A patient was tested by Neighborhood Health clinic this summer to find out if he had COVID-19, a disease that could potentially be fatal because of his co-morbidities.
He tested negative, but died 11 days later, succumbing to a chronic condition.
Brian Haile, CEO of the Middle Tennessee network of clinics, says the patient’s death is emblematic of a broader trend in health care during the pandemic, one where chronic conditions go untreated while the coronavirus dominates nearly every aspect of life and medicine.
Haile and other Middle Tennessee medical professionals said restrictions at doctor’s offices and patients’ fears about catching the coronavirus have limited the care they seek. The industry is racing to meet a new set of needs through telemedicine efforts, using video conferencing and phone calls instead of in-person appointments.
The stakes are dire.
“COVID is horrible, but this pandemic’s effect is going to be a culmination of untreated chronic disease in the southeast,” Haile said. “What’s going to kill many more Nashvillians is going to be that untreated hypertension, diabetes and (the lung disease) COPD.”
COVID-19 has reshaped medical care in many ways, delaying surgeries and treatment deemed “non-essential” in a scramble to slow the spread of the virus.
The fall-out dealt a financial blow to hospitals, primary care practices and dentists, among others. And it’s hit vulnerable patients who depend on regular doctor visits to trouble shoot medical problems before they grow to become crises.
A Vanderbilt Child Health Poll conducted this summer found more than a third of families had delayed or canceled children’s health care during the pandemic. Nearly half of those delays were for routine well-child visits meant to track health at pivotal points in a child’s life.
Those trends are extending into adult care, too.
Dr. Farere Dyer, a medical extern in Nashville, adapted his approach to treating his Type 1 diabetes during the pandemic, cutting back on in-person appointments and relying on unorthodox methods to keep his condition in check.
He started seeing his endocrinologist via video conference — she monitors his insulin readings remotely after they have been logged into a computer program. Dyer cut back on visits to a retinal specialist he sees due to complications from his diabetes.
“That’s been tough because whenever I have a change in my vision I kind of have to self diagnose,” Dyer said. “A lot of the onus of controlling the disease goes back onto the patient. That’s probably the toughest part of this era is that you’re having to make a lot of decisions yourself that could change the outcome of a chronic disease.”
Dyer knows he’s atypical. His parents were both doctors and so is he. For patients with less medical experience, it’s a steeper challenge.
The fear for local medical experts is that some patients won’t or can’t seek guidance to maintain their health.
Dr. Jim Henderson, the chief medical officer at Siloam Health, said something as simple as strep throat can become life threatening if left untreated.
His organization, which treats uninsured and underserved populations, diverted patients away from their clinics in the early days of the pandemic in February and March. Then they saw a continued dip in patients after they instituted on-site precautions to make in-person treatment safer.
So Siloam mounted an aggressive campaign to encourage patients to seek treatment.
In June they sent text messages and emails in Spanish, Arabic and English to tell patients about the protections they had in place. The health network also spoke to churches and community leaders in an attempt to get the word out.
By late July, he said, patient traffic at Siloam’s main clinic in Melrose was back to about 70% of normal levels.
“People who have chronic conditions that really need attention need to know the steps we’ve taken,” he said.
“Things like hypertension lead to damage of the heart,” he said. “In general staying on top of a condition like hypertension or diabetes helps prevent these kinds of complications from occurring.”
Dr. Millard D. Collins, who works at Meharry Medical College, said the pandemic had deepened health disparities that have troubled medical experts for generations.
The historically black college, which works in tandem with the city’s safety net hospital, is scrambling to get care to vulnerable patients, particularly those who struggle with poverty, homelessness and systemic racism.
It’s long been an uphill battle.
“They often have to chose to sacrifice something as it pertains to their health,” Collins said. “They think that their diabetes or their blood pressure can just wait.”
If convincing vulnerable patients to get treatment for chronic conditions is hard, he said, getting that population to embrace telehealth during a pandemic is harder.
“What COVID-19 has done, specifically for the patient population that we’re talking about is it’s exposed our failures,” Collins said, speaking broadly about society and the health care system. “Our vulnerabilities have been exposed.”
Collins said the pandemic, and a national reckoning on racial inequality this summer, led to a new surge in interest in treating chronic conditions and reaching vulnerable patients.
In June, the Federal Communications Commission gave Meharry $718,752 for desktop computers, tablets, mobile hotspots to use for screening low-income and elderly patients who were at a higher for complications from COVID-19.
Those kinds of efforts are a start, he said. But true progress in aggressively treating and managing chronic diseases that make people vulnerable will required sustained commitment.
“Grant moneys only get you started,” Collins said.
“The responsibility is ours to keep the pressure on and remind them that these issues have not been addressed yet,” he said. “If Black lives matter, we need to show it more than in the news, we need to show it in the clinic.”
Reach Adam Tamburin at 615-726-5986 and email@example.com. Follow him on Twitter @tamburintweets.