Effects of the Pandemic on Healthcare – A Case Study

Author: Sathvik Kurapati

 

In December 2019, a new coronavirus was detected in the city of Wuhan, China called COVID-19. It quickly spread around the world, causing the World Health Organization to declare a Global Health Emergency just one month later. COVID-19 is a deadly disease, with the ability to spread quickly from person-to-person while sometimes being undetectable, and as of July 2022, over 6.3 million people have died from this disease. The arrival of this global pandemic led to some massive restructuring in the healthcare system, as healthcare providers had to triage large volumes of patients while not compromising on the quality of care. In the early days of the pandemic, healthcare professionals were overwhelmed by the sheer numbers of patients and had to develop ways to make sure that everything was handled efficiently.

HealthCare Experiences

During June and July 2020, when the pandemic was at its peak, 48.4% of adults were not able to receive one or more types of medical care (including urgent care, surgery, screening tests, ongoing treatment, regular checkups, prescriptions, dental care, vision care, and hearing care) due to the pandemic. Furthermore, people with less severe illnesses used the healthcare system significantly less as compared to the general population. “Healthcare utilization decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness.” The pandemic challenged the Healthcare industry and forced a quick transition to a world with less-than-ideal tools and processes. The healthcare workers themselves lacked robust protection mechanism, stretching the system and has multiple side effects. Lack of early disease detection was a common theme which often led to bad consequences down the line. Many issues surfaced and hit the population which otherwise were treated and avoided in the pre-pandemic world.

 

My grandfather had an experience that many of the people in his age group typically had. He was, generally, a healthy person. He spent at least a couple of hours a day exercising, he ate healthily, and was generally in good health. Although he had diabetes and had heart surgery in the past, he is very health-conscious and would be considered to be doing well given his 70+ age. During the pandemic, he struggled a lot as he was not able to receive the amount of healthcare that he normally would.

 

His medical history looked like the following:

  • He had Atrial Fibrillation with Flutter, Coronary Artery disease and Severe calcific aortic stenosis for which he underwent CABG and valve replacement almost a decade ago
  • He has Type 2 diabetes for which he is on maintenance medication
  • He has mild systemic hypertension and hypothyroidism for which he is taking medication

 

Usually, he would have

  • Blood test for diabetes every month
  • Heart checkup every quarter
  • Physical activities with a group of people like yoga, walking etc.
  • Complete health check once every year

What he did during pandemic

  • Continued existing medicines
  • Skipped diabetes test and heart check up
  • Was confined to the house

 

Constant monitoring and adjustment to his medication was important for him because he was a heart patient and had diabetes. However, he was not aware of the criticality of these activities relative to the risk of visiting a hospital and exposing himself to covid. Basically, was flying blind assuming everything was normal and continued with his current medication for several years. Some people think of healthcare as a delicate balance scale - many different factors like exercise, nutrition, and rest play into it. Once one of these is out of whack - either too much or too little - that is when problems start to arise. Little did we know that many underlying conditions were gradually becoming worse without any indication on the surface. For my grandfather, sunstroke was what tipped him off. He exposed himself to a brief period in an otherwise very hot day to the sun and quickly became sick with sunstroke. By the evening, he developed a fever and stopped passing urine. The situation got worse in a day, and he developed urinary infection, cough and completely stopped passing urine. These issues caused further complications and his body reached a state where he had to go to be immediately rushed to the hospital.

 

He developed the following complications because of the above incident:

  • Urosepsis
  • Obstructive uropathy
  • Acute kidney injury
  • Prostratomegaly
Grandfather admitted with complications

He has been on blood thinners due to heart surgery that made it challenging for the blood to clot and his wounds to heal. The urinary infection he developed quickly reached his kidney and subsequently reached all of his blood. His diabetes levels went way out of control due to the infection and his blood became fully acidic which if ignored would lead to multiple organ failures. He was reporting sugar levels of 720 and passing blood instead of urine before he was rushed to the hospital. His heart rate was 170 which should have been in the range of 60 to 100.

 

At the hospital:

  • First thing, they put a catheter and relieved pressure on the urinary bladder, performed by Dr. Vilvapathy Karthikeyan, chief urologist and surgeon, performed the procedures and treated my grandfather.
  • They got his diabetes in control by giving insulin
  • They gave medication to regulate the heart rate. After all attempts failed, they gave shock two times trying to reset his heartbeat
  • Treated him with antibiotics for infection
  • Gave medicines to help kidney and kept dialysis as the very next option if his creatinine levels didn’t come down
  • His PSA was 32 which should have been in single digits - he was given medicine

Treatment at the hospital

The function of the urinary system is to filter blood, and a byproduct of that is the creation and (dispellation) of urine. Once food is consumed, the nutrients are taken into the bloodstream and transported around the body. After the different organs take the nutrients they need from the blood, waste products, like urea and ammonia, remain. The urinary system helps to filter out these toxic waste products. The blood enters each kidney through many arteries, where the toxins and nutrients are then separated. The nutrients go back into the bloodstream, while the urine goes through the ureters to the bladder, where it is then stored and later dispelled from the body through the urethra. For people who have trouble urinating, a catheter is a tube that provides a way to drain the urine from the bladder. The type of catheter that my grandfather used is a tube that is inserted through a small hole in the stomach to the bladder. This tube allows the urine to drain through the catheter’s tube into a drainage bag that can then be emptied.

Urinary Catheter   

After my grandfather got to a state where his critical problems were taken care of, the hospital discharged him. He wasn’t quite fully recovered, but he was sent home. Why would the hospital do this? There were two main reasons - because of the pandemic and the hospital environment. The hospital that my grandfather was in had many COVID-19 patients come in. The doctors were also concerned that his chances of contracting COVID from other COVID patients in the hospital, increased significantly if he stayed longer in the hospital. The inflow of COVID patients led to the hospital being constantly over capacity. Since my grandfather was out of an emergency state, the medical professionals believed that he could recover and that his place in the hospital might be given to someone who needed it more. They also sent him home because of the environment that the hospital provided. Since it was so crowded in the hospital, there were many germs that made the hospital a more dangerous place for him. Therefore, to reduce the risk of him getting another infection, the doctors thought it might be best to send him home and allow him to recover there. Because of these reasons, my grandfather was discharged from the hospital.

   Repeated stays at the hospital
My grandfather continued to recover at home as he was still healing from the procedures that he went through. He was prematurely discharged as the healthcare systems could not handle the effects of the pandemic and this presented few challenges that at times had disproportionate consequences. These were the 5 things that he struggled with when he had the catheter at home where the hospital staff wasn’t constantly monitoring him.

 

 

   Challenges at home

Timeframe

Problem Encountered

Actual Result

Patient Outcome

Week 1

Urine flow is missing or reduced

Oftentimes a sign of kidney failure or a urinary tract infection (UTI)

No indication of reduced flow

Week 2

Bag is not being cleaned/replaced correctly

Could lead to development of bacteria and possible UTI

No indication - assumes the bag is in a good state

Week 3

Fluid isn’t draining at a constant rate

Urine is not being produced at a consistent rate - sign of bladder or kidney issues

No indication about the changes in the rate of drainage

Week 4

Fluid weight changes

Might indicate buildup of a new infection

No Indication

Week 5

No way to see if bag is close to being filled

Could lead to potential backflow of urine from the bag (that usually contains more types of bacteria) into the urinary track or bladder

No Indication

 

 

Problems with the catheter

There was no indication of an issue in any of the cases mentioned above and each of them led to an episode of developing further complications and hospital visits and hospitalization. These side effects had a bigger effect on the overall trend of my grandfather’s health and recovery chances as they kept recurring and burdening his urinary system which was already under stress. Looking back, I realize how silly the problems were but how big a price we had to pay for those problems. I am fortunate that my grandfather could come out of it - many people would pass away or would develop chronic life-limiting conditions and live with them. I was determined to see how I can make the system better for the next set of people, so based on this, I wrote a research publication to address these common problems.

 

 

 

 

 

 

 

 

SOURCES:

Drapeaux, Alisa, et al. “The Impact of Covid-19 on Patient Experience within a Midwest Hospital System: A Case Study.” Journal of Patient Experience, SAGE Publications, 8 Dec. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664302/.

“Reduced Access to Care - Research and Development Survey - COVID-19.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 6 Aug. 2021, https://www.cdc.gov/nchs/covid19/rands/reduced-access-to-care.htm.

Moynihan, Ray, et al. “Impact of Covid-19 Pandemic on Utilisation of Healthcare Services: A Systematic Review.” BMJ Open, British Medical Journal Publishing Group, 1 Mar. 2021, https://bmjopen.bmj.com/content/11/3/e045343.