Those Other Patients

They don’t have COVID-19, but fear has caused them to delay treatment for other conditions—sometimes too long.




 

The chest pains began in mid-March, just after the lockdown, but Jean Gold—that’s what we’ll call her—kept them to herself despite a history of cardiovascular disease. Until May, when she could no longer ignore the pain, neither her husband nor her cardiologist had any idea that she’d been experiencing the symptoms of what her doctors determined were a series of heart attacks. In late May, she finally underwent surgery to open several blocked arteries. The following day she explained to her family doctor, internist Stephen Brunnquell, M.D., why she’d been reluctant to seek care. “I didn’t call you,” she told him, “because I knew what you’d say. I didn’t come to the hospital because I knew I’d get the virus if I did.” Gold lived for two more days, but her decision to put off care proved fatal.

Dr. Brunnquell, president of the Englewood Health Physician Network, found her death deeply troubling. “It was completely avoidable,” he says. “If she’d sought care promptly, we could have preserved her heart function.”

Gold is one of a growing number of patients some are calling the secondary victims of the coronavirus pandemic: people with troubling symptoms who delay care for fear of contracting COVID-19. A study released in June revealed that, across the U.S., up to 60 percent of patients suffering from cardiovascular symptoms refused to be treated because of the coronavirus. Another recent study indicated that nearly 40 percent of patients with life-threatening heart blockages like Gold’s put off seeking care, likely because they feared exposure to the virus. In Bergen County, as in most other parts of the country, visits to hospital emergency departments were down more than 50 percent this spring.

“As the pandemic increased in intensity, more and more of what emergency departments were seeing was COVID, and less and less was non-COVID-related emergencies,” says Joseph Underwood, M.D., chair of the Emergency Department at Hackensack University Medical Center. He notes that, like Gold, patients were coming into the ED later in the course of their illnesses and exhibiting complications that wouldn’t have occurred had they been treated sooner. A perfect example, says Underwood, is appendicitis. “We’ve been seeing patients coming in with perforated appendixes, which wasn’t typical prior to COVID.”

And it isn’t just hospitals that patients have shunned. Elana Clar, M.D., is a neurologist in Oradell who specializes in movement disorders such as Parkinson’s disease. Many of her patients have been treated with a surgical procedure known as deep brain stimulation (DBS). During the surgery, doctors place a battery-controlled device in the brain to control tremors; periodically those batteries need to be reprogrammed or replaced. What Dr. Clar noted in early spring was that a great many patients weren’t coming in to have their batteries checked, with the result that their tremors were starting to reemerge. When DBS no longer works as it should, she explains, “patients may feel much slower or much stiffer; they can’t walk normally; they may have more gait imbalance; they may risk more falls.”

Quality of life has become one more victim of the pandemic. Hackensack resident Caryl Blank, for instance, still hasn’t obtained the nerve block that would have mitigated the severe pain she experiences from chronic sciatica. “I’m in pain all the time,” she says. “There have been weekends when all I’ve done is lie on ice. But I just don’t feel comfortable going into the medical suite right now.”

Among the most serious of COVID’s secondary victims are cancer patients— not so much those already diagnosed and in treatment, says Hackensack oncologist Andrew Jennis, M.D., but patients who’ve put off diagnostic tests such as mammograms and colonoscopies or who’ve noticed troubling symptoms but won’t seek treatment for fear of COVID exposure. “New-patient diagnoses have dropped off by a solid 50 percent,” says Dr. Jennis, “and that’s very worrying.” He and his colleagues are expecting a higher rate of cancer deaths over the next several years. “We’re already seeing some people coming in with more advanced disease or more complicated situations,” he says, “which means their outcomes are going to be less good than if they’d been diagnosed earlier.”

Though damage has been done, the good news is that patients in increasing numbers are returning to their doctors and hospital EDs. In mid-June, Dr. Underwood said that he hadn’t personally treated a coronavirus patient in five to six weeks. “The medical center now has only a very small number of COVID patients, who’ve been in the hospital for a long time and are still awaiting discharge,” he explained.

Perhaps most encouraging is that hospitals and doctors’ offices are putting in place even more stringent disinfecting procedures than existed before the pandemic. “We’re smarter now,” says Dr. Jennis. “We know how to protect both the patients and the staff.” Even if there’s a second wave of COVID-19, he says, these treatment facilities have instituted systems to protect non-COVID patients. Patients are issued masks upon arrival and waiting rooms are set up to ensure social distancing, while those with COVID (or suspected COVID) are kept separate from the general population. “We know that people aren’t contracting COVID from coming to the cancer center or the ED because of all of the PPE”—personal protective equipment—“interventions that have been done.” Data has shown that, once hospital staffers were issued proper PPE, they weren’t contracting COVID and therefore not passing it along to patients.

“If patients are coming in for their procedures and getting fixed, they should be fine,” says Dr. Brunnquell. “And that makes me feel good.”

— By Leslie Garisto Pfaff

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