Alaska doctors say the pandemic has been deadly — even for patients without COVID-19

So far, none of Dr. Kathy Hurlburt’s patients have tested positive for the coronavirus.

But, Hurlburt said in an email, “what I have seen lately are numerous cases of shingles — a horrible sequelae of chickenpox, usually brought on by stress.”

Hurlburt, an internal medicine physician in Anchorage, is one of many doctors in Alaska who say pandemic-related fear can endanger their patients.

While these doctors all stress that this virus should be taken seriously, that social distancing should continue and masks should be worn in public, they also counsel their patients to not let virus-related anxiety keep them from seeking both routine and urgent medical care that may now be particularly important.

“Please don’t misunderstand,” wrote Hurlburt. “I have a healthy respect for this virus. But while I have no patients with complications from COVID-19, I have many well on their way to an early heart attack or stroke because of their health decline created from this pandemic.”

Hurlburt said that since March, she has had patients “start drinking excessively, and resume smoking.” She has seen weight and blood pressures rise, and blood sugars levels that are “out of control.”

She has even had patients who refused to call 911 for stroke symptoms, or canceled necessary doctor appointments during the past few months for COVID-19-related reasons.

“Many can’t afford the copays as a direct result of the economic impact from COVID-19,” she wrote. “And many are just fearful to leave their homes.”

Not every doctor has witnessed quite such extreme health declines from the virus.

Dr. Dennis Linderman, a family medicine physician at the Anchorage Neighborhood Health Center, said that while he has many patients talk to him about their increased stress levels, he has not yet seen the poor health outcomes that Hulburt has observed.

“But it may just be too soon to tell,” he said.

Dr. Steve Compton, a cardiologist in Anchorage, said that the biggest negative health outcomes he has observed happened when patients avoided seeking care.

“We have seen a number of deaths that we thought were directly attributable to people avoiding seeking obvious, important care because they were worried about COVID in emergency rooms,” he said in an interview. In March, he identified about a half-dozen deaths he believed were attributable to people avoiding care.

Many reports suggest this phenomenon of neglect has been happening outside Alaska too.

An April dispatch from the American College of Cardiology noted a drop in reported heart attacks and strokes nationally that it said can be attributed to people avoiding seeking care.

“COVID-19 is definitely not stopping people from having heart attacks, strokes and cardiac arrests,” the report said. “We fear it is stopping people from going to the hospital and that can be devastating.”

The report also cautioned that although COVID-19 is certainly a threat, “we must remember the ever-lurking dangers of heart disease and stroke — which, year in and year out, are the top two killers worldwide.”

A May poll by the Kaiser Family Foundation indicated that nearly half of adults say they or someone in their household have postponed or skipped medical care due to the coronavirus outbreak.

And as stay-at-home restrictions were eased, only about two-thirds of those who delayed care said they expect to get the delayed care in the next three months, according to the poll.

A recent article from The New York Times suggested that while many patients may have originally deferred care out of fear, the biggest reason people may now be avoiding seeking care is economic hardship brought on by the pandemic.

In Anchorage, a number of doctors contacted for this article emphasized that no one would be turned away because they couldn’t afford to pay for care.

Linderman said he regularly sees financially insecure patients and provides quality health care regardless of anyone’s ability to pay.

“No matter what,” he said, “it’s important you seek care when you need it.”

Dr. Habir Makin, an internal medicine doctor at Providence, said that’s because the earlier you seek care, the better your chances of survival and recovery.

Stroke patients need help within minutes to prevent neurological brain damage, he said, cautioning patients to never ignore symptoms of stroke such as facial numbness and slurred speech. Follow-ups and regular check-ins are also important, he said.

“There’s a risk of complications when patients with, say, congestive heart failure won’t come in for checkup,” he said. “I had a patient who refused to come in who ended up suffering a heart attack.”

During the pandemic, many patients have switched to virtual “telemedicine” visits. These can be helpful in some cases, doctors said, especially for rural patients who live far from major hospitals. But this is not always a good substitute for in-person care.

“You can’t check someone’s heart over a screen,” Makin said.

May brought a drop in coronavirus cases in Alaska, and with it, anxiety around going to the doctor partially lessened, these doctors said.

“We have seen a partial return to pre-pandemic visit volume,” said Dr. Michael Bernstein, the chief medical officer at Providence Alaska Medical Center in Anchorage, “but not as much as you might think.”

The part that’s still missing is the low-level visits, like preventive care, he said.

This worries him. He stressed the importance of routine screenings and checkups, and in particular of getting vaccinated for the flu.

“Otherwise, everyone who comes in with the flu this year, we’re going to worry whether they have COVID,” he said. “And we don’t know what the effects might be of getting both at the same time.”

Makin’s message was simple: “Physician offices are safe to go to,” he said. “People are going to the grocery stores, which are probably less safe than doctors’ offices.”

He and others described comprehensive policies they’ve put into place to keep their patients safe, including requiring patients to sit in their car while they wait, disallowing walk-ins, conducting pre-visit health screenings and requiring masks at all times.

Plus, Makin said, doctors’ offices are particularly equipped to prevent the spread of a highly contagious virus.

“We take extra precautions every year during flu season,” he said. “It’s like any other infectious disease.”

Dr. Linderman added that while he’s had people express concern, most say they feel reassured once they do come in for a visit and see the new office safety protocols.

“We think they get that, yes, there is a chance of getting COVID,” he said. “But at least their health care workers are taking the utmost precautions to keep them safe.”

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