Mostly Non-COVID-19 Related Miscellany

Some updates from Doc Gumshoe on Hydroxychloroquine, Aspirin for cancer, stem cells for Parkinson's and CRISPR for blindness

By Michael Jorrin, "Doc Gumshoe", June 11, 2020

It’s not as though the pandemic has cleared the decks of all other health-related issues.   I’m sorry to report that people still have heart attacks, strokes, and cancer as well as all the plethora of other ailments, diseases, and conditions that affect our species.   For example, I was thinking of putting in a phone call to my orthopedist, because I seem to have pulled a back muscle while lifting soggy bags of mulch to spread in the garden.   I’m happy to report that I don’t have to at this moment, because my wrenched muscle seems to have relaxed a good deal – happy not only because my back feels a lot better, but also because I don’t have to be sitting in the doctor’s waiting room when some infected person wanders in spreading the evil virus.

But, as it happens, the pandemic has apparently had a quite significant effect on the numbers of people seeking care for those other, non-COVID-19 ailments.   A close friend of ours who was scheduled for a total knee replacement (TKR) in March of this year had her procedure postponed for the time being. 

Postponing TKR is highly unlikely to lead to severe consequences to life or health, other than the discomfort and pain of continuing to hobble around on a creaky knee until the surgery can be safely done, and the patient goes through the necessary (and painful) rehab process.   In the case of our friend, both the surgery itself and the rehab posed the risks of fairly close physical contact with persons who might have been infected with the corona virus although not yet showing symptoms, so the deferment of her surgery was a sound move.

However, non-treatment of other conditions can have dire results.   For example, a new study from Beth Israel Deaconess Medical Center in Boston suggests that a considerable number of patients may have put off emergency care for such issues as heart attacks and strokes.   It is not known why these patients did not seek emergency care, but a likely supposition is that they were wary of becoming infected with the corona virus and simply avoided going to a hospital emergency department, where presumably there would be significant numbers of patients with symptoms suggesting a corona virus infection, and therefore, probably highly contagious.

The Beth Israel study found that in March and April of this year, there was a 33% drop in the number of patients presenting to the emergency department with heart attacks, compared with the same period in other years.   A much larger drop – 58% — in the number of patients with strokes was characterized as “stunning” by one of the authors of the study, Dr Dhruv Kazi, director of Beth Israel’s Cardiac Critical Care Unit and a Harvard Medical School faculty member.

It’s possible that some of this drop may be due to changes in the living conditions of the population during the pandemic.   Many more people have been staying at home, perhaps eating better, working out more often, not feeling stressed about commuting to work in heavy traffic.   And air quality has gotten somewhat better.   But those changes are nowhere near enough to account for large differences in the numbers of patients presenting with what certainly might be life-threatening health conditions.   And at the same time, recently released data suggest that concerns about the pandemic and its effects on the economy are resulting in increased levels of anxiety and stress in the general population.

Similar drops in the numbers of patients seeking treatment for conditions that would normally unquestionably bring patients to hospital emergency departments have been seen in places like Northern California and Italy.   The perception that the disease caused by this virus is exceedingly infectious and frequently fatal, and the widespread news that hospitals are swamped with a tidal wave of dangerously infectious patients has persuaded patients that in spite of symptoms that would otherwise have led them immediately to seek treatment, they are better off taking the chance that they will weather their symptoms than risking infection with the virus. 

Dr Kazi emphasized that hospitals needed to do a better job convincing patients that their risk of contracting the corona virus infection, when presenting at a hospital for urgent care, was very small.   He pointed out that hospitals have extensive experience with infection control in emergency room settings.   In an interview, he was quoted as follows:   “Very quickly, for instance, we split our emergency room into a section that would care for people with respiratory complaints that might be COVID-19 and an entirely separate section that dealt with individuals who clearly did not have complaints resembling COVID-19. In the COVID-19 section of the emergency room, patients were masked immediately, and clinicians took ample precautions to ensure there was no risk of transmission from patients to clinicians or among patients. This went into place even before the first trickle of patients started showing up in our emergency rooms. So, the risk was very, very low from the get-go.”

The COVID-19 pandemic has had major effects on the ability of patients with other conditions to receive necessary treatment.   For example, the American Cancer Society Cancer Action Network initiated a survey on April 30th to get a sense of the delays and cancellations in health care services and economic challenges affecting their ability to pay for care and their future ability to access and afford the care they need.   The most alarming finding was that 79% of patients in active treatment for some form of cancer reported delays in their treatment including chemotherapy, radiation, or hormone therapy.   A total of 87% of respondents to the survey reported some change, delay, or disruption to their health care as a result of the pandemic including not only care related to their cancer, but care for chronic and ongoing conditions, and regular preventive health care.   The survey did not clarify whether the delays and disruptions were primarily due to patients’ fears of corona virus infection or other pandemic-related issues, such as a widespread avoidance by health care pr