Unintended ConsequencesF. Amos Bailey, MD May 19, 2020
Recently, while on a clinical service for the Inpatient Palliative Care Consult Service we remarked on all the patients we were seeing who had COVID-19 but what about those folks we usually consulted on? Those being considered for a destination LVAD, or living with metastatic and progressive cancer, being considered for, or recovering from a Bone Marrow Transplant…where are these people? Many are at home, impatiently waiting for things to get back to normal. They will not have the time, the months and maybe years that it will take to get back to normal; there will be no normal without COVID-19.
I have a friend who has being living with adult ALL for more than 2 years. Recently he traveled across country in a travel trailer with his wife and family. He had been accepted into a CAR-T trial. The only treatment that has the potential to cure his illness. He got in just under the wire before the trial was temporarily closed. The concern was for his own safety and what would they do if he needs ICU and those beds were all in use?
Lisa Rosenbaum wrote in her essay in the New England Journal of Medicine
“Yet as we begin to observe fewer admissions 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.”
We may be nearing this peak of COVID-19 but there will be other peaks and outbreaks. We will live with COVID for many years. We need to make sure that patients in need of life-saving treatments for non-COVID disease have that same opportunity.
The keys to this are:
Testing: Currently we are only able to do about 150,000 test for COVID a day. We need to be able to do 2 or 3 million tests in the US and a billion tests over the next year if we are going to be able to allow the our communities to be more opened up and test for any suspected cases.
Case Tracking: With mass testing comes mass case tracing. With every positive test we need to trace and contact all the people that person recently interacted with, test them and self-quarantine. It will take 100,000’s of healthcare providers to do this. Noble work for many recently furloughed.
Effective Treatment and Vaccinations: No effective treatments have been developed yet. Hydroxychloroquine has been demonstrated in a VA study to increase risk of death. Many other treatments are under investigation but it will take months to know what the benefit will be. While we all hope for a vaccine it takes at least a year to develop and the process of manufacturing the vaccine and doses for the world will take a moon shop effort.
Therefore we should concentrate on COVID-19 Testing and contact tracking to control the spread