Those at risk plead for others to listen
Cancer, chronic illnesses add to coronavirus fears
Sarah Acker, a 59-year-old with a severe lung disease, has not taken a single step outside her Glendale home in over a week as she monitors news about the coronavirus.
“Not one step,” she said, “because I am so vulnerable.”
Every day, Acker has been measuring the capacity of her scarred lungs, which is regularly much lower than others’. She worries about coronavirus reducing that any further.
“I really would not be able to breathe,” she said. “It’s scary.”
Acker is one of about 16% of U.S. adults under age 60 who have a health condition that puts them at higher risk
for severe illness from coronavirus, according to a Kaiser Family Foundation analysis of federal data.
Many of these vulnerable adults are being denied testing for the virus, while those who do test positive are finding very few treatment options. As they work to stay safe in their homes, they’re struggling to safely access food and other necessities.
Residents like Acker are being especially cautious as they watch the virus spread while others disregard precautions and the country runs short of vital medical supplies. They are supporting each other in lieu of systemic support for their daily needs and they hope medical care will be there for them when they need it.
Colleen McShane, a 25-year-old Franklin resident, also isn’t leaving her house. She has had six surgeries in the past three years and lives with multiple health conditions including asthma.
“I hear a lot of people saying, ‘Oh, it’s just older people and the really sick people that have to worry,’ ” she said. “And it’s like, I am a really sick person. So you’re OK with me dying?”
In most people, the body’s immune system can beat coronavirus before it causes anything more than a fever, cough and some shortness of breath. But it can get more dangerous and cause severe pneumonia.
In Wisconsin, 13% of adults under age 60 have health conditions that put them at greater risk, according to the Kaiser Family Foundation. Conditions include heart disease, lung disease, cancer and diabetes.
Adults age 60 and above are considered to be at higher risk based just on their age, with more than half of these adults also living with serious medical conditions.
When you consider both older adults and adults with underlying health conditions, 41% of U.S. adults are vulnerable.
Others at greater risk include organ transplant recipients, people with asthma, people with high blood pressure and people using immunosuppressant treatments for other conditions.
Milwaukee resident Nadia Musallam said her oncologist advised her to stop immunotherapy treatments because it put her at too much risk for COVID-19.
Dr. Ruth O’Regan, an oncologist at UW Health, said it’s a conversation more cancer patients may have to have — not only for their own protection but because health workers are being pulled away from their regular jobs to help coronavirus patients.
“It’s really, unfortunately, going to be a bandwidth issue,” O’Regan said. “There’s no question we’re going to have less resources and ability to treat these patients. We already have a lot of health workers at home being self-quarantined.”
To buy the health system time, health officials are urging everyone to stay home as much as possible. Those at greatest risk make the same plea.
“You hear comments — people have said this to me — only the old and immunocompromised people will die,” Musallam said. “My fear is once people get sick of social distancing, they’ll go back to normal and we are just considered expendable to some.”
Testing, treatment options limited
Options for even the highest-risk patients are very limited, beginning with finding out whether they even have coronavirus. Wisconsin’s public labs are only offering coronavirus testing for patients who are hospitalized or who are health workers with severe symptoms.
Clinicians are advising most others with symptoms to use over-the-counter medication and stay home.
McShane has had a fever running as high as 101.4 but said she was rejected for testing because her symptoms haven’t been severe enough to require hospitalization. She worries about what will happen if they get worse.
“The fact that it would have to get so severe I’d have to be admitted to the hospital scares me,” she said.
For patients who are hospitalized and test positive, treatment options are also limited. While researchers work to develop a treatment that can directly combat the virus, clinicians are using what seems like the next best thing: drugs previously used for other diseases that seem to help the body fight coronavirus.
For over a week now, doctors at Froedtert Hospital have been using hydroxychloroquine, an anti-malaria drug, to help coronavirus patients who are having serious trouble breathing, said Dr. Mary Beth Graham, the hospital’s medical director of infection prevention and control.
Graham would not say whether any patients given the drug have died or how many recovered but said the effectiveness “varies.”
Graham said she’s also been talking with Versiti Blood Center of Wisconsin about using plasma from COVID-19 survivors and transfusing it into other patients. The idea is that people who recovered from the virus have developed antibodies capable of fighting it — antibodies that continue to live in their blood and could help others do the same.
This could be particularly helpful for patients with suppressed immune systems who might have a harder time making their own antibodies, she said.
Patients with severe illness from coronavirus may also require oxygen from a ventilator, and the supply of ventilators has run short worldwide.
At UW Health, O’Regan said she is anticipating there will not be enough ventilators in Wisconsin for those who need them: a situation where clinicians will have to decide who to try to save.
“For our cancer patients, one of the things we’ll be thinking about is how curable their cancer is,” O’Regan said. “That will, unfortunately, have to be taken into account when making decisions about who to ventilate and who not to ventilate.”
Residents need groceries, supplies
Coronavirus is exacerbating the challenges people with health conditions already face in accessing health care, healthy food, safe housing and transportation, said psychologist Ben Miller, chief strategy officer at the nonprofit Well Being Trust.
“The more diagnoses you have or the more severe your illness, the more coordination you yourself have to manage as the health care system has not yet proven it’s capable of helping,” Miller said. “One of the cruelest ironies in health care is that we make people who need help the most have to work the hardest to get help.”
As food and supplies fly off shelves, some stores are making efforts to help the most vulnerable residents get what they need.
Sendik’s Food Market, for example, has asked customers to only shop between 7 a.m. and 8 a.m. every morning if they are considered high-risk for becoming severely ill from COVID-19.
McShane said she’s had trouble finding food that she’s able to eat with her gastroparesis. She also hasn’t been able to get masks.
“I wasn’t able to get any, even a few, and I’m a person who needs them to even leave the house,” McShane said. “So I can’t leave.”
Danielle Clapham, a Marquette graduate student, needs a monthly treatment for rheumatoid arthritis that stops her immune system from attacking her healthy tissue. Because this makes her more vulnerable to infection, she’s already been cautious in public spaces. Now she’s taking extra precautions.
But Clapham said grocery delivery services have been booked up several days out, forcing some people to visit stores. She urged people to remember that many shoppers who need to use special shopping hours might not be visibly old or sick.
“I’m 30 years old, I don’t look disabled without my cane or my wheelchair,” she said. “People need to be very conscious of invisible disabilities and vulnerabilities and just take people on their words.”
Kevin Isaacson, a Milwaukee resident who said he is at higher risk, said he’d like to see government food assistance programs allow recipients to use the benefits to cover grocery delivery services.
Health experts also encouraged residents to use delivery services for obtaining medications from pharmacies, and to order as much of a supply as their insurance will allow.
“Anything we can do to keep them in the house,” O’Regan said.
While individuals do what they can to meet their needs from home, they hope they can wait out the virus long enough. It will ultimately depend on how quickly authorities can expand supplies and support for health workers and researchers.
Acker will be keeping tabs on the action from home and hoping for good news.
“Just because we have health issues, we are not ‘throw-away people,’ ” Acker said. “I’m 59, and a mother, sister, wife and aunt. I don’t want to be a statistic — just one more number of people who died because of the inaction of this administration.”