On March 18th the Centers for Medicare & Medicaid Services (CMS) recommended limiting non-essential care in hospitals to focus on the influx of COVID-19 patients. However, on April 19th, CMS responded to the president’s plan for “Opening Up America Again” with recommendations acknowledging that:
“…at this time many areas have a low, or relatively low and stable incidence of COVID-19, and that it is important to be flexible and allow facilities to provide care for patients needing non-emergent, non-COVID-19 healthcare.”
As COVID-19 spreads across the United States, the unfortunate reality is that other illnesses don’t go on hiatus while the country is at war with the virus. With procedures postponed as “elective” or “non-essential” only starting to resume, what effect is this having on patients and the doctors who treat them?
We’ve captured insights from a few who are working feverishly on the other front lines of healthcare – including kidney dialysis and cancer. Here are some of the actions and insights they’ve offered about how they are adapting and coping during this time.
Kidney Dialysis – Combining Forces to Keep Patients Safe
Patients in need of treatment for kidney failure have no choice but to receive dialysis at least three days a week. Since these patients are often older and already have challenged immune systems, coming in for treatment can be seen as risking another life-threatening illness to treat the one they already have.
Further, The New York Times recently reported that “kidney specialists now estimate that 20 percent to 40 percent of I.C.U. patients with the coronavirus suffered kidney failure and needed emergency dialysis”, further taxing these essential machines.
This struggle is why kidney care organizations including Fresenius Medical Care and DaVita are working together by offering a nationwide contingency plan to help maintain continuity of care by treating dialysis patients in isolated areas that can be accessed by other providers. Their goal is to keep dialysis patients out of the hospital, and free up limited hospital resources by ensuring care in a way that does not unnecessarily expose them to COVID-19 patients, and vice versa.
According to DaVita CEO Javier Rodriguez, “Dialysis is not optional, it is life-sustaining. In these trying times, we think that by working collaboratively, we can combine resources, clinical expertise, and physical space to help ensure all patients across the kidney care community have access to life-sustaining care in the safest environment possible.”
“Cancer is a Difficult Area”
Dr. Michael H. Kleinman, MD, FACS, is a General Surgeon at Memorial Hermann SW hospital in Houston, TX. When I asked him about cancer surgeries – something you’d think would be deemed as “essential” – his response was, “Cancer is a difficult area” since some types, such as breast cancer, can be treated with medications such as Tamoxifen, and these cancers are very slow growing, so putting off surgery is not likely to cause any further harm to the patient.
“Talking to a cancer patient is challenging under the best of circumstances,” he cautioned. “It requires trust and a strong relationship built between the patient and doctor in order for the patient to accept the news, not only that they have a malignancy, but that they may not be able to have surgery right away. To help assuage their concerns, he stresses that “it is very important to reassure patients that a limited delay in care will not affect their prognosis.”
His advice to surgeons who have to explain this situation to their patients is to consult an online medical forum for physicians and ask other doctors their advice on how soon surgery may be needed. It will put a patient at ease to know that “you’ve reached out to other doctors and that they’ve confirmed your recommendation.” When all else fails, he said, “you can encourage patients to get a second opinion.”
Screening is Essential
Lisa Romano, RN, MSN, Chief Nursing Officer of CipherHealth and former ICU nurse, believes that, “For anyone affected with diagnoses ranging from Stage 1 Breast Cancer to chronic health conditions such as diabetes, kidney and heart disease, the need for treatment or surgery is not ‘elective’ to them. Their need for medical care is also a priority, not just to relieve their anxiety, but to prevent their disease from growing into something more critical or even life-threatening. We must prioritize non-COVID-19 patient care in a way that also preserves the critical healthcare resources that are necessary for the overwhelming numbers of COVID-19 patients.”
With sources estimating the arrival of a vaccine taking as long as 18 months, some of these conditions may be able to wait, many can not. “Screening these patients for COVID symptoms and history will be essential to prevent further community spread and protect our vital healthcare staff and resources,” Romano said.
We at CipherHealth have been proactively working to meet the needs of hospital and healthcare workers during the pandemic with new solutions specifically tailored for the crisis — to help those on the front lines of COVID-19, as well as the other front lines. Contact us or email [email protected] to learn more.