August 6, 2020
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Fear of COVID causes other patients to refuse critical treatment

Fear of COVID causes other patients to refuse critical treatment

AliExpress WW

It was a call that Lance Hansen, a seriously ill liver disease, had been waiting for several weeks, and he arrived shortly before midnight in late April. A liver was available to him. He got up to get dressed for a three-hour trip to San Francisco for a transplant operation.

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And then he panicked.

“Five minutes after he hung up, he started hyperventilating,” said his wife Carmen. “He continued to say:“ I am going to get a COVID, and then I will die. And if I die, I want my family to be there. I could not believe what I heard. “

She promised that she would wait outside the hospital, as patient families were forbidden to enter. She warned that he could not get another chance for a new liver before it was too late. She told him that he could die if he did not leave. However, the 59-year-old Hansen refused.

In a world filled with anxiety, fear covers not only people who suffer from coronavirus, but also those who need urgent medical attention. Although the incidence of COVID is decreasing in many places, patients with cancer, heart disease and strokes, among other things, delay or refuse critical procedures that can support them. And since the virus is being rekindled in the pockets of the country, people generally ignore the symptoms, are afraid to step into emergency departments or even doctors’ offices.

On the orders of their states, many hospitals canceled elective surgeries, such as hip replacement, as the incidence of COVID has increased. Now most are gradually allowing the resumption of electoral operations. But for this, as well as for more time-sensitive procedures, such as cardiac catheterization, cancer surgery and blood tests or computed tomography to monitor serious chronic conditions, doctors now spend hours on the phone trying to persuade terrified patients.

Insurance company Cigna Corp. found that in her claims reports and preauthorization data for seven acute conditions, including heart attacks, appendicitis, and aortic aneurysms, there was a decrease of 11% for acute coronary syndromes to 35% for atrial fibrillation. hospitalizations in the last two months. In a study published Tuesday in the New England Medical Journal, Kaiser Permanent reported a nearly 50% reduction in heart attack cases in Northern California hospitals.

At the University of Rochester’s Medical Center in Rochester, NY, the number of emergency visits has fallen by 50%, and many of the visiting patients have been waiting too long to seek treatment. They are “late with strokes and heart attacks,” said Dr. Michael Apostolakos, chief medical officer of the system. “Or they don’t appear until they barely breathe from heart failure.”

In Newark, NJ, ambulance groups made 239 in-place deaths in April, four times more than in April 2019. Less than half of these additional deaths can be attributed directly to COVID-19, said Dr. Sheriff Elnahal, president and CEO of Newark University Hospital.

Rejecting a crucial, potentially life-saving treatment may seem irrational. Mental health experts explain that anxiety affects the part of the brain involved in thinking and planning for the future. This happens when this part, the prefrontal cortex, does not have enough information to accurately predict what lies ahead, forcing the brain to twist fear scenarios.

Enter a panic.

“If you have anxiety, and then you make it worse by watching the news and reading social networks, this is where you start to panic,” said Dr. Jude Brewer, a psychiatrist and behavioral neuroscientist at Brown University. “And the rational, thinking parts of the brain stop functioning well when we are in a panic.”

According to Brewer and others, panic, in turn, can lead to impulsive behavior and dangerous decisions.

“People say,“ So, I have a heart attack. I am going to stay home. I’m not going to die in this hospital, ”said Dr. Marlene Millen, a primary care doctor at the University of California at San Diego. “I really heard that a few times.”

Dr. Susanne George, an oncologist at the Dana-Farber Cancer Institute in Boston, has patients receiving oral chemotherapy regimens who refuse to attend lab work. Cancer patients receiving chemotherapy have a particularly high risk of serious illness if they become infected with the coronavirus.

“They don’t want to leave their home, so we can get tested to make sure they are on safe chemotherapy,” George said, adding that blood tests are crucial for early detection of potentially serious side effects.

George said the fear she had seen a few weeks ago had subsided. However, she said: “We all need to get together to make people feel safe.”

Most hospitals and clinics have made changes to ensure the safety of patients and staff. Many test patients and some workers. In many hospitals, patients with COVID are kept in separate departments. Masks are usually required for both patients and doctors. The cleaning protocols were turbocharged. As a result, according to experts, the risk of acquiring COVID upon admission to the hospital is very low.

But one of the common safety measures – the prohibition of visiting even close family members – is a huge reason for fear and concerns of patients.

“The hospital was an ominous, nervous, and scary place for patients before COVID,” said Dr. Lisa Van Wagner, a transplant hepatologist at Northwestern Medicine in Chicago. “Now you perceive the stressful situation as a pandemic, and tell people that they cannot have a normal support system while they are in the hospital, and this really strengthens these fears.”

Transplant specialists across the country describe patients such as Hansen who refuse to have organs because they worry that patients with COPD may see them, or because they cannot have a close relative or friend in the hospital.

54-year-old David Rivera, who has liver cancer, abandoned the liver in late March in the northwest. In an interview, he said that he was afraid that a deceased donor might be infected with the virus.

Van Wagner, who works on a transplant team in the Northwest, said Rivera had given up on the liver, even though the donor was negative on COVID-19. However, the hospital cannot guarantee that the liver is free of coronavirus, although VanVagner and others have stated that the chances of a donor of a liver with a negative test passing the virus to the recipient were extremely low.

Van Wagner said Rivera needed a transplant before his cancer could progress.

“His window is closing,” she said. “You can go so long before you run out of chances.”

Hansen said he now regrets the decision he made last month and will accept the next liver, which will become available.

“I was just freaking out,” Hansen recently said over the phone, his voice was weak and weak. “I had to leave, but I was just scared.”

Health care administrators are redoubling their efforts to convince patients that it is safe to come to hospitals and dispensaries, even though testing for hospital staff and patients remains unreliable.

“Our goal is to spend almost all of our marketing dollars over the next year on the security of our facility,” said Dr. Stephen Clasco, Executive Director of Jefferson Health, a system of 14 hospitals based in Philadelphia.

Some doctors help patients with chronic illnesses rethink their treatment aspects.

For the past 21 years, 45-year-old Rob Russo has been living with a rare type of cancer of the gastrointestinal tract that has spread to his liver. Over the years, he made regular trips from his home in New York to Dana Farber in Boston. When the pandemic began, oncologist Russo helped him transfer much of his care to the Sloan Kettering Memorial Cancer Center and Weil Cornell’s New York-based Presbyterian / Medical Center in New York.

In late April, Rousseau needed a procedure at Weill Cornell to clean the stent that kept his bile duct open. Before the procedure, Rousseau had scripts in his head: there was a virus in this place. What if someone with an asymptomatic COVID-19 has infected him and needs to be hospitalized? But what if it meant never seeing his wife again?

“She can drop me off and we last see each other,” he said.

Like the others interviewed for this story, Rousseau found that as soon as he arrived at the hospital, he felt safe. Numerous precautions have been taken. The procedure went well. But before the procedure, it was checked for COVID. The test came back positive. Now he is on a separate floor in his house.

Mary Ann Oldford, 72, with a progressive form of sarcoma, a rare cancer, leads an online support group called Sunflower Sarcoma. Members of the organization did not want to raise COVID, but when Oldford recently asked them to weigh their concern about the coronavirus, she received answers that illustrated various shades of sheer horror. One woman told the group that every time she needed to get a scan or a blood test: “I have a border collapse.”

Oldford, who herself was afraid to take blood tests, came up with a solution for herself. She found a clinic that agreed to do her blood tests at home.

She advises other members of the support group to look for effective alternatives.

“If you are afraid and froze, you need to reach out and just say:“ Please help me figure out how to do this so that I don’t feel so scared, ”she said.

Bill Sieber, a psychologist at UCSD, said that the key to patients’ fear is to develop the appearance of control over their predicament.

“Control is the key,” Sieber said. “If you cannot control the fact that your spouse cannot come to the recovery room, ask what you can control.”

Sieber also recommended breathing episodes of panic.

“We can control our breathing mainly,” he said. “Breathing signals that the brain is calming down.”

One step he suggested was an extra second to prolong the exhalation.

Controlled breathing helped Megan Jennings. Jennings, 36, who lives near Seattle, decided to save the life of her 7-year-old niece, who has a congenital liver disease, sacrificing part of her liver.

This was a dangerous decision not only for Jennings, but also for the University of Washington transplant team.

“This child was ill, and we had to decide whether we would move forward with a living donor in our hospital, which had a lot of COVID at the peak of our surge,” said Dr. Scott Biggins, Head of Hepatology at UW Medicine.

Jennings used various breathing techniques to overcome the constant fear of hospitals and operations, which are now exacerbated by the fear of coronavirus.

“The ability to slow my breathing, feel my body and ground myself, remembering what is happening around me, helped me keep my brain from going crazy,” Jennings said.

The operation lasted seven hours.

After a five-day stay in the hospital, with no visitors, she was finally discharged. But a few days after she returned home, her wound became infected, and she had no choice but to return to the hospital so that the incision was again opened and cleaned. Doctors in the emergency room recommended that she spend the night in the hospital, but there was a limit to how much anxiety she could endure. She insisted that she be shown how to care for a wound at home.

“There was no way for me to be accepted,” she said and left the hospital at 3:30 in the morning.

Deprived of sleep and hazy from pain medication, she slept in her car for two hours. Then she went home.

This article originally appeared in New York Times,

© 2020 The New York Times Company


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