The coronavirus pandemic is going to trigger a second healthcare crisis


Originally published in Business Insider

By Daniel Greenleaf

As hospitals are inundated with COVID-19 cases, countless other patients are being asked to stay away. If we’re not careful, we will have a second health crisis to face as our most chronically ill populations are unable to access the care they need to manage their conditions.

Multiple states are now restricting hospitals to emergency care. Some are shrinking everyday procedures by as much as 50%. But while limitations on elective surgeries get the most attention, the impact on truly vulnerable patients is largely playing out away from the limelight.

This is a call to public health officials and municipal leaders who are in the hot seat of tough decisions in the face of a crisis: We need to keep a lane clear for chronically ill patients.

They include 34 million diabetics and hundreds of thousands of people with chronic kidney disease, who are being asked to postpone visits. Both are uniquely susceptible to infection. Yet, hospitals can handle only their most pressing, emergency needs.

Then come the canceling of joint surgeries for chronic pain. The delays in treatment for lower-risk cancer, cardiac bypass, and congestive heart failure patients. Even organ donor programs are being put on hold, with recent transplant patients foregoing follow up appointments. One Colorado man had his liver transplant surgery aborted after it was deemed elective. Without it, he’s thought to have less than two months to live.

Add in the millions of people losing or seeing limited treatment for things like mental health and opioid addiction. Those most reliant on the healthcare system, who need preventative care most, are being pushed to the sidelines.

And this is at a moment when our economy is also taking a turn for the worse and unemployment is rising.

Federal, state, and local health officials are doing the best they can. But I fear that they may be applying unilateral decisions to attack COVID-19 within a healthcare and economic ecosystem that is complex and multivariate.

It may work for the short-term, as physicians postpone only non-urgent matters. And with a medical system preparing to be overwhelmed, few would argue against an all-hands-on-deck, single-minded approach to assembling ourselves to combat COVID-19 effectively.

But we need to look up for a minute at the larger picture or we will pay a big price down the line. Beyond the economic pain inflicted upon frontline primary care practices, there is also the spectre that four to six months out we will face a second healthcare crisis: The build-up and eventual explosion from all those people now going untreated, whose care can only be delayed so long, some of whom are bound to become emergencies or fatalities of their own.

The making of a second crisis

To the healthy, the relatively prosperous, and the socially connected, being barred from the doctor may seem a minor inconvenience. Not so for the perennially sick and isolated.

For them, the term “non-emergency” is a bit of a misnomer. Many might be better described as “chronic emergencies.” There’s a reason they were receiving continuous treatment in the first place.

Begin with the mentally ill, who struggle during the best of times. Even before the coronavirus hit, most states had nowhere near the beds to handle their needs. Now, with clinics closing and hospitals practicing triage, a good percentage will be left to their own devices — just as a global pandemic and economic pullback delivers spikes of anxiety and paranoia.

Meanwhile, the opioid addicted, who must receive their methadone and suboxone treatment in person, are facing lines as long as five hours. It’s only a matter of time before many decide the streets offer a more convenient cure.

Add to this an already short supply of dialysis centers, the elderly who avoid crowded waiting rooms and medical workers without proper protective gear, and the restricting of care for the disabled. Mix it with a shortage of coronavirus tests, forcing these same people to self-diagnose, and so begins a bubble that has no choice but to eventually burst.

How will I get there? 

Even if they can get appointments, the most vulnerable will soon find no way of getting there.

To stem COVID-19’s spread, hospitals have begun to confine medical transport services and ridesharing operations from delivering patients to their doors. In a sign of things to come, Colorado’s Summit County, for example, has suspended ridesharing altogether.

The idea is that relatives and neighbors — who’ve had less contact with others en masse — will pick up the slack. It sounds prudent in theory. But it’s a notion built from a gross misread of those who need care most.

These are people whose conditions often leave them entirely isolated. For the mentally ill or severely addicted, they may be ostracized from any friend at all. Then come patients like the 80-year-old with emphysema, whose social orbit extends little beyond bed, couch, and bathroom.

If crisis strikes, many will be reliant on ambulances. Yet EMS operators I know privately admit they’re already at capacity. And that’s about to get worse as insurers begin to mandate that coronavirus victims be transported only by emergency vehicle.

The bill for an ambulance ride can mean financial ruin to someone living paycheck-to-paycheck, or who just got laid off. Which means many may choose to avoid getting the care they need, because they simply can’t get there.

Telemedicine is no savior

To hear politicians talk, telemedicine will provide the cure. But in reality it’s an emerging concept, not a finished product.

Two years ago, a study by Avizia found that four out of five consumers were unaware of telehealth at all, much less using it. That’s likely because most US hospitals and private practices are unequipped to handle it. Expecting them to now offer service in a matter of weeks — when all manpower and resources are being hurled elsewhere — is a pipe dream at best.

Telemedicine is simply not a solution for our most vulnerable populations. 40% of the country still uses landlines. In large swaths of rural America, internet service remains at the level of 1990s dial-up, with incessant crashing during peak times.

Worse, telemedicine poses special obstacles for the elderly, the blind, the disabled and others, many of whom rely on a library for internet, or only own flip phones.

All of which leads to a coming crush of vulnerable patients who’ve missed multiple appointments, and can wait no longer.

The key will be finding creative and strategic ways to extend care to vulnerable patients as the coronavirus ascends to its peak. While formulating crisis policy, public health officials need to be especially mindful about leaving some frictionless pathways open for sick and marginalized patients to connect to care.

If we don’t, we’ll have inadvertently created a second crisis. And we may find ourselves looking back on the onslaught of today as a calmer, quainter time.

Daniel E. Greenleaf is President and Chief Executive Officer of Providence and LogistiCare.