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Jessica Gosnell, MD, 41, from Portland, Oregon, lives daily with the knowledge that her rare disease — a form of hereditary angioedema — could cause a sudden, severe swelling in her throat that could require quick intubation and land her in an intensive care unit (ICU) for days.
“I’ve been hospitalized for throat swells three times in the last year,” she told Medscape Medical News.
Dr Jessica Gosnell
Gosnell no longer practices medicine because of a combination of illnesses, but lives with her husband, where to buy generic torsemide canada no prescription Andrew, and two young children, and said they are all “terrified” she will have to go to the hospital amid a COVID-19 surge that had shrunk the number of available ICU beds to152 from 780 in Oregon as of Monday. Thirty percent of the beds are in use for patients with COVID-19.
She said her life depends on being near hospitals that have ICUs and having access to highly specialized medications, one of which can cost up to $50,000 for the rescue dose.
Her fear has her “literally living bedbound.” In addition to hereditary angioedema, she has Ehlers-Danlos syndrome, which weakens connective tissue. She wears a cervical collar 24/7 to keep from tearing tissues, as any tissue injury can trigger a swell.
Patients Worry There Won’t Be Room
As ICU beds in most states are filling with COVID-19 patients as the Delta variant spreads, fears are rising among people like Gosnell, who have chronic conditions and diseases with unpredictable emergency visits, who worry that if they need emergency care there won’t be room.
As of Monday, in the United States, 79% of ICU beds nationally were in use, 30% of them for COVID-19 patients, according to the US Department of Health and Human Services.
In individual states, the picture is dire. Alabama has fewer than 10% of its ICU beds open across the entire state. In Florida, 93% of ICU beds are filled, 53% of them with COVID patients. In Louisiana, 87% of beds were already in use, 45% of them with COVID patients, just as category 4 hurricane Ida smashed into the coastline on Sunday.
News reports have told of people transported and airlifted as hospitals reach capacity.
In Bellville, Texas, US Army veteran Daniel Wilkinson needed advanced care for gallstone pancreatitis that normally would take 30 minutes to treat, his Bellville doctor, Hasan Kakli, MD, told CBS News.
Wilkinson’s house was three doors from Bellville Hospital, but the hospital was not equipped to treat the condition. Calls to other hospitals found the same answer: no empty ICU beds. After a 7-hour wait on a stretcher, he was airlifted to a Veterans Affairs hospital in Houston, but it was too late. He died on August 22 at age 46.
Kakli said, “I’ve never lost a patient with this diagnosis. Ever. I’m scared that the next patient I see is someone that I can’t get to where they need to get to. We are playing musical chairs with 100 people and 10 chairs. When the music stops, what happens?”
Also in Texas earlier this month, Joe Valdez, a bystander shot six times as an unlucky bystander in a domestic dispute, waited for more than a week for surgery at Ben Taub Hospital in Houston, which was over capacity with COVID patients, the Washington Post reported.
Others with chronic diseases fear needing emergency services or even entering a hospital for regular care with the COVID surge.
Nicole Seefeldt, 44, from Easton, Pennsylvania, who had a double-lung transplant in 2016, told Medscape Medical News that she hasn’t been able to see her lung transplant specialists in Philadelphia — an hour-and-a-half drive — for almost 2 years because of fear of contracting COVID. Before the pandemic, she made the trip almost weekly.
“I protect my lungs like they’re children,” she said.
She relies on her local hospital for care, but has put off some needed care, such as a colonoscopy, and has relied on telemedicine because she wants to limit her hospital exposure.
Seefeldt now faces an eventual kidney transplant, as her kidney function has been reduced to 20%. In the meantime, she worries she will need emergency care for either her lungs or kidneys.
“For those of us who are chronically ill or disabled, what if we have an emergency that is not COVID-related? Are we going to be able to get a bed? Are we going to be able to get treatment? It’s not just COVID patients who come to the [emergency room],” she said.
A Pandemic Problem
Dr Paul Casey
Paul E. Casey, MD, MBA, chief medical officer at Rush University Medical Center in Chicago, Illinois, told Medscape Medical News that high vaccination rates in Chicago have helped Rush continue to accommodate both non-COVID and COVID patients in the emergency department.
Though the hospital treated a large volume of COVID patients, “The vast majority of people we see and did see through the pandemic were non-COVID patents,” he said.
Casey said that in the first wave the hospital noticed a concerning drop in patients coming in for strokes and heart attacks — “things we knew hadn’t gone away.”
And the data backs it up. Over the course of the pandemic, the Centers for Disease Control and Prevention’s National Health Interview Survey found that the percentage of Americans who reported seeing a doctor or health professional fell from 85% at the end of 2019 to about 80% in the first three months of 2021. The survey did not differentiate between in-person visits and telehealth appointments.
Medical practices and patients themselves postponed elective procedures and delayed routine visits during the early months of the crisis.
Patients also reported staying away from hospitals’ emergency departments throughout the pandemic. At the end of 2019, 22% of respondents reported visiting an emergency department in the past year. That dropped to 17% by the end of 2020, and was at 17.7% in the first 3 months of 2021.
Casey said that, in his hospital’s case, clear messaging became very important to assure patients it was safe to come back. And the message is still critical.
“We want to be loud and clear that patients should continue to seek care for those conditions,” Casey said. “Deferring healthcare only comes with the long-term sequelae of disease left untreated so we want people to be as proactive in seeking care as they always would be.”
In some cases, fears of entering emergency rooms because of excess patients and risk for infection are keeping some patients from seeking necessary care for minor injuries.
Dr Jim Rickert
Jim Rickert, MD, an orthopedic surgeon with Indiana University Health in Bloomington, Indiana, told Medscape Medical News that some of his patients have expressed fears of coming into the hospital for fractures.
Some patients, particularly elderly patients, he said, are having falls and fractures and wearing slings or braces at home rather than going into the hospital for injuries that need immediate attention.
Bones start healing incorrectly, Rickert said, and the correction becomes much more difficult.
Plea for Vaccinations
Gosnell made a plea posted on her neighborhood news forum for people to get COVID vaccinations.
“It seems to me it’s easy for other people who are not in bodies like mine to take health for granted,” she said. “But there are a lot of us who live in very fragile bodies and our entire life is at the intersection of us and getting healthcare treatment. Small complications to getting treatment can be life altering.”
Gosnell, Seefeldt, Casey, and Rickert reported no relevant financial relationships.
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.
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