Delayed care adds to impact

Some put off elective treatments, causing deaths, complications

In March, Lehigh Valley Health Network temporarily closed some outpatient and doctor’s offices and urged people to stay away from emergency rooms if they could. The coronavirus had just began spreading and claiming lives in Pennsylvania.

By the end of April, hospital officials were getting worried that people experiencing lifethreatening emergencies were also avoiding the hospital, according to a late April email from CEO Dr. Brian Nester to staff.

“Sadly, however, we have observed that some people are so worried about contracting COVID-19, they are ignoring signs of serious health emergencies, such as heart attacks and strokes, and avoiding a necessary visit to the hospital,” Nester wrote. “To be clear, those poor decisions can have deadly consequences.”

The pandemic’s damage

spans beyond the nearly 170,000 people who have died from the coronavirus in the United States and the millions who have gotten sick or lost their jobs. For months, some people had to put off elective surgeries that could improve their quality of life and relieve pain and discomfort and others lived in fear of getting the care they needed.

More people are suffering from depression and anxiety as they live through uncertainty, isolated from family and friends and unable to find comfort in the hobbies and activities they loved. Group therapy stopped for many; outpatient offices closed or moved online; and people weren’t sure if they should use emergency rooms.

Five months into the pandemic, people are still grappling with how to manage health problems.

That has been a concern for Lehigh County coroner Eric Minnich, who has seen a few cases where people died because they didn’t seek treatment medical care.

“They haven’t been feeling right for a couple of days, but they’re fearful of COVID and end up dying from not accessing medical care due to fear of contracting cases,” Minnich said.

“We try to get the information out that it’s safe to go to the doctor,” Minnich said.

Some health networks are running radio and TV ads to let people know it’s safe and smart for them to see their doctors for preventive or emergency treatment. A note on LVHN’s homepage tells patients, “We are taking extreme measures to help keep you safe.” And on St. Luke’s University Health Network’s website, the message is, “We’re ready for you.”

Elective surgeries are lucrative for hospitals and shutting them down for a few months proved costly. The American Hospital Association and others have argued that the cost of caring for coronavirus patients along with the revenue loss from postponing elective surgeries hurt hospitals financially and could force some smaller ones to close. The federal government offset some of that loss with a $175 billion aid package to hospitals, but it wasn’t enough to keep many from resorting to costcutting measures such as furloughs and layoffs.

Doctors are seeing more and more patients return, but the volume hasn’t returned to prepandemic levels across the state because of patient fear of returning as well as social distancing guidelines that limit the number of people at an office,

“It’s not fun getting to the starting gate and having someone call you on the phone and say sorry, you won’t be able to get that operation.” — Dr. Paul Pollice

said Dr. Michael DellaVecchia, president-elect of the Pennsylvania Medical Society. He’s worried about patients who are delaying important visits.

“Diseases didn’t stop because of COVID,” he said.

And sometimes postponing even elective surgeries can make the procedure more complicated. In the case of a hernia, for example, “it could get to the point where the bowel strangulates,” DellaVecchia said.

While delaying most elective care, such as a knee replacement or bariatric surgery, is unlikely to have long-term health consequences, putting off some diagnostic procedures, such as biopsies, colonoscopies, mammograms and other tests, may be cause for concern, as early cancer detection is key to successful treatments.

How elective is the surgery, anyway

The balance between getting elective care and avoiding coronavirus exposure is not easy to strike.

When elective surgeries reopened in May in the Lehigh Valley, most of Dr. Paul Pollice’s patients were eager to reschedule, which packed his schedule. However, not everybody could or would go into surgery. Pollice, a hip and knee replacement surgeon at OAA Orthopaedic Specialists in South Whitehall Township, estimated that about 5% didn’t want to get surgery during the pandemic and another 5%-10% had health problems that made surgery too risky.

He recommends patients hold off if they have diabetes, autoimmune diseases, a transplanted organ or a history of cancer because they’re susceptible to getting seriously sick with the coronavirus.

People who seek knee and hip replacements often have suffered through chronic pain that makes it hard for them to do simple tasks like grocery shopping, Pollice said.

“It’s not fun getting to the starting gate and having someone call you on the phone and say sorry, you won’t be able to get that operation,” he said.

Often, elective surgery is the last measure after alternative therapies have been exhausted. When prescribed correctly, elective surgery can significantly change a person’s life, enabling them to feel comfortable in their bodies and do activities that were off limits.

This is particularly true for people who undergo gender affirmation surgery, which changes their bodies to match their gender identities. Some transgender people suffer serious mental health problems because they don’t feel right in their bodies and are often not accepted by their family, friends and community. Many spend years saving and preparing for surgery, said Corinne Goodwin, executive director of the Eastern PA Trans Equity Project.

“There are a lot of things you have to go through in advance of getting confirmation surgery,” she said. “You need to see two different therapists who have to write letters, and one must be a Ph.D, to say you have gender dysphoria and recommend surgery as treatment. Often you have to have a low body mass, so people go on crazy diets to meet the qualifications.”

Goodwin knows of one person during the pandemic who became suicidal because of the suspension of their gender affirmation surgery.

Because so few surgeons perform such surgery, it can be hard to get an appointment. So people who scheduled surgeries around summer vacations may not be able to reschedule, Goodwin said.

Sarah Morin, of Lebanon County, spent a year preparing for her gender affirmation surgery before she realized in March that it might not happen as scheduled in June, which would have allowed her to recover during her summer vacation from school.

Morin, a teacher, was scared that she’d have to delay it another year, which made her anxious and depressed.

“I always feel like I’m a puzzle, just missing one piece. The idea of having another year of being an incomplete puzzle, it was difficult,” she said.

Luckily, she found out in June that she could reschedule in July, which would just require her to take some time off in the beginning of the school year.

When the choice is clear

Schuylkill County resident Sheri Warhola knows what it’s like to have a chronic disease that’s worse than the prospect of contracting the coronavirus.

For four years, she has felt sick and tired while on dialysis, a physically and emotionally taxing procedure that cleans out the toxins in her body because her kidneys cannot. UPOn dialysis, She couldn’t swim, exercise or live the life she wanted.

So when she got the call from LVHN in April informing her in she’s in line for a kidney from a deceased donor, she did not hesitate to go — even during the peak of the pandemic.

“I knew they were treating COVID patients. I couldn’t worry about that. I didn’t want to say no at the chance at a second chance,” she said, adding the safety measures at the hospital put her mind at ease.

LVHN’s transplant program suspended living donor transplants for six weeks but continued with deceased donor transplants for people who were not likely to have serious complications from surgery, said Dr. Michael Moritz, the program’s director. During the height of the pandemic, nearly all the intensive care beds were used, so anyone who might need that kind of intensive care did not go through transplant surgery. Typically, about 20% of kidney transplant patients end up needing intensive care after surgery, he said.

Through the pandemic, about seven surgeries were postponed, Moritz estimated.

While transplant recipients are at higher risk of getting seriously ill with the coronavirus, it’s unclear if that’s primarily due to underlying health conditions or the transplant medication that suppresses the immune system.

“Your preexisting health condition probably governs things more than a transplant or transplant medication,” Moritz said.

So far, none of the transplant recipients or donors at LVHN has contracted the coronavirus, Moritz said.