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Reviews |  One million pandemic deaths, and those still aren’t counted


While digging through the grim landscape of tragedy, my colleagues and I often mourned the stories of patients who sought medical care despite their fears of contracting Covid, only to become victims of an overburdened system. At the start of the pandemic, a colleague told me about an elderly patient with heart disease who died in the emergency room while waiting almost a day to be admitted to a hospital full of Covid patients. During the 2020 winter surge in Los Angeles, another patient developed a terrible headache at home, and by the time paramedics arrived an hour later, blood had flooded her brain. She never regained consciousness.

Around the same time, a woman with cirrhosis started drinking more and was unable to get timely appointments with her regular doctor, who had been deployed to treat Covid patients in hospital. Shortly after going to an urgent care center, she died of liver failure.

The families of these people suffered the singular pain of wondering if they had pushed their loved ones enough to get them to the hospital or pleaded enough to get them the care they needed. Their doctors have often asked themselves the same question.

I wondered if listening to patients’ stories earlier in the pandemic might have improved health systems’ responses to their needs during those tumultuous years. In April 2020, leaders at Adventist Health Lodi Memorial, a community hospital in central California, noticed that ER visits dropped about 50% shortly after California issued its first stay-at-home order. home. Paramedics reported a record number of cardiac arrests outside the hospital, and stroke patients almost uniformly waited to seek help until the severity of their symptoms subsided. worsen.

A team of researchers primarily from the University of California, San Francisco, interviewed patients and physicians in Lodi about their health care experiences during the early months of the pandemic and reported that “the overriding theme of these talks was fear”. To feel safe, patients said they needed an understanding of the hospital’s efforts to minimize transmission of the virus as well as clear guidance on when to go to the emergency room and reassurance that that they would receive care.

The hospital responded quickly. Patients with respiratory symptoms that could signal Covid were assessed in a part of the emergency room, at a safe distance from others. Patients received emails about measures being taken to keep the hospital clean, the prevalence of Covid cases in the community and symptoms that should prompt an immediate visit to the emergency room. People quickly started returning to the ER and lives were potentially saved.

The health system should emulate Lodi Memorial’s approach and pursue the stories of those who died in the shadows to prevent such deaths from occurring in the midst of the next crisis or outbreak. Researchers and policymakers need to investigate and learn from the experiences of people like my patient and Lodi’s patients to understand how to minimize barriers to getting care even amid the tumult of a pandemic — especially emergency care. for people with heart attacks and strokes.

nytimes Gt

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