Dr. Nicole Saphier: Correct the coronavirus bugs: As the first wave continues, we can learn from these lessons


Around 3 a.m., one day in April, they called an ambulance to the home of a young family in New Jersey who were doing everything they could to say they were safe during the COVID-19 pandemic.

Let's go back a couple of weeks to when Executive Order No. 109 was announced in New Jersey. He directed the suspension of all elective surgeries and invasive procedures performed on adults beginning March 27. This was an unprecedented move that most of our generations have not seen before and is now happening again in areas of the country with new and increasing cases.

After seeing the tragedies in Italy, I knew that lives would be saved if we did our best to make sure that Americans had enough hospital beds, ventilators, and staff available to prepare for the influx of critically ill patients who would soon arrive. However, the concept of something being "elective" in healthcare was quite difficult to come up with, outside of the obvious purely cosmetic plastic surgeries.


What our healthcare system (primarily administrators with nominal clinical experience) did not do correctly was assume that each case out of the emergency department was an elective procedure and took the decision from doctors and patients. Not only were plastic surgeries canceled, but other interventions, such as cancer screenings and preventive surgeries, were discontinued.

The reason for the 3 a.m. phone call in April was a ruptured brain aneurysm in a young woman who was home with her husband and two young children. The aneurysm had initially been discovered incidentally a month earlier during a brain image obtained for an auxiliary reason.

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The risk of death in a person with a ruptured brain aneurysm ranges from 70 to 80 percent, so the goal is to identify the aneurysm before it ruptures. In the young woman's case, the risk of rupture of her aneurysm given the size was around 40 percent in the next five years. It was not an "emergency," in the sense that he was not dying at the time, but he did die three weeks after the rupture of his aneurysm.

That was the phone call the first responders received: Someone was dying of a ruptured aneurysm and needed immediate medical attention. This is not unusual. A brain aneurysm breaks every 18 minutes, and most people don't even know they have one.

This woman was fortunate to have found her before it broke and had secured treatment to prevent it from breaking. However, due to the executive order trying to make room for COVID patients, his "elective" procedure to treat his aneurysm was canceled despite persistent refutation. After it broke, he lay down on an ICU bed for two weeks before succumbing to the devastating brain injury.

Ultimately, the cancellation of her "elective" procedure, which would have been performed on an outpatient basis and would not have required a hospital bed, resulted in delayed care requiring a bed in the ICU and ultimately the death of this young mother.

As SARS-CoV-2 cases increased in late March, hospitals, health systems, and even private practices dramatically reduced hospital and non-emergency services to prepare for an influx of patients with COVID-19. Unfortunately, more selectivity and thought should have entered this decision.

Our closure of medical care is the double-edged sword that no one wanted and we are seeing the ramifications of such efforts.

Instead of suspending medical care, indoor social gatherings should have been conducted first to lessen the spread. Now, as we are seeing a continuation of the first wave in various regions of our country, I warn our leaders and the American public to avoid repeating our mistakes.

A Kaiser Family Foundation survey found that 48 percent of Americans said they or a family member canceled or delayed medical care due to the pandemic, and 11 percent said the person's condition worsened as result of delayed care.

With an increase in cases, the media reports less hospital availability in some areas. However, in Houston and Austin, less than 15 percent of hospital beds are full of COVID-19 patients. Many patients are people who need hospitalization because they delayed care to the point that they now require more intensive treatment.

Additionally, hospitals are testing all patients in the hospital for COVID-19 regardless of the reason for presentation, which may artificially inflate the number reported as COVID-related hospitalizations. This was a common criticism in the New York City area, which promulgated fear and gave a false sense of reality regarding the situation.

While the increase in new cases is troubling, we must take a moment and praise the American people for using the knowledge gained in recent months and doing everything possible to protect the most susceptible: the elderly and people with chronic medical conditions. . The average age of those who tested positive and were hospitalized is significantly younger now than it was even a month ago, so the death rate has not reflected what we saw earlier. This is incredible news and something we should be proud of as our elders seem to be more protected. While we remain vigilant in protecting the vulnerable as we reopen, let's also remember to take care of ourselves in the meantime.

The harsh reality is that Americans tend to lead less healthy lives than our global counterparts, primarily in terms of obesity, heart disease, and diabetes. Since many of us avoid or delay routine medical care during this time, hospital systems now care for patients whose blatant chronic illnesses now require hospitalization and even ICU treatment.


Our closure of medical care is the double-edged sword that no one wanted and we are seeing the ramifications of such efforts.

People died because they avoided care or were unintentionally delayed, and now our health system is being tested as it tries to repair the damage caused in the midst of fighting a pandemic with limited treatment options and no vaccine available.

From cancer to COVID19, early diagnosis and treatment are key to survival and to lessening the social burden of advanced disease. What can be easily treated as an outpatient requires a hospital bed if you delay care. Get your mammogram, check your blood pressure, and make sure you have enough refills of any medications. These simple actions will help keep our hospital beds available for the most urgent cases. If our goal is to ensure spacious hospital and ICU beds while trying to keep our economy open, we need to live our healthiest lives to ensure that there is a safety net when needed.


The virus thrives indoors with prolonged exposure, and activity trackers tell us that congregating in bars and nightclubs is spreading the disease. If canceling happy hour means we can avoid shutting down medical services and the entire economy again, we should. Let's focus on long-term goals instead of giving in to short-term joys that will do little more than pass on a virus that has already killed more than 120,000 Americans in just over three months.

No single legislation, medicine or vaccine will get us out of this crisis. Rather, it will be our own behaviors that will ensure adequate hospital availability and decrease the spread of the virus among the elderly. I'm doing my part. Are you doing yours?



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