By Jamie Ducharme
When Dr. mark Lewis has To give a cancer patient bad news, he usually o ers a hug or a hand to hold. The idea of doing so by phone felt heartbreakingly imper- sonal, he says. But in the face of the COVID-19 pandemic, the Salt Lake City–based gastrointestinal oncologist has had to do many things that make his “conscience weigh heavy.” He’s delivered tough prognoses virtually, to limit the chance of spreading the virus. He’s delayed chemo- therapy for patients who—he hopes—can wait, knowing the treatment would wipe out their immune
system. He’s made the opposite choice for pa-
tients with cancer spreading faster than corona-
virus. All he can do is hope he’s gambled well.
Welcome to medicine in the age of COVID-19.
hospital systems, on partners of women in labor. Doctors of all specialties and career stages are pausing their day jobs to provide critical care or pitching in to support phy- sicians on the front lines. “I’ve been brushing up on how to manage a ventilator, because I haven’t had to do that in almost a decade,” Lewis says. “In a week, two weeks,
I might have to shift from the long-term care of cancer patients to acute critical care.”
Lewis and other doctors have little choice, and the consequences of that fact will be far-reaching. Dr. Anupam Jena, an associate professor of health care policy at Har- vard Medical School, says patients with conditions like strokes and heart attacks may fare worse than normal if they delay going to the hospital or if emergency depart- ments can’t see them as quickly. Some people who follow directions and cancel routine screenings may go longer
The novel coronavirus has upended the U.S.
medical system—and not just for those deal-
ing directly with the pandemic. Patients with
‘We’re going to know— for better
or worse— whether we
have enough of what it takes.’
without knowing if they have cancer or diabetes. The outbreak has also thrown the relationship
between wealth and health into sharper relief than ever. Research suggests the richest 1% of Ameri- cans can expect to live more than a decade longer than the poorest 1%—and that’s without a pan- demic. COVID-19 has drawn a clear line between people who can work from home and those in service-focused jobs who must be physically pres-
chronic conditions will have to ght to get the
care they need, not only now but also after the ent, thereby risking infection. The country’s most
outbreak ends, when hospitals are left to deal DR. ANTHONY FAUCI, vulnerable populations, like the homeless and those
with backlogs of appointments canceled en masse. Anyone with the misfortune to get into a car accident or have a heart attack during the outbreak will be at the mercy of a strained sys- tem. And in this environment, the gulf between people who can and cannot a ord to seek out good care will become ever more apparent.
As of publication, U.S. hospitals are still op- erating smoothly, for the most part, but obsta- cles are mounting. In a system in which routine supply and demand leaves only about a third of hospital beds open on a normal day, medi- cal centers are nearing capacity, particularly
in hard-hit areas. As fears mount, “morale
is low,” says Dr. Chethan Sathya, an assis- tant professor of surgery and pediatrics at New York’s Cohen Children’s Hospital. Each day’s work, Sathya says, raises the chances of doctors getting sick and passing the virus to their families. Ready as they are to serve, that thought is never far from their minds.
Surgeons like Sathya have been directed by the Centers for Medicare and Medicaid Ser- vices (CMS) to postpone elective procedures
to keep beds and supplies available. Deciding whose care can’t wait, however, isn’t always easy. A patient on dialysis can wait a few weeks for a kidney transplant, but should she? And facilities have placed often heartbreaking limits on visitors—including, in some New York City
8 Time APRIL 6–13, 2020
on March 18, on whether doctors will be able to keep up with
“the kind of medicine that we optimally would
want to practice”
living below the poverty line, are the least able to stock up on groceries and hunker down inside; they’re also less likely to have the means to safely travel to a doctor’s o ce if that’s what’s needed.
And the gap is likely to widen, Sathya says. “As the unemployment rate rises because of this, people are going to have less and less access to health insurance,” he says. If health care is in high demand and short supply, wealth will play an increasingly ugly role in who gets it.
But some doctors hope COVID-19 will push one fairly egalitarian solution into prime time: telemedicine. Virtual appointments have long
been seen as a way to expand access to care, but
adoption of the system has been sluggish. Tele- medicine provider Amwell, which works with
more than 2,000 U.S. hospitals, has seen usage grow 257% nationwide during the pandemic, and about 700% in Washington State, a company rep- resentative says. The crisis has also prompted CMS to temporarily ease long-standing restrictions, al- lowing Medicare to cover more telehealth services.
Telemedicine isn’t a cure-all. Some ailments can’t be treated this way, and some patients can’t access the technology. But its proponents say those changes—and a growing awareness of the dispari- ties that prompted them—would be one of the ripple e ects worth keeping around even after life goes back to normal. “Out of every catastrophe,” Lewis says, “we try to see the silver lining.” •
FAUCI: JIM LO SCALZO—EPA-EFE/SHUTTERSTOCK
GROCERS Major chains like Kroger are hiring employees and increasing pay. They are limiting some purchases and are reducing shopping hours to stock and sanitize the stores.
PRODUCTION So far, COVID-19 hasn’t disrupted farming, but demand is shifting. Sales of dried beans are up 231% year over year. Rice is up 166%. Even some perishables are up 50%.
How COVID-19 affects pregnancy
Pregnancy can be an uncertain time even without a pandemic. Now researchers are rapidly trying to gure out the risks of COVID-19 to pregnant women and newborns.
U.S. experts say that
for now, pregnant women should follow general guidelines, including hand- washing, and continue
to attend their prenatal checkups. The World Health Organization agrees, say- ing there is “no evidence” that pregnant women are
at higher risk from COVID- 19 but that because of changes in their bodies and immune systems, they can be badly affected by respira-
that supply restaurants, like US Foods, are contracting their workers to grocery suppliers and re- routing inventory to supermarkets.
STORAGE To focus on household staples, including food
items, Amazon is halting deliveries of nonessential goods to its warehouses.
We’re online more than ever right now. Can the Internet keep up?
To meet that need, highway- safety regulators relaxed limits on driving hours for truckers carrying critical goods. Trucks are moving faster as a result of less car traf c.
PROCESSING Tyson is deployin