Young woman with face protective mask taking care of hand hygiene before working

Managing Chronic Disease During COVID

Since the onset of the pandemic, local hospitals have streamlined care for patients in a variety of ways. Learn what local experts have to say about managing chronic diseases during this time.

Now that we’re a few months into the “new normal,” you’re probably empowered with the most prevalent, basic knowledge to mitigate health risks for yourself and others in your community. You’ve heard reiterations that you should wash your hands often, wear a face covering and practice social distancing.

If you live with a chronic health condition, such as diabetes, cancer or heart disease, you’ve probably also heard that you might be more at risk for complications to arise should you contract the COVID-19 virus. And you may have asked these questions:

-Do I need to take extra precautions to avoid the virus?
-How am I supposed to get the care I need?
-How do I prioritize my health without sacrificing the joys of life?
With information updating constantly, these questions can be tough to navigate.

For answers, we’ve turned to physicians from our region’s local hospitals.

Dr. Clarence Parks

As the director of hospital medicine and the director of community health at FHN, Dr. Clarence Parks sees just about everything in the emergency room.

“It runs the gamut, but the major hot-button issues are heart disease, high blood pressure and diabetes,” he says. “Complications from those, by far, are what we see most often.”

Since the onset of the pandemic, Parks has noticed that patients with these and other chronic illnesses have exhibited apprehension about going to the emergency room. Even before the pandemic, there was often the question of “When is something truly an emergency?”

“One of the things we’ve mentioned to our patient population, and it’s been echoed across the country, is that when you have symptoms or signs that your medical condition isn’t well-controlled – in other words, you’re not at your baseline – those are the instances where you need to seek medical attention in the emergency department,” Parks says. “We also strongly recommend that patients continue visiting their primary care providers in a timely fashion so that hopefully these issues can be managed before they become critical or urgent.”

Take diabetes. In a pre-COVID world, Parks advised patients to see their primary care provider every two to three months for an assessment. This visit included a foot exam – since damaged nerves can be a side effect of diabetes, and diabetic patients may not notice blisters or cuts on their feet – and laboratory studies of the patient’s hemoglobin A1c level, or their average blood sugar level over a three-month time period.

These tests are still necessary for diabetic patients in our post-COVID world. But now, FHN provider visits are much more-efficiently streamlined with the increased use of telehealth, or video conferencing with a care provider.

Since diabetes requires consistent monitoring, many diabetic patients were already monitoring their own blood sugars anyway, Park says. Telehealth enables these patients to share their results and receive follow-up support without having to leave home.

 “And in general, a lot of patients with chronic medical conditions can be evaluated through a telehealth visit or an at-home visit,” Parks adds. “And that can go all the way up to having patients sign up for what’s called telemonitoring, which employs technology where patients can use a blood pressure cuff, or a pulse oximetry test to measure the oxygen levels in their blood, or other technologies depending on the individual case. We’re looking at ways in which we can further employ telemonitoring for patients with chronic illness.”

In addition, as health care continues to move more toward patient convenience, it can be common for patients to receive their medications through mail-order pharmacies, Parks adds. If for some reason patients aren’t getting their prescriptions delivered on schedule, there are recourse options.

“We strongly recommend you contact your mail-order pharmacy. Oftentimes, they also have a local retail pharmacy that can dispense you an emergency stock of medications,” Parks says.

“I think it’s important that we get as much information out to the public as possible,” he adds. “This is a time we’ve never experienced before, both from a community standpoint and a health care institutions standpoint. But one of the most important things we can do is empower individuals to do what they can to stay healthy and keep others in their community healthy as well.”

Dr. Eric Xanthopoulos

Early on in the pandemic, radiation oncologist Dr. Eric Xanthopoulos was tasked with triaging his cancer patients at Beloit Health System UW Cancer Center. 

“We had to re-think how we were flowing patients through the clinic,” Xanthopoulos says. “So, if a patient had a low-risk breast cancer or a low-risk prostate cancer, we might say, ‘Hey, let’s see if we can delay your treatment by one or two months, or maybe start some hormone therapy upfront, which wasn’t something we did before the pandemic.”

Now, the cancer center has adjusted its practices – picture hospital workers wearing masks and shields, constantly washing their hands, screening temperatures, and cleaning treatment rooms between every patient – so the need to triage patients has rescinded. 

Still, if a patient tests positive for coronavirus before their treatment begins, their care is delayed to prevent complications.

“Delaying treatment by a little bit is often not a big deal,” Xanthopoulos explains. “What you don’t want to do is break treatment once you’ve already started. It’s kind of like stopping a course of antibiotics halfway through. If you do that, you’ve killed off the weaker cancer cells and you give the hardier cancer cells a chance to grow and take over, and you don’t want that.”

If a patient does happen to test positive for COVID-19 during the middle of their treatment, they’ll then have to receive treatments at the end of the day, after other non-COVID patients have already been treated, Xanthopoulos explains. And afterwards, the treatment room gets an extra-thorough deep clean.

“It’s all geared toward eliminating the virus and not putting other people at risk,” he says. 

Xanthopoulos has been impressed with his patients and how they’ve responded to the pandemic. Overall, he’s observed that patients are adamant about protecting themselves by wearing facial coverings and practicing social distancing. 

But still, humans crave social interaction. Xanthopoulos understands his patients want to be safe while also living full lives.

“I tell my patients, especially those who are at higher risk, to form social pods,” Xanthopoulos says. “I see families or groups who know they’re basically seeing each other exclusively, so they’re not really seeing too many people outside of their pods, so that way patients can get that social contact they need but not put themselves at unnecessary risk.”

When weddings, funerals or other large-gathering events come up, Xanthopoulos offers his patients some guidance.

“What I’ve started telling them is, “Look, you have to understand up front, if you’re going to a bigger group interaction, you’re at higher risk for encountering COVID,’ he says. 

“There are about 5 million cases in the United States right now. If you go to a small dinner party that has about 10 people, there’s about a 5% chance that you’re going to encounter someone who has COVID,” he adds. “Now, it doesn’t mean there’s a 5% chance you’ll get it. You might get it, but it means there’s a 1 in 20 chance that someone’s going to be there who has this disease whether they know it or not. If you go to a wedding, where there are about 100 people, there’s about a 50% chance. Again, not a 50% chance that you’re going to get it, but a 50% chance that someone there is going to have this disease whether they know it or not. So, the risk of bumping into someone who has COVID is real. But, these events are important. This is what life is about. So, if you need to go to these events, just be careful. Wear a mask, social distance, and steer clear of people who obviously have cold symptoms and are sniffling and coughing all over the place.”

Despite the pandemic continuing on, Xanthopoulos feels encouraged that Beloit Health System UW Cancer Center can still provide what he considers to be world-class care in a small-community environment.

“I feel fortunate to help people, but I also feel fortunate the hospital has empowered me to bring in newer, better techniques,” he says. “I’ve been here for two years now, and it’s proven true that patients get university-level care in a local community setting. It’s been a really positive and wonderful experience.”

Dr. Iftekhar Ahmad

While there’s a new normal for cancer care in terms of hospital protocols, there’s not a new normal for how cancer progresses as a disease. That’s why it’s important to continue your routine health screenings, including mammograms, Pap smears, colonoscopies, and other preventional diagnostic exams, says Dr. Iftekhar Ahmad, medical director of oncology services at the Patricia D. Pepe Center for Cancer Care at OSF Saint Anthony Medical Center.

“One thing to keep in mind is that cancer doesn’t wait for anything, including COVID,” he says. “Breast cancer, colon cancer, they’re still fairly highly prevalent, and getting your routine mammogram, colonoscopies, is critical for early detection. At this point, unless an individual is sick, or having symptoms, there’s no reason to delay these routine tests or checkups with your primary care physician.”

By now, the cancer center staff is well-accustomed to making adjustments to treat patients in the safest way possible. Any patient who visits the cancer center, whether it’s to receive treatment or to attend a follow-up appointment, is contacted the day before by phone to go over their symptoms, recent travels, and potential contact with any COVID-positive individuals. During the call, patients are reminded to bring a mask to their appointment and expect a temperature check.

To ensure continued safety for all patients and staff, the cancer center has placed decals on the ground to demonstrate appropriate social distances, and in addition to routine cleaning, there’s now specific room cleaning after every single patient appointment, followed by a deep-clean at the end of the day.

“One other point I think is really important is that it’s not just the facility that’s being very careful, but it’s the actual mission partners – the physicians, advanced practice nurses, nurses,medical office assistants, therapists – everybody is doing their part as well,” Ahmad says. “All employees here at the cancer center are required to wear a mask and eyewear, and they also log their temperature in the morning as well. Hand hygiene has always been important, but it’s even more important now. Everybody is very cognizant of the safety of the patients and each other.”

While social distancing is important, Ahmad also recognizes that emotional support can be critical for patients undergoing cancer treatment. So, at this time, each patient is able to bring along one family member or friend for moral support during treatments and doctor visits. 

“But again, that individual is also screened and required to wear a mask and follow the cancer center’s guidelines,” Ahmad says. “I think the main point of it is to say that despite the pandemic, we’re still actively treating cancer patients, and I don’t want to say business as usual, but we’ve obviously made adjustments to how we do things so that we can treat patients in the safest way possible. Because it’s still very important to have your cancer treatment.”

Dr. Jeffrey Smith

It’s important for patients with chronic cardiovascular disease to remain especially vigilant of their health, says Dr. Jeffrey Smith, cardiac electrophysiologist at Mercyhealth and clinical associate professor of medicine at the University of Illinois College of Medicine.

“First of all, people with cardiac disease are going to have a harder time surviving COVID if they get it,” Smith says. According to the Centers for Disease Control, patients infected with COVID-19 who have underlying cardiovascular disease have an estimated mortality rate of 10.5% compared to the average mortality rate of 3.8%.

“But second of all, there’s the indirect cost of the patient’s health from interruptions in their routine medical care,” Smith adds. “My biggest concern – patients with congestive heart failure need frequent monitoring, usually with office visits. If they don’t get that care, they can end up severely short of breath and in the emergency room.”

It’s important for cardiac patients to remain aware of their cholesterol and glucose numbers so that they don’t fall into the “danger zone” of nearing stroke or heart attack, Smith adds. Since the pandemic began, telehealth has played a huge factor in providing patients with appropriate medical care. During telehealth appointments, Smith can evaluate his patient’s overall health and look for early signs of decompensation, or heart failure, and even diagnose arrhythmias, or irregular heart rhythms, that may have developed since the patient’s last appointment. 

Telehealth appointments are also an opportunity for patients to maintain accountability, Smith adds. In addition to seeking medical care for chronic conditions, patients can strive for a heart-healthy lifestyle by prioritizing exercise and a healthy diet. 

“We have the opportunity to counsel them,” Smith says. “If patients aren’t seeing their doctors, and if they’re under stress because of what’s going on in the world, then they might not be following a good diet and exercise plan, or they might fall back into the habit of smoking or drinking again. Having contact with a caregiver, whether it’s now in person or by telehealth, helps reinforce the importance of being compliant with those lifestyle modifications.”

In addition to telehealth, another way for patients to receive socially distant care is to take advantage of Mercyhealth’s drive-through blood testing program at its Riverside campus.

“It’s very important to monitor blood thinners, because if patients are skipping their blood tests, their blood could get so thin that they could have a severe bleeding complication, or the blood could gel up and they could have a stroke,” Smith explains. “So, now you can make an appointment to drive up and have your blood tested without even needing to get out of the car.”

Regardless of if someone has a chronic heart condition or not, Smith reminds people that it’s always important to go to the emergency room if you’re experiencing chest pain, shortness of breath, or any sign of stroke, such as a facial droop, inability to speak or weakness on half of the body. 

“In the first few weeks of COVID, hospitalizations for heart attack dropped by 40 to 50%,” Smith says. “It’s not because people weren’t having heart attacks, it’s because they weren’t going to the hospital. And some studies have revealed that out-of-hospital cardiac arrest rates went up around 25%. That’s probably because people aren’t coming to the hospital when they need to.” 

“The bottom line is, it’s really important for patients to seek acute cardiac care if they have symptoms, and to continue their chronic cardiac care,” Smith adds.