The Untold Toll — The Pandemic’s Effects on Patients without Covid-19

Lisa Rosenbaum, M.D. NEJM DOI: 10.1056/NEJMms2009984 Published April 17, 2020.

  • Dr. Rosenbaum’s comments are in the New England Journal of Medicine’s Medicine and Society Section and succinctly points out with case examples patients who because of the understandable focus on COVID – 19 as a disease and as a risk to patients and medical staff receive non-standard care for non-COVID – 19 related serious medical problems. Examples include
  • Patients with serious cancers who either feel to have missed the value of a “real” multidisciplinary (and usually “face to face”) discussion of options and plans or even potential delays in treatments with unknown consequences.
  • Patients with potentially life-threatening Acute Coronary Syndromes who present with accelerated symptoms but without ECG/Biomarker evidence of infarction are sent home – and only if fortunate to return in time and undergo appropriate coronary angiography.
  • A patient whose delay in care for acute myocardial infarction, awaiting assessment of COVID – 19 status (ultimately negative) led to progressive deterioration with cardiogenic shock and ultimately death.
  • These are not examples from a remote or rural location but from top tier, major medical centers –
  • Reasons include concerns about availability of PPE for staff and a general concern about how to manage no COVID illness in the wake of a Pandemic.
  • A recent study (Garcia S, Albaghdadi MS, Meraj PM, et al. Reduction in ST- segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol 2020 April 9 (Epub ahead of print) demonstrated a 38% reduction in STEMI procedures since the onset of the COVID – 19 Pandemic.
  • The focus of risk/benefit in patient care has at times moved from patient to staff in the current Pandemic.
  • Dr. Rosenbaum concludes with two comments:
    • “Humanity absent sound medical judgment is meaningless.”
    • “Yet as we begin to observe fewer admis- sions for common emergencies such as heart attack and stroke, … the need for vigilance about viral transmission need not detract from an equally important message: Covid or no Covid, we are still here to care for you.”
  • Standard diseases in the setting of COVID – 19 still exist and still require standard treatments – our challenge is to provide that care safely (for all involved), compassionately, and appropriately.