WEBVTT - The Patients Left Behind

0:00:00.400 --> 0:00:03.480
<v Speaker 1>Hey, before we start the show, we have a quick

0:00:03.520 --> 0:00:07.400
<v Speaker 1>favor to ask you. As many places in America enter

0:00:07.480 --> 0:00:11.160
<v Speaker 1>their second month of social distancing, questions are coming up

0:00:11.200 --> 0:00:14.920
<v Speaker 1>about what's okay? Can you drive to another town to

0:00:14.960 --> 0:00:17.520
<v Speaker 1>see your mom from a distance if you never get

0:00:17.560 --> 0:00:20.520
<v Speaker 1>out of the car. What about taking a bike ride

0:00:20.520 --> 0:00:24.360
<v Speaker 1>with a friend two days six ft away? Daily life

0:00:24.400 --> 0:00:28.600
<v Speaker 1>now involves a lot of confusing risk calculations. So what

0:00:28.840 --> 0:00:33.000
<v Speaker 1>social distancing ethics and etiquette argue you wondering about? We

0:00:33.040 --> 0:00:36.519
<v Speaker 1>want to know. Leave us a voicemail with your question

0:00:36.720 --> 0:00:40.920
<v Speaker 1>at six four six three two four three four zero.

0:00:41.800 --> 0:00:44.720
<v Speaker 1>We'll answer some of your questions and we may use

0:00:44.760 --> 0:00:54.200
<v Speaker 1>your voice on a future show. And now today's show,

0:00:55.520 --> 0:00:59.920
<v Speaker 1>it's day forty two since coronavirus was declared a global pandemic.

0:01:00.920 --> 0:01:05.200
<v Speaker 1>Our main story, patients who are seriously ill from diseases

0:01:05.440 --> 0:01:10.200
<v Speaker 1>besides COVID nineteen are finding themselves in a strange limbo.

0:01:11.440 --> 0:01:15.560
<v Speaker 1>Getting treatment in hospitals is riskier than ever, and doctors

0:01:15.560 --> 0:01:20.199
<v Speaker 1>are forced to delay procedures without knowing for sure whether

0:01:20.280 --> 0:01:25.679
<v Speaker 1>patients will suffer long term harm. But first, here's what

0:01:25.800 --> 0:01:39.560
<v Speaker 1>happened today. New York is building a tracing Army to

0:01:39.600 --> 0:01:43.640
<v Speaker 1>attract the origin of individual coronavirus cases, according to Governor

0:01:43.720 --> 0:01:47.720
<v Speaker 1>Andrew Cuomo at his daily press conference today, the governor

0:01:47.760 --> 0:01:51.080
<v Speaker 1>said that doing this kind of so called contact tracing

0:01:51.320 --> 0:01:54.320
<v Speaker 1>will reduce the spread and let the state focus on

0:01:54.440 --> 0:02:00.320
<v Speaker 1>reopening UH. And we've been talking about testing, tracing and

0:02:00.360 --> 0:02:04.080
<v Speaker 1>then isolating UH and that is going to be the

0:02:04.200 --> 0:02:07.840
<v Speaker 1>key going forward. That's how you are educated and have

0:02:08.040 --> 0:02:11.440
<v Speaker 1>some data points as you're working your way through this

0:02:11.520 --> 0:02:15.480
<v Speaker 1>reopening calibration. And we set as a goal yesterday to

0:02:15.639 --> 0:02:19.520
<v Speaker 1>double the number of state tests, to go from twenty

0:02:19.560 --> 0:02:23.640
<v Speaker 1>thousand on average to that almost at the state would

0:02:23.639 --> 0:02:27.720
<v Speaker 1>work with Connecticut and New Jersey on the initiative. Former

0:02:27.760 --> 0:02:30.920
<v Speaker 1>New York City Mayor Michael Bloomberg volunteered to help the

0:02:30.960 --> 0:02:34.760
<v Speaker 1>state implement the program and will donate ten million dollars

0:02:34.919 --> 0:02:38.800
<v Speaker 1>to the effort. Michael Bloomberg is the founder and majority

0:02:38.840 --> 0:02:42.880
<v Speaker 1>owner of Bloomberg LP, the parent company of Bloomberg News.

0:02:45.040 --> 0:02:48.680
<v Speaker 1>New evidence suggests the new coronavirus may have been spreading

0:02:48.720 --> 0:02:53.160
<v Speaker 1>in the US earlier than previously thought. In California, to

0:02:53.360 --> 0:02:57.239
<v Speaker 1>Santa Clara, residents who died in early February were infected

0:02:57.240 --> 0:03:01.000
<v Speaker 1>with the virus. According to the Counties Public Health Department,

0:03:02.160 --> 0:03:06.160
<v Speaker 1>the first death on February six was twenty days earlier

0:03:06.240 --> 0:03:09.880
<v Speaker 1>than what was previously believed to be the first US fatality,

0:03:10.400 --> 0:03:14.120
<v Speaker 1>and it came three weeks before health officials identified the

0:03:14.120 --> 0:03:18.000
<v Speaker 1>first infection that didn't have a known tie to other cases.

0:03:19.080 --> 0:03:22.640
<v Speaker 1>The deaths were also weeks before cities and states started

0:03:22.680 --> 0:03:28.040
<v Speaker 1>implementing widespread social distancing measures. At the time, US attempts

0:03:28.080 --> 0:03:31.520
<v Speaker 1>to track the virus were limited, Tests were scarce, and

0:03:31.560 --> 0:03:34.960
<v Speaker 1>the criteria for who could be tested was tightly limited.

0:03:35.960 --> 0:03:38.200
<v Speaker 1>It's not the only thing the US may have gotten

0:03:38.240 --> 0:03:42.120
<v Speaker 1>wrong about the spread of the virus. The Trump administration's

0:03:42.160 --> 0:03:45.120
<v Speaker 1>projections for how many in the country will die from

0:03:45.160 --> 0:03:49.920
<v Speaker 1>the coronavirus maybe short by about a hundred thousand. According

0:03:49.960 --> 0:03:54.280
<v Speaker 1>to the American Civil Liberties Union, that's because it hasn't

0:03:54.360 --> 0:03:58.400
<v Speaker 1>fully accounted for the high prison population in the country.

0:03:58.880 --> 0:04:02.080
<v Speaker 1>Models that account for the hundreds of thousands of incarcerated

0:04:02.160 --> 0:04:05.960
<v Speaker 1>people suggest there will be many more deaths than projected

0:04:06.440 --> 0:04:10.400
<v Speaker 1>unless inmate populations are rapidly reduced. The A C. L.

0:04:10.520 --> 0:04:14.880
<v Speaker 1>You said, and how Speaker Nancy Pelosi said, the House

0:04:14.880 --> 0:04:18.159
<v Speaker 1>will pass the emergency four hundred and eighty four billion

0:04:18.200 --> 0:04:23.359
<v Speaker 1>dollar relief package tomorrow, giving small companies quick access to

0:04:23.440 --> 0:04:28.440
<v Speaker 1>additional loans. Pelosi also said on Bloomberg Television that a

0:04:28.520 --> 0:04:31.520
<v Speaker 1>major package of aid for state and local government will

0:04:31.560 --> 0:04:36.400
<v Speaker 1>be in the next stimulus legislation considered by Congress. That

0:04:36.480 --> 0:04:40.200
<v Speaker 1>sets up a conflict with Senate Majority Leader Mitch McConnell,

0:04:40.600 --> 0:04:44.200
<v Speaker 1>who was urging a slowdown in dolling out federal help.

0:04:49.040 --> 0:04:54.640
<v Speaker 1>And now our main story, the waves of coronavirus patients

0:04:54.839 --> 0:04:59.120
<v Speaker 1>flooding hospitals across the country have put an unprecedented strain

0:04:59.279 --> 0:05:03.440
<v Speaker 1>on our healthcare system. But it doesn't mean other diseases

0:05:03.520 --> 0:05:07.160
<v Speaker 1>just go away. The crisis is putting care on hold

0:05:07.480 --> 0:05:10.520
<v Speaker 1>for a lot of people with other serious health conditions

0:05:11.120 --> 0:05:16.400
<v Speaker 1>like cancer. Doctors are delaying procedures and surgeries in order

0:05:16.440 --> 0:05:20.240
<v Speaker 1>to save resources like hospital beds and ventilators for COVID

0:05:20.320 --> 0:05:25.920
<v Speaker 1>nineteen patients and prevent the infection from spreading. But as

0:05:25.920 --> 0:05:30.279
<v Speaker 1>Bloomberg News reporter and Accord explains, doctors are forced to

0:05:30.360 --> 0:05:34.920
<v Speaker 1>make often difficult choices about what constitutes an urgent procedure,

0:05:36.279 --> 0:05:40.080
<v Speaker 1>and experts worry that we're feeding another kind of healthcare

0:05:40.160 --> 0:05:48.120
<v Speaker 1>crisis one with consequences we're only beginning to see. Jenny

0:05:48.200 --> 0:05:53.040
<v Speaker 1>Alstrom has had a type of blood cancer since. Jenny

0:05:53.160 --> 0:05:55.760
<v Speaker 1>is fifty two and lives in Salt Lake City with

0:05:55.839 --> 0:05:59.440
<v Speaker 1>her family. In early April, she needed to see the

0:05:59.520 --> 0:06:02.560
<v Speaker 1>doctor for some tests that would help her understand the

0:06:02.640 --> 0:06:07.000
<v Speaker 1>status of her cancer, but she was worried. I had

0:06:07.040 --> 0:06:11.200
<v Speaker 1>to make this risk benefit analysis. Is it worse for

0:06:11.240 --> 0:06:13.480
<v Speaker 1>me to wait and then how my numbers go up

0:06:13.520 --> 0:06:16.240
<v Speaker 1>and not know what I could be doing about it,

0:06:16.480 --> 0:06:19.839
<v Speaker 1>even if I had to start treatment, or do I

0:06:19.920 --> 0:06:24.800
<v Speaker 1>wait and maybe have a disease that's growing more out

0:06:24.800 --> 0:06:28.240
<v Speaker 1>of control. So I was really holding off on doing

0:06:28.279 --> 0:06:31.480
<v Speaker 1>that just because I didn't want to put myself at risk.

0:06:35.560 --> 0:06:38.800
<v Speaker 1>Jenny did decide to go to the hospital. Her doctor

0:06:38.839 --> 0:06:42.359
<v Speaker 1>recommended a seven am appointment as the safest time to

0:06:42.440 --> 0:06:46.880
<v Speaker 1>go in. She didn't sleep well the night before. I

0:06:46.920 --> 0:06:49.839
<v Speaker 1>woke up really early and I had an in ninety

0:06:49.839 --> 0:06:53.080
<v Speaker 1>five mask, put that on, put my gloves on, and

0:06:53.240 --> 0:06:57.000
<v Speaker 1>went in And the streets are pretty quiet. There was

0:06:57.040 --> 0:06:59.679
<v Speaker 1>no traffic going up to the university, which there usually

0:06:59.760 --> 0:07:03.559
<v Speaker 1>is even at that time of the morning. Jenny says. Now,

0:07:03.839 --> 0:07:07.719
<v Speaker 1>even getting into the hospital to receive care is different

0:07:08.080 --> 0:07:10.520
<v Speaker 1>going into the facility. You know, I walked in, they

0:07:10.560 --> 0:07:13.320
<v Speaker 1>took my temperature. They were taking everyone's temperature that was

0:07:13.320 --> 0:07:17.600
<v Speaker 1>walking in the facility. There were signs everywhere that basically

0:07:18.120 --> 0:07:22.000
<v Speaker 1>there are no visitors or very few visitors, a single visitor.

0:07:22.760 --> 0:07:25.040
<v Speaker 1>And I went up to the floor and I was

0:07:25.080 --> 0:07:27.960
<v Speaker 1>the only patient that I saw on the entire floor.

0:07:28.360 --> 0:07:31.440
<v Speaker 1>No one's getting routine testing right now, no mamograms, no

0:07:32.360 --> 0:07:36.240
<v Speaker 1>stuff you would normally schedule for primitive care or even

0:07:36.400 --> 0:07:39.480
<v Speaker 1>just part of your regular care. They were cleaning off

0:07:39.520 --> 0:07:44.400
<v Speaker 1>all the chairs and surfaces when I got in, and

0:07:44.680 --> 0:07:48.520
<v Speaker 1>there were very few people working in the lab. So

0:07:48.720 --> 0:07:54.520
<v Speaker 1>it's truly changing normal cancer care, and I think that's

0:07:54.560 --> 0:07:58.960
<v Speaker 1>the case for every other disease to Jenny says she's

0:07:59.040 --> 0:08:02.600
<v Speaker 1>glad she went in for the tests. The doctor told

0:08:02.600 --> 0:08:06.400
<v Speaker 1>her she won't have to start treatment immediately, but it's

0:08:06.400 --> 0:08:09.920
<v Speaker 1>not always up to the patient. Hospitals are still doing

0:08:09.960 --> 0:08:13.720
<v Speaker 1>surgeries that are considered emergencies, but in many cases are

0:08:13.760 --> 0:08:19.080
<v Speaker 1>pushing off other kinds of procedures. Those procedures include lots

0:08:19.080 --> 0:08:23.360
<v Speaker 1>of things the average patient wouldn't consider optional, like cancer

0:08:23.400 --> 0:08:28.000
<v Speaker 1>surgeries or a knee replacement. John Hick is an emergency

0:08:28.040 --> 0:08:33.600
<v Speaker 1>medicine doctor in Minneapolis, Minnesota. He says doctors often make

0:08:33.679 --> 0:08:36.720
<v Speaker 1>the decision to delay this kind of care based on

0:08:36.880 --> 0:08:40.560
<v Speaker 1>three things. How much time it will take, how much

0:08:40.600 --> 0:08:45.480
<v Speaker 1>expertise is needed, and what the treatment involves. You know,

0:08:45.600 --> 0:08:49.640
<v Speaker 1>if we needed to take those resources altogether, what's the

0:08:49.679 --> 0:08:52.240
<v Speaker 1>overall investment that we're going to have to make, you know,

0:08:52.360 --> 0:08:55.040
<v Speaker 1>in the patient, And then what are we investing in,

0:08:55.240 --> 0:08:58.840
<v Speaker 1>you know, so kind of cold hard economic terms, what's

0:08:58.880 --> 0:09:02.080
<v Speaker 1>the return on investment here for this particular patient. So

0:09:02.200 --> 0:09:04.280
<v Speaker 1>we have to try to bring the best evidence that

0:09:04.360 --> 0:09:07.640
<v Speaker 1>we can to bear on the situation. But nothing's perfect,

0:09:08.080 --> 0:09:09.720
<v Speaker 1>you know. And I think that's the thing with medicine

0:09:09.800 --> 0:09:13.440
<v Speaker 1>is I used to tell people who wanted a firm answer,

0:09:13.440 --> 0:09:15.000
<v Speaker 1>and I get that all the time. Doctor, you have

0:09:15.080 --> 0:09:17.200
<v Speaker 1>to tell me, you know, I need to know, I

0:09:17.240 --> 0:09:19.360
<v Speaker 1>need to know a hundred percent. And I always say,

0:09:19.400 --> 0:09:23.640
<v Speaker 1>there's nothing that's in medicine. Doctors in the US are

0:09:23.679 --> 0:09:27.480
<v Speaker 1>delaying care for some in order to avoid what happened

0:09:27.559 --> 0:09:32.800
<v Speaker 1>in China and Italy. Hospitals there were overwhelmed by COVID

0:09:32.920 --> 0:09:37.600
<v Speaker 1>nineteen patients. This led doctors to have to make agonizing

0:09:37.720 --> 0:09:41.800
<v Speaker 1>decisions about who to treat and where to put resources.

0:09:43.120 --> 0:09:47.679
<v Speaker 1>Matthew Winnia is a bioethicist at the University of Colorado.

0:09:48.520 --> 0:09:53.920
<v Speaker 1>He says the situation presents major ethical questions. We're almost

0:09:54.000 --> 0:09:57.760
<v Speaker 1>certainly going to have some people with non COVID disease

0:09:58.040 --> 0:10:01.800
<v Speaker 1>who are harmed as result of delays in the care

0:10:01.880 --> 0:10:04.720
<v Speaker 1>that they receive. There's no perfect way to do this,

0:10:04.760 --> 0:10:08.559
<v Speaker 1>because no matter how you slice up that pie, someone's

0:10:08.559 --> 0:10:12.120
<v Speaker 1>not gonna like how much they got. Many doctors are

0:10:12.200 --> 0:10:15.959
<v Speaker 1>turning to virtual visits with their patients to fill the gap,

0:10:16.640 --> 0:10:20.560
<v Speaker 1>but not everything can be done that way. Jason Fung

0:10:20.920 --> 0:10:25.240
<v Speaker 1>is a kidney specialist based in Toronto, Canada. He says

0:10:25.280 --> 0:10:28.400
<v Speaker 1>he worries that people are staying home even when it

0:10:28.440 --> 0:10:33.600
<v Speaker 1>poses health risks. Many of Fung's patients are elderly and

0:10:33.640 --> 0:10:37.920
<v Speaker 1>have other health problems. They're more vulnerable to COVID nineteen

0:10:38.280 --> 0:10:41.080
<v Speaker 1>and they're afraid of getting it. The other day, I

0:10:41.120 --> 0:10:45.040
<v Speaker 1>admitted a patient who was so scared about COVID that

0:10:45.120 --> 0:10:47.400
<v Speaker 1>they didn't get their blood pressures checked, they didn't get

0:10:47.400 --> 0:10:50.440
<v Speaker 1>it taken care of, and I admitted that patient with

0:10:50.480 --> 0:10:54.400
<v Speaker 1>a stroke. That's not reversible, like they will suffer from that.

0:10:54.440 --> 0:10:57.200
<v Speaker 1>They can't see properly, so they will suffer from that

0:10:57.280 --> 0:11:06.319
<v Speaker 1>for the rest of their life. M bioethicist Matthew Whinia

0:11:06.559 --> 0:11:10.000
<v Speaker 1>says access to medical care has always been an issue

0:11:10.120 --> 0:11:13.679
<v Speaker 1>in our health system. The pandemic has just thrust these

0:11:13.679 --> 0:11:17.720
<v Speaker 1>subjects into even clearer view. But he does see a

0:11:17.760 --> 0:11:21.960
<v Speaker 1>silver lining here. Things like virtual visits are becoming much

0:11:22.040 --> 0:11:26.160
<v Speaker 1>more used and accepted. So there are ways in which

0:11:26.440 --> 0:11:30.920
<v Speaker 1>because of a disaster you develop new ways of thinking

0:11:30.960 --> 0:11:33.720
<v Speaker 1>and new ways of doing things that will then carry

0:11:33.720 --> 0:11:37.080
<v Speaker 1>on afterwards. You know, they're saying that necessity is the

0:11:37.120 --> 0:11:40.760
<v Speaker 1>mother of invention. We're having to invent a lot of

0:11:40.760 --> 0:11:44.280
<v Speaker 1>things right now because we have to, and some of

0:11:44.320 --> 0:11:47.920
<v Speaker 1>those will lead to long term improvements, I hope in

0:11:48.040 --> 0:11:51.679
<v Speaker 1>the health care system. The US is starting to talk

0:11:51.720 --> 0:11:57.680
<v Speaker 1>about reopening states that would include non COVID procedures, but

0:11:57.800 --> 0:12:01.840
<v Speaker 1>until then, patients and doctor will still have to make

0:12:02.200 --> 0:12:07.640
<v Speaker 1>the difficult choices about when and where care happens. And

0:12:15.240 --> 0:12:18.560
<v Speaker 1>that was Emma Court and that's it for our show today.

0:12:19.320 --> 0:12:22.000
<v Speaker 1>For more on the outbreak from one and twenty bureaus

0:12:22.040 --> 0:12:27.720
<v Speaker 1>around the world, visit Bloomberg Dot com slash Coronavirus, and

0:12:27.840 --> 0:12:31.839
<v Speaker 1>one small favor. If you appreciate the show, please leave

0:12:31.920 --> 0:12:35.559
<v Speaker 1>us a review and a rating on Apple Podcasts or Spotify.

0:12:36.400 --> 0:12:39.079
<v Speaker 1>It's the best way to help more listeners find our

0:12:39.080 --> 0:12:43.560
<v Speaker 1>global reporting. The Prognosis Daily edition is hosted by Me

0:12:44.160 --> 0:12:48.280
<v Speaker 1>Laura Carlson. The show was produced by Me, top foreheads

0:12:48.440 --> 0:12:53.760
<v Speaker 1>Jordan Gospore and Magnus Henriksen. Today's main story was reported

0:12:53.760 --> 0:12:57.760
<v Speaker 1>by Emma Court. Original music by Leo Sidrin, and our

0:12:57.920 --> 0:13:02.120
<v Speaker 1>editors are Francesco Leady and Rick sh Francesco Levi is

0:13:02.120 --> 0:13:10.439
<v Speaker 1>Bloomberg's head of Podcasts. Thanks for listening. H