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Infectious disease expert: Expanded stay-at-home orders could be risking people’s lives | COMMENTARY

Maryland Gov. Larry Hogan first announced a "stay at home" directive for state residents on Monday, March 30.
Maryland Gov. Larry Hogan first announced a "stay at home" directive for state residents on Monday, March 30. (Pamela Wood / Baltimore Sun)

When should we reopen the economy? While debating this question, people typically compare the health benefits of COVID-19 stay-at-home orders against economic costs. However, another risk lurks right beneath the fears of a looming recession: non-COVID-19 related diseases and deaths. As an infectious disease specialist, I believe that extending stay-at-home orders for many more months can hurt lives, not just the economy.

This is how it works.

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In Harford County, where I practice, the number of 911 calls to EMS has already dropped by 30% during the first half of April, compared to the same dates last year. Simultaneously, the number of patients coming to the emergency room with mini-strokes has also plummeted by 50%. We are observing a similar downward trend in patients with acute chest pain, heart failure and heart rhythm-related problems.

This worries clinicians. A cardiologist recently said to me: “I wonder where all the heart attack patients have gone?” Surgeons joke, “How did COVID-19 fix people’s gall bladders?” We worry that patients are avoiding necessary ER visits for fear of catching COVID-19. We worry that patients are dying at home.

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And the national data seems to confirm such fears. In New York, city officials recorded a six-fold increase in deaths at home — over 200 home deaths per day — compared to recent years, according to an analysis by ProPublica. In Detroit, that number is four times higher than the baseline. Boston is following a similar trajectory. We don’t know yet what’s killing these Americans: silent COVID infections or their baseline diseases.

And then there are the psycho-social effects of stay-at-home policies. U.S. sales of alcoholic beverages rose 55% in the week ending March 21st, compared to the same period last year, according to Nielsen. Online alcohol sales soared by 243%. And while the virus may not take as many young lives, the shutdowns are taking the life out of this group. Over 65% of Britons between the ages of 18 and 34 find it hard to remain upbeat these days, one study found.

Many of my colleagues feel the same way. They worry that flattening the COVID-19 curve with extended stay-at-home policies will inadvertently create a bubble of non-COVID mortality and morbidity in the coming months. It is not just a worry; it is happening.

In Taiwan, diabetes-related hospitalizations skyrocketed after the SARS outbreak. Earlier this year, in Hong Kong, the median time for a patient with symptoms of a heart attack to call his doctor (or go to the emergency room) increased fourfold, from 82.5 minutes to 318 minutes. We know office visits are limited, elective surgeries are suspended, and transplants aren’t happening; we dread that the number of amputations and new cancer diagnoses may surge in the fall because patients missed timely screening appointments.

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The point we need to understand is this. Stay-at-home policies save lives and are critical in fighting this pandemic. But we must balance their benefit not only against the economic cost but also against the human suffering and loss of life due to routine illnesses.

That’s why I fully support the governor’s vision of safely reopening the state. But what should it look like? I see it as a three-step process.

  • Step One: Allow healthy Marylanders under the age of 60 (the least vulnerable) to restart life. Prerequisites include universal face masks, daily fever checks, tenacious hand-washing and maintaining proper distancing at work. These steps will further mitigate their already reduced risk. Most of the deaths are people over age 60. A tighter approach could be used in the hot spots (Prince George’s, Montgomery, Anne Arundel and Baltimore counties plus Baltimore City), where combined a vast-majority of COVID-19 cases in Maryland have occurred. Bars, movie theaters, concerts, sports arenas and any other place that attracts a crowd should remain shut down for now.
  • Step Two: Dedicate extra resources for nursing homes and state prisons. COVID-19 outbreaks have been confirmed in more than two-thirds of the state’s 226 nursing homes, according to a recent Baltimore Sun article. Similarly, 136 COVID-19 cases and one death have already been reported within the Maryland correctional system as of Apr. 16. If Maryland experiences a second wave of COVID-19 cases before schools reopen, it’s likely to emerge from one of these two demographics.
  • Step Three: Build capacity before schools reopen. Ensuring adequate testing (like a rapid strep test), procuring ample personal protective equipment and strengthening the local health departments with more human resources will allow us to pull a South Korea should COVID-19 rear its ugly head again. South Korea, whose population is 51 million compared to 6 million Marylanders, controlled the outbreak without lockdowns.

A timely stay-at-home order was a crucial step to mitigate the potential harm of COVID-19. The next correct step involves gradually easing that order. I trust my governor and his team to decide the right time to take that step.

Dr. Faheem Younus (fyounus@umm.edu) is the chief quality officer and chief of infectious diseases at the University of Maryland Upper Chesapeake Health.

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