After being diagnosed with breast and thyroid cancer last spring, LaDonna Lokey knew she had a long year of surgery and chemotherapy ahead of her.
By the end of January, she had finished chemo and needed one more operation to remove the lymph nodes that closed in on her vocal cords. But then the coronavirus pandemic struck, overwhelming his Wisconsin hospital and others across the United States.
As coronavirus patients flood clinics and hospitals, health workers are acting on the recommendation of state and federal authorities to cancel elective procedures, close non-emergency medical offices and reschedule non-essential appointments . This puts people with other health problems – from cancer to pregnancy – in a precarious position.
For some, the services on which they counted are no longer available or have been canceled. Others say the services they need are still available, but they are too afraid to venture out and risk contracting the virus.
Put the treatment on hold
Before her lymph node surgery, Lokey had to have an ultrasound at a hospital in the Green Bay area. But before she could go, they called to say that it should be postponed until the end of April, at the earliest.
They told him that the ultrasound should wait. “From my feeling of all health care providers, they just felt like they didn’t know what was going to happen,” she told CNN.
Without the ultrasound, Lokey can’t have an operation. But even if she could get an ultrasound, she was afraid of having an operation during a virus pandemic.
“The first is that they would, and the second, do I want to,” said Lokey. “I’m just going over there, I’m in danger … even if they said,” Yeah, I’m going to go, “do I want to do it now? I’m afraid anyway. I don’t know if I would. I could wait. “
At the moment, Lokey can live with the lymph nodes in and around his throat, but it’s uncomfortable, she said. The longer they are there, the higher the risk of growth, or the cancer spreads to other parts of their body.
“I also want to rip it out of my throat, that’s how I feel,” said Lokey. “Every day he is, he could go deeper into my lymph nodes. “
Like other cancer patients, Lokey’s treatment plan is on hold indefinitely.
Some patients will die
Anna Steegmann, a 65-year-old professor in New York, did not think that a ringing noise in her ears would lead her to a diagnosis of cancer. But after a series of blood tests, four days in the emergency room, and a bone marrow biopsy, she was diagnosed with myelodysplastic syndrome, a type of blood cancer.
Steegmann was diagnosed on March 13, when New York already had more than 400 cases of coronavirus. After being diagnosed, she contacted Memorial Sloan Kettering, the region’s best cancer hospital. They said they are not taking new patients anymore.
“They said we were on hold right now. They said they couldn’t accept anyone, “Steegmann told CNN.
After weeks of calling doctors’ offices and coordinating medical records to be sent to these locations, Steegmann was able to arrange a video streaming telehealth appointment with a specialist. She said she wanted to ask basic questions like the length of her prognosis – this type of cancer has no cure – and what treatment options are available to her.
“I feel like I am waiting, waiting, waiting, being sentenced to wait, and I am wasting time that could be better spent getting treatment,” said Steegmann. “Anyone who has recently been diagnosed with a serious illness will have difficulty getting treatment.”
Dr. Arthur Caplan, medical analyst at CNN and director of the Division of Medical Ethics at New York University School of Medicine, said the pandemic would certainly hurt virus-free patients.
“People will be at risk and some will die because normal treatment, especially early treatment of cancer, is not available,” Caplan told CNN. “Hopefully we are talking about a matter of months, but if it lasts for, say, a year, you are talking about people who die not from the virus, but from the virus. “
Managing long-term care
For patients managing long-term health conditions, the pandemic increases their doctor’s routine visits, tests and treatments
Molly Schreiber, 40, was diagnosed with type 1 diabetes as a child. Years later, she was diagnosed with rheumatoid arthritis, an autoimmune disorder.
For his arthritis, Schreiber receives IV infusions of a drug called Rituxan every four months. These infusions should be done in a hospital. Although her next infusion will not take place before the end of May, she is already nervous.
“My greatest fear … of entering a hospital environment,” Schreiber told CNN. “My concern is that I would make something much worse at the hospital.”
The medications Schreiber takes for his arthritis weakens his immune system, which puts him at increased risk for contracting a coronavirus.
In addition to the infusions, Schreiber usually does blood tests every six weeks to check for certain markers and to make sure his health is stable. She plans to postpone them for the moment, she said.
Her rheumatologist and other doctors who can make telehealth appointments recommended that she stay indoors as much as possible. Her hospital told her that if she were to come for diabetes-related problems, she would need to bring her own equipment to check her blood sugar.
“They’re putting guidelines in place to just bring your own needles, your own supplies, everything, so we can check your blood sugar,” said Schreiber.
Telehealth helps, but not always
Telehealth services have increased in recent weeks as an alternative for people who fear going to hospital and potentially exposing themselves to the coronavirus. Federal agencies have deregulated some of the provisions that prevented insurance companies from covering these services, allowing Medicaid to cover telehealth.
Heal, a telehealth and home care service, has been in business for more than five years, but founder and medical director Renee Dua said the company had seen a 640% increase in patients in the past month. Dua said telehealth and home care services can provide a safe alternative so that preventive medicine and intensive care for autoimmune disorders are not abandoned during this time.
“The growth has been deep,” Dua told CNN. “We call this filling the gaps in care. We should not avoid preventive screening and primary care at this time. “
Although telehealth services and home visits may supplement certain hospital visits, other in-person appointments cannot be replaced.
Rebecca Gray, a 28-year-old mother of two with another baby on the way, says ultrasounds are necessary – and they can only be done at the hospital.
“It is scary. You fear for the worst. You see they have a little tent set up because the emergency room at the hospital where you walk is in plain sight of each other, “Gray told CNN. “I have to do what’s best for my unborn child … make sure we’re on the right track for that, and also try to make sure that my two other children are safe and healthy. “
Lokey said she wants hospitals to communicate better about those who have or don’t have coronavirus patients, as this would make it easier to know when she is at increased risk.
“It is not clear what they are doing. We don’t want to go there at all, ”said Lokey.
Caplan agreed that the federal government and local emergency management teams could better tell people which hospitals are safer than the others.
“I think we should hear more from the White House on this problem,” said Caplan. “We should see more first responders in the cities. Here’s the contract, that’s when you have to call an ambulance, that’s when you have to call the fire department. We don’t get enough advice. “
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