by James A. Bacon
More than 600 physicians have signed a letter to President Trump calling for an end to the national shutdown aimed at slowing the spread of the coronavirus. The letter describes the unmeasured and overlooked health consequences of skyrocketing unemployment and income loss as a “mass casualty incident.”
The letter makes the same point I have been emphasizing over the past several weeks, but with the authority borne of first-hand interactions with patients: The policy response to the COVID-19 virus has been driven by adverse health effects that we are measuring and reporting in real time rather than adverse effects that we either cannot measure or are reported only after delays of weeks, months, or years.
“We are alarmed at what appears to be the lack of consideration for the future health of our patients,” write the doctors. “The downstream health effects … are being massively under-estimated and under-reported. This is an order of magnitude error.”
The docs are particularly concerned with the shutdown of elective procedures, a lockdown measure still in place in several states. Governor Ralph Northam rescinded the elective-procedure ban in Virginia effective last Friday. But other observations are germane to the situation in Virginia and worth quoting at some length.
During a mass casualty incident, write the docs, victims are triaged in four classifications: black, red, yellow and green. Millions of Americans are at triage level red, those with severe but survivable injuries.
These include 150,000 Americans per month who would have had a new cancer detected through routine screening that hasn’t happened, millions who have missed routine dental care to fix problems strongly linked to heart disease/death, and preventable cases of stroke, heart attack, and child abuse. Suicide hotline phone calls have increased 600%.
Tens of millions of Americans are at triage level yellow, with serious but not immediately life-threatening injuries. “Liquor sales have increased 300-600%, cigarette sales have increased, rent has gone unpaid, family relationships have become frayed, and millions of well-child check-ups have been missed.
Hundreds of millions are at triage level green. These are people who currently are solvent, but at risk should economic conditions worsen. Poverty and financial uncertainty is linked to poor health.
A continued shutdown means hundreds of millions of Americans will downgrade a level. The following are real examples from our practices.
Patient E.S. is a mother with two children whose office job was reduced to part-time and whose husband was furloughed. The father is drinking more, the mother is depressed and not managing her diabetes well, and the children are barely doing any schoolwork.
Patient A.F. has chronic but previously stable health conditions. Her elective hip replacement was delayed, which caused her to become nearly sedentary, resulting in a pulmonary embolism in April.
Patient R.T. is an elderly nursing home patient, who had a small stroke in early March but was expected to make a nearly complete recovery. Since the shutdown, he has had no physical or speech therapy, and no visitors. He has lost weight, and is deteriorating rather than making progress.
Patient S.O. is a college freshman who cannot return to normal life, school, and friendships. He risks depression, alcohol abuse, drug abuse, trauma, and future financial uncertainty.
The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.
Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise.
Northam is a physician. He should grasp this reality immediately. If he does, his shutdown decrees do not reflect it.
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