A personal perspective on the long-tail impact of COVID-19

June 28, 2021 / By Steve Cantwell

We’ve all learned some hard lessons from COVID-19, but it will be years before we begin to understand the full impact of COVID-19, both positive and negative.

The development speed, effectiveness and broad distribution of vaccines is nothing short of miraculous. The mRNA vaccine technology underpinning some COVID-19 vaccines is being used to develop other vaccines and medical treatments. My family has all been vaccinated. Even our teenagers’ vaccine immunity is now at full strength. Both of my sons went to prom this spring. They went back to in-person school for the last two months of the year. They can visit their friends again. My oldest son celebrated high school graduation at a crowded outdoor soccer stadium. Each student had their moment of glory displayed on a huge screen above the scoreboard. In recent weeks, we celebrated birthdays and holidays in person with my wife’s family and we all visited my mother, who we had protected very cautiously due to immune system issues, in her own home for the first time in eight months.

On the other hand, many serious illnesses have gone untreated during the pandemic crisis. Take tuberculosis, which will likely grow in the pandemic aftermath due to a 23 percent drop in testing and diagnosis. Many people have not been getting treated for strokes and heart attacks. The effective management of chronic illness has waned. The result is more advanced disease to treat, permanent damage to heart tissue and neurological function. There has also been a sharp decline in elective procedures like mammograms or colonoscopies with obvious consequences.

Then there is the plight of COVID-19 long haulers, suffering ongoing chronic respiratory failure, chronic fatigue, and the loss of taste and smell. Think for a moment about the scope of such losses on the quality of a human life.

In a personal way, this past week brought home to me both these harsh and hopeful perspectives on the long-tail impact of COVID-19.

Last Friday evening, I returned home from a three-mile hike and still wanted to stay active outside. Over the last year, staying in motion (especially outside) has helped me cope with the anxieties we have all experienced. So with the heat of the day (high nineties) just starting to ease, I continued to work through my pent-up energy with comic vigor: pulling weeds, sweeping the backyard deck, tossing balls for our dog and trying to do as many push-ups as I could (I did 80 in 20-push-up sets). I know, I was really overdoing it. And, of course, I wasn’t drinking enough water.

I could never have foreseen what happened next: I found myself back in the house in my bedroom with absolutely no memory of how I got there. It was like waking up to find my boat had drifted out to sea, beyond sight of land. It was that chilling feeling you get the moment you realize you’re lost in the forest or desert. I had completely lost time. I had no idea how much time. Ten minutes? An hour? A day?

My wife walked into the room with an alarmed expression on her face. She had her cell phone in one hand as if someone was still on the line. She put her other hand on my chest and said calmly, but firmly: “I’m going to take you the hospital right now. You may have had a stroke.” I agreed immediately. I knew something was wrong. I had seen my father have a stroke and taken him to the hospital myself. I was suddenly in his shoes.

While I was lost in time, this is what my wife had seen: She was surprised how long I stayed outside. Then when I came inside, I wasn’t myself. I stared at her blankly and asked, “Where is Colin? I just don’t know where Colin is.” Colin, my oldest son, was on a trip with friends to celebrate high school graduation. He had been gone all week. My wife, who initially thought I was making a joke, tried to trigger my memory with details: Colin was mountain biking with friends today. He was with Carter, Elizabeth, Josh, Connor, Addie and Tess. Yesterday he had gone cliff jumping at a lake. He had talked to both of us on video the night before when he told us about caves they had explored, what movies they had watched into the wee hours, and how one of his friends was sleeping on top of the air hockey table. I listened to all this detail with the same blank expression and then repeated the question as if I hadn’t heard a word: “Where is Colin? I don’t know where Colin is.”

Seconds after we arrived at the emergency room, I was in a wheelchair being pushed toward a gurney coming the opposite direction. Then I was on the gurney, my shirt off, heart monitor wires attached to my chest, an IV in my arm. A minute later a radiology tech had finished the CT scan, the next minute a chest X-ray. It felt like the whole ER staff was involved. All these faces around me. One of the ER doctors asked about my symptoms and my current mental clarity. Had I fallen or hit my head? Was my short-term memory returning? He asked me to list medications I was taking, and I could do it. My clarity was increasing, but so was my dread that I had actually experienced a stroke like my father.

I remember my father’s stroke vividly. Much of my extended family were together for dinner. My father was about to bless the food. We all bowed our heads and closed our eyes, but there was no prayer. After a few awkward seconds, I looked up to see my dad staring straight ahead, his eyes bewildered, childlike. My 95-year old grandmother took one look and said, “He’s having a stroke. Take him to the hospital now!” She took some chewable aspirin out of her purse and someone put the aspirin under his tongue. Then I guided him to a chair and asked if he wanted to go to the hospital. He couldn’t speak but nodded his head earnestly, a pleading alarm in his eyes. At the hospital, before I had even said the word “stroke,” the ER nurses were on their feet. Within minutes, he was in a bed with an IV in his arm delivering lifesaving medicine.

My own visit to the ER was very similar up to this point, though my father’s symptoms where much more severe: He couldn’t speak, write or walk without help. For me, after a tense 20-minute wait for lab and radiology results, the doctor returned with good news. “I’m going to let you go,” he said. “No sign of a bleed. No stroke. No mini stroke. You’re in good shape.” He went on to explain that I had likely experienced “transient global amnesia,” possibly brought on by stress, overexertion and dehydration. He smiled and said, “Go get some rest. Eighty push-ups? Really?”

For my father, the drastic difference was he actually had a stroke. It was days instead of minutes before he was back to himself. He recovered miraculously, though for months he would pause in his speech and search for words.

The question is: How would all this have been different during COVID-19? Would we have taken my father to the ER right away or would we have hesitated? Would they have delayed treatment to test for COVID-19 while his brief opportunity for recovery slipped away?

Even during a pandemic, if someone severs an artery and is bleeding profusely, they will get immediate treatment at the ER. But an internal bleed, like a stroke, something very dangerous but less visible, may not have been treated as quickly. Most of the time because the patient never showed up at the hospital due to COVID-19 fears. We will never know how many people were too afraid to go the ER for treatment when they needed it most. If you don’t get treated for a stroke as soon as possible, the long-term impact will be worse, perhaps far worse, even fatal.

In a recent meeting, one of our 3M clients brought up an alarming fact: treatment for strokes at her hospital had dropped off sharply during COVID-19. At first this seemed so obvious, but she said: “This is not like elective surgery. This is not the kind of metric that should ever flex or change. People will keep having strokes at about the same rate, year after year. The implications of this are so far reaching I can’t wrap my mind around it.”

In the case of my father, I wonder what would have happened if we had hesitated for even an hour while we weighed the risks between stroke and contracting COVID-19. Or what if we had been turned away from the ER because they were overwhelmed with COVID-19 patients? Would he have spent the last 15 years of his life without the ability to speak or write? After his stroke, he taught college classes for another three years and wrote two more books. Not to mention the thousands of conversations, letters, and emails with us (the kids) and a broad network of friends. And most important of all, his hour to hour interactions with his wife. My father was gregarious and almost chronically extraverted. I can’t imagine what the loss would have meant for him and my mother.

COVID-19 has brought in its wake untold collateral damage and change that it will take many years to sort out. Many things we’ll never be able to measure or fully address. But we need to balance this difficult awareness with an equal awareness of the medical advances and logistical miracles we have witnessed in everything from vaccines and food delivery to remote work and telemedicine for mental illness. We have learned much to help us move forward with hope.

Steve Cantwell is a senior marketing communications specialist at 3M Health Information Systems.

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