Posted on 04/20/2020 8:38:24 AM PDT by Kaslin
Our leaders are making decisions based on training, experience, intelligence, and wisdom, and they have our best interests in mind. But this does not mean they are always correct.
I had a patient once with a liver lesion. At the community hospital where I worked, I reviewed her MRI with the radiologist carefully and we concluded it was a possible liver cancer.
Unfortunately, I shared her care with a university hospital. In their opinion, the lesion was definitely cancer and they so informed her. She promptly drank herself to death.
Of course, it could be argued that the university care did not kill my patient. Expert opinion was rendered and honestly delivered. Diagnostic uncertainty is common in medicine, and her unfortunate reaction was not their responsibility.
But that’s incorrect. What those good doctors did not know at the time, and therefore could not consider, was that my patient had recently lost her husband due to cancer and was in a fragile remission from her alcohol-use disorder. She was living on a margin already.
Once the news was delivered, there was no walking it back and no opportunity to explain that many liver cancers are highly treatable. Instead, a life was lost due to a singular focus on the lesion rather than the whole person. It did not, and should not, matter that the lesion was later proven to be benign.
Today, state and local governments, on the counsel of public health experts, have implemented changes due to COVID-19 that affect nearly every aspect of life, medical and otherwise. Our leaders are making decisions based on training, experience, intelligence, and wisdom, and they have our best interests in mind. But this does not mean they are always correct.
Treatments always have consequences. Risks and side effects need to be placed in the context of the entire person or, in this case, the entire community. Quarantine causes a lot of harm. Care for non-COVID patients suffers through cancelled appointments and delayed surgeries.
Routine health maintenance, including proven strategies such as cancer screenings, has stopped. Patients are afraid to get needed lab work. Pregnant women cannot find willing obstetricians.
Clinical research trials for non-COVID-19 diseases, including everything from lupus to heart disease, are on indefinite hold. For many of these trials, resumption post-quarantine may not be possible. People suffer and die of non-COVID diseases too.
As a liver transplant physician, I am concerned by the potential for reduced access to care and life-saving procedures. Before COVID-19, patients routinely died of liver failure because there aren’t enough donor organs to meet the need. What will happen if, as is now occurring in parts of Europe, organ transplantation is halted altogether? The effects for my patients will be grave. This is true also of friend waiting for a new heart.
And then there is the economy. Here, it is appropriate to remember that, during the last Great Recession, public health experts wisely identified and counted the “deaths of despair” due to increases in alcohol and substance abuse, depression, and so on. In the practice of liver medicine, I witnessed firsthand many “deaths of despair” from alcohol during the Great Recession. It was terrible.
These victims were folks who lost their jobs and so not only their income, but also their security, self-identity, meaning, and social connectivity. They were living on a margin already.
Counting their deaths is not straightforward; after all, pink slips, like MRI interpretations, do not directly kill people. But many thousands of such midlife deaths occurred, and this risk should matter now as well. The conclusion here is simple: a good economy makes good health, and the opposite is also true.
In the present uncertainty, we should support and thank our government leaders and the public health experts for their courage and their willingness. But we, the non-expert public, should nonetheless feel empowered to challenge their decisions and ask: in addition to counting COVID-19 deaths, how are we counting the quarantine’s impact on non-COVID health-care delivery? On the broader economy and its health consequences? How will we know if and when the quarantine confers greater harm than COVID-19, and how might we recognize and address those harms?
The end of the pandemic may weeks or months away. Some believe COVID-19 may become a new normal. These are reasonable uncertainties. But they also lend greater urgency to answering these questions now, or at least trying. Otherwise, using a singular COVID-19 lens, we risk over-response to the detriment of the greater good.
If, in the meantime, my friend dies without a transplant, I want his death counted.
Steven F. Solga, MD is a transplant physician in Philadelphia and associate professor of clinical medicine at the University of Pennsylvania. His views are his own.
The damage done to our healthcare system can’t even be fully contemplated as yet, much less anticipated. It seems to me very likely we will be set back decades if not a century.
They will only notice if it’s of political benefit. Right now, it’s a benefit to say the only solution is for everyone to stay home and cower. It does the most damage to President Trump.
They don’t care if Americans die. They have become true leftists.
I agree that we need to be collecting stats of people that died due to elective surgeries being postponed during the lock down, as well as lock down linked suicides.
But I doubt it’s more than a handful of people, while 41,000 have died from CV in the US.
“You can’t manage what you don’t measure”
If you’ve got credible stats, let’s see them.
Their interest is in power.
The optimistic point would be that our healthcare would improve. The screw-ups of the FDA, WHO, Chinese dependency on medicine and devices have been exposed.
Democrats actively withholding life saving medication for political purposes has been exposed.
The ball is ours, we need to run with it.
Certainly not for any of us.
Important article, thank you for posting.
I expect a number fo different degradations are already occurring. The Neonatal ICU just being one of them. These facilities burn PPE to protect the 24 weekers like an oil rig fire. The Neonatologists are already in such short supply they can’t take vacations and have a great deal of trouble even attending meetings in their profession. I expect the INfant Mortality Rate is already climbing.
Others have pointed out a potential loss of Organ Transplants altogether. Which is gonna be real hard because the demand for Renal Dialysis is about to skyrocket. Which is a resource that was already stretched pretty thin. Expect to see quite a number of people who “survived” but ended up with Renal Failure and in desperate need of Dialysis to actually “survive” the illness.
Expect to see joint transplant to disappear at least for a while as the PPE demand and OR Tech for that is idled for months. You can go right down the list. Things are gonna change. Just how that works out is to be seen. It might be snarky to say,”Well if they can’t do joint replacement they will just kill less people!” But the fact is, disability and immobility are killers as well. Which is how they “justify” joint replacement. Getting people back to their life quickly is KNOWN to be a factor in improving outcomes there.
Things are going to change, for sure, but IMHO NOT for “the better”. YMMV.
Only if they stop voting Democrat
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