COMMENTARY

COVID-19 Diary Week 5: We're Open, but Where Are All the Patients?

Don S. Dizon, MD

Disclosures

May 29, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

As we finish May and head into June, in some ways we seem to be out of the proverbial woods with COVID-19. Although cases continue to rise and, sadly, people continue to succumb to this pandemic, the numbers in many areas are trending downward.

Don S. Dizon, MD

For those of us in Rhode Island, our hospital systems were not overwhelmed. We came together as a medical community and, more importantly, as a state to mitigate contagion. We are now opening up and starting a slow and deliberate march toward something near normal.

I would have thought that once our political leaders said, "We're opening," there would be wide celebration, with people leaving their homes in droves. But that's not what has happened. Some businesses and stores have opened, but it has been far from normal; there are restrictions on capacity at many stores, as well as mask policies. Likewise for restaurants that have opened, where restrictions are preventing them from seating at full capacity.

In the end, "open" has been something very different from an all-or-none proposition. This mirrors public demand. Although a vocal minority have been clamoring to #ReopenAmerica and their protests have made the national news, surveys show that most people care more about the risk of contracting COVID-19 than going out to a nice restaurant.

As part of the slow reopening of communities, hospitals and cancer centers are also trying to resume normal operations. In Rhode Island, screening programs are restarting and elective surgeries are getting scheduled.

I'll admit, I thought that once we flung our doors open, people would come back readily, that there would be lines of patients waiting for their mammograms and screening colonoscopies. In short, our centers would resume normal operations: finding early-stage cancers and treating as many as possible with the aim of cure.

But that's not the reality right now. Programs are open, but as in other sectors of society, it's not back to normal. The sense is that people aren't coming in. During this pandemic, we told people to stay home, even if they had a fever, cough, fatigue, or were worried that they had COVID-19. As long as they could breathe "okay" and were otherwise stable, we told people to quarantine at home for a couple of weeks.

Hospitals were ground zero during the pandemic: regular floors were converted to intensive care units, personal protective equipment became the norm for all clinical encounters, and perhaps most important, visitation was significantly curtailed and all patients had to come in alone.

To put it starkly, unless people absolutely, 100% needed care, hospitals became inhospitable—they were, in fact, the very symbol of the pandemic. So people probably experienced chest pain and didn't come in and then died of a heart attack. Others probably experienced a facial droop or a severe headache but didn't come in and died of a stroke. In my own practice, people canceled planned infusions, choosing to delay care rather than risk exposure to COVID-19.

Ultimately, the pandemic was a form of "societal trauma" and we are now just beginning to grapple with what happened. Our lives have been changed by it, whether it be those coping with the death of a loved one in a hospital with no one but the ICU staff at their bedside, or those of us in healthcare who had to work in the most challenging emergency of our lifetime (which, by the way, continues in many places). It may be the way in which a young person's final year of school was essentially canceled, or the experience of countless people finding themselves suddenly unemployed.

We are different, and for some, I fear that these scars may prevent them from seeking care. Even as I and my fellow oncologists go back to a more normal work routine, our schedules aren't full. Center-wide, we have seen a reduction in the volume of new consults compared with this time last year. I know it's because of the lack of screening, beginning in March, and I fear the implications: people diagnosed with later-stage breast, cervical, and colorectal cancers. The same could be true for my colleagues in primary care, where people have put off getting vaccinated.

But as we look past the surge and open our doors for more "routine" care, it's important that our communities know that we are also holding out a proverbial hand, welcoming them back, and pledging our help for everyone. I hope it's a message that every hospital and health center sends, because no matter what, primary prevention, risk reduction, and cancer screening go hand in hand with nationwide testing, contact tracing, and physical distancing. 

Don S. Dizon, MD, is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

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