By Kendra Sitton
Photo: Telehealth is increasingly being used to provide patients access to physicians (CC by NC-ND)
May 2, 2020 (San Diego’s East County) -- Governor Gavin Newsom is lifting some hospital restrictions on elective surgeries, bringing parts of the healthcare system back online. COVID-19 has yet to overwhelm hospitals locally, but in preparation, only essential surgeries were conducted for the past two months. Other medical offices switched to telehealth options or shut down completely. For some patients, particularly in East County, health care has gotten harder to access.
In a survey of 1200 cancer patients and survivors, the American Cancer Society Cancer Action Network (ACS CAN) found half of them had care that was impacted by the virus. A quarter of those who were impacted had treatment that was delayed and 13% do not know when their care will be rescheduled.
“The survey results are deeply concerning. What we heard from them is that delays and treatment and financial strain really are dominating the cancer patients experienced during the pandemic,” said Lori Bremner, California grassroots director of ACS CAN.
The delays are significant for cancer patients because early detection and early action are life-saving in many cases.
“Any delay in treatment or care can cause a more negative outcome, as well as delays in screening. We're worried that perhaps cancer will be found at a later stage because routine screenings are also being delayed,” Bremner said. She also believes that this is causing extra stress in people who are survivors or who are hoping to be diagnosed. They are facing other stressors as well.
“As cancer survivors and patients, we are all really well aware that our underlying health condition increases our chance of severe complications if we contract COVID-19,” Bremner said. “It's scary to have cancer in the best of times. To have cancer right now is really terrifying.”
Healthcare has gotten particularly out of reach for some in East County. Regional healthcare providers like Sharp and Kaiser have closed some East County locations for non-emergency visits. If an in-person visit is required, patients must drive further to a more central location where services are being consolidated. Scripps continued operating one clinic in Rancho San Diego and Kaiser reopened its Rancho San Diego for members on April 29.
Hospital capacity was an issue even before coronavirus hit. Sharp Grossmont Hospital in La Mesa is the only hospital in all of East County and services 750 square miles. Under normal circumstances, it has the busiest emergency room in all of San Diego County.
“Rural people face additional challenges of getting to care — traveling long distances at a time that we're not supposed to leave our home,” said Bremner.
Some primary care offices closed completely. Gabby O’Keefe, a nurse practitioner at AFC Urgent Care in Kearny Mesa said she has refilled many prescriptions for patients after telehealth consultations because they cannot access their regular doctor.
“With a lot of primary care providers shutting down or not seeing patients telemedicine, they have been directing patients to urgent care telemedicine for certain things,” O’Keefe explained. “A lot of people don't really know where to turn, because they know their doctors who they've been able to get into prior are not seeing patients and while some primaries are doing telemedicine too a lot of them aren't.”
While addressing health issues like diabetes and hypertension are on the backburner during the pandemic, they are still vitally important for sufferers. Other important treatments that are not essential have been delayed, leaving people to continue living with gallbladder issues, back pain and other issues until elective surgeries are rescheduled.
For some people, the easing of restrictions on telehealth by the Trump administration is long overdue. People with chronic pain or disabilities have long pushed for virtual appointments that are easier to access even when they are having bad pain days or struggle to travel. Elderly people have also embraced the change, according to O’Keefe.
“The older population really appreciate [telemedicine]. They know that they're more vulnerable to the virus and the fact that they don't have to go out is really good,” she said.
However, not every older adult has a computer or access to the internet.
The suspension in other hospital functions had other consequences. Voice of San Diego reported that many doctors and nurses are being laid off or having their hours cut because the most profitable hospital services have been suspended.
Patients have had economic impacts of their own. The closure of some non-essential medical services was also coupled with record job loss in the region, with one in four San Diegans unemployed. For many, this means loss of health insurance that could prevent them from seeking necessary medical care. Covered California has extended the deadline to sign up for healthcare coverage with subsidies under the Affordable Care Act until June 30th to help those who lost jobs and health insurance during the pandemic.
Fear of getting sick is also keeping people away from hospitals and other medical care providers. Sharp recently released a statement urging patients to come in if they experienced chest pains and other signs of serious medical problems. It explained that the number of heart attacks, strokes, seizures and aneurysms has likely not gone down during the pandemic, but the number of people seeking treatment has dropped at health centers across the region. Sharp is urging patients to utilize the health care available to them as more comes back online.