020, which will cause an increase in advanced diagnoses of cancers that had been missed early on.

The jeopardization of elective procedures is one that disproportionately affects the disabled community, who are already at a disadvantage in seeking care due to ableism ingrained in the medical system. Postponing elective procedures—potentially at the expense of those who need them—is essentially an extension of medical rationing, of deciding who is “worth” care at a given time and who isn’t. Dr. Shanna Kattari of the University of Michigan points out the Kansas triage guidelines for a public health emergency, reinstated for the coronavirus pandemic, which prohibit the use of life-saving resources on patients who meet certain exclusion criteria (some of which include age and chronic illness) in order to save the scarce resources for those deemed “more likely to experience medical success” (3). As the COVID-19 pandemic continues to tear at the seams of healthcare systems in the U.S., providers are forced into the difficult territory of making decisions that seem at odds with what medicine is at its core: first, do no harm. 

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