12 Time APRIL 6–13, 2020W
hen Dr. mark Lewis has To give a
cancer patient bad news, he usually offers
a hug or a hand to hold. The idea of doing
so by phone felt heartbreakingly imper-
sonal, he says. But in the face of the COVID-19 pandemic,
the Salt Lake City–based gastrointestinal oncologist has
had to do many things that make his “conscience weigh
heavy.” He’s delivered tough prognoses virtually, to limit
the chance of spreading the virus. He’s delayed chemo-
therapy for patients who—he hopes—can wait, knowing
the treatment would wipe out their immune
system. He’s made the opposite choice for pa-
tients with cancer spreading faster than corona-
virus. All he can do is hope he’s gambled well.
Welcome to medicine in the age of COVID-19.
The novel coronavirus has upended the U.S.
medical system—and not just for those deal-
ing directly with the pandemic. Patients with
chronic conditions will have to fight to get the
care they need, not only now but also after the
outbreak ends, when hospitals are left to deal
with backlogs of appointments canceled en
masse. Anyone with the misfortune to get into
a car accident or have a heart attack during the
outbreak will be at the mercy of a strained sys-
tem. And in this environment, the gulf between
people who can and cannot afford to seek out
good care will become ever more apparent.
As of publication, U.S. hospitals are still op-
erating smoothly, for the most part, but obsta-
cles are mounting. In a system in which routine
supply and demand leaves only about a third
of hospital beds open on a normal day, medi-
cal centers are nearing capacity, particularly
in hard-hit areas. As fears mount, “morale
is low,” says Dr. Chethan Sathya, an assis-
tant professor of surgery and pediatrics at
New York’s Cohen Children’s Hospital. Each
day’s work, Sathya says, raises the chances of
doctors getting sick and passing the virus to
their fa milies. Ready as they are to serve, that
thought is never far from their minds.
Surgeons like Sathya have been directed by
the Centers for Medicare and Medicaid Ser-
vices (CMS) to postpone elective procedures
to keep beds and supplies available. Deciding
whose care can’t wait, however, isn’t always
easy. A patient on dialysis can wait a few weeks
for a kidney transplant, but should she? And
fa cilities have placed often heartbreaking limits
on visitors—including, in some New York Cityhospital systems, on partners of women in labor. Doctors
of all specialties and career stages are pausing their day
jobs to provide critical care or pitching in to support phy-
sicians on the front lines. “I’ve been brushing up on how
to manage a ventilator, because I haven’t had to do that
in almost a decade,” Lewis says. “In a week, two weeks,
I might have to shift from the long-term care of cancer
patients to acute critical care.”Lewis and other doctors have little choice, and the
consequences of that fact will be far-reaching. Dr. Anupam
Jena, an associate professor of health care policy at Har-
vard Medical School, says patients with conditions like
strokes and heart attacks may fare worse than normal if
they delay going to the hospital or if emergency depart-
ments can’t see them as quickly. Some people who follow
directions and cancel routine screenings may go longer
without knowing if they have cancer or diabetes.
The outbreak has also thrown the relationship
between wealth and health into sharper relief than
ever. Research suggests the richest 1% of Ameri-
cans can expect to live more than a decade longer
than the poorest 1%—and that’s without a pan-
demic. COVID-19 has drawn a clear line between
people who can work from home and those in
service-focused jobs who must be physically pres-
ent, thereby risking infection. The country’s most
vulnerable populations, like the homeless and those
living below the poverty line, are the least able to
stock up on groceries and hunker down inside;
they’re also less likely to have the means to safely
travel to a doctor’s office if that’s what’s needed.
And the gap is likely to widen, Sathya says.
“As the unemployment rate rises because of this,
people are going to have less and less access to
health insurance,” he says. If health care is in high
demand and short supply, wealth will play an
increasingly ugly role in who gets it.
But some doctors hope COVID-19 will p ush
one fairly egalitarian solution into prime time:
telemedicine. Virtual appointments have long
been s een a s a way to expand access to care, but
adoption o f t he s ystem has been sluggish. Tele-
medicine provider Amwell, which works with
more than 2,000 U.S. hospitals, has seen u sage
grow 257% nationwide during the pandemic, and
about 700% in Washington State, a company rep-
resentative says. The crisis has also prompted CMS
to t emporarily ease long-standing restrictions, a l-
lowing Medicare to cover more telehealth services.
Telemedicine isn’t a cure-all. Some ailments
can’t be treated this way, and some patients c an’t
access t he t echnology. But its proponents s ay those
changes—and a growing awareness of the dispari-
ties t hat p rompted them—would be one of the
ripple e ffects worth keeping around even after l ife
goes back to normal. “Out of every catastrophe,”
Lewis s ays, “we try to s ee t he s ilver lining.” •TheBrief Opener‘We’re going
to know—
for better
or worse—
whether we
have e nough of
what it takes.’
DR. A NTHONY FAUCI,
on M arch 1 8, o n
whether d octors w ill
be a ble t o keep u p w ith
“the k ind o f m edicine
that we o ptimally w ould
wa nt t o p ractice”HEALTH
A medical systemon life support
By Jamie DucharmeFAUCI: JIM LO SCALZO—EPA-EFE/SHUTTERSTOCK
BRLEDE.indd 12 3/25/20 4:17 PM