The COVID-19 crisis has affected many. But we're not just talking about those who have dealt with the virus—we're also talking about people who have diabetes and peripheral artery disease (PAD), many of whom were forced to delay care and consequently lost their legs.
A report published in the Journal of the American Podiatric Medical Association showed that, during the pandemic, amputations increased by 11 times. The University of California San Francisco (UCSF) also reported that patients early in the pandemic had more severe foot infections and were more likely to need major limb amputation than six months previously.
For many patients with diabetes, the first sign of trouble comes in the form of a foot ulcer. But when the government implemented stay-at-home orders during the first few months of the pandemic, many were forced to hold out to avoid overwhelming the healthcare system further. They held out until it was too late.
This was the case for Leafer Miller, who developed an ulcer on his right sole in May 2020, when COVID-19 caseloads were soaring. At this time, Fresno's interim health officer also encouraged people to do "everything we can do to prevent hospital admissions."
However, in an interview with WebMD, Miller said that two weeks after developing a foot ulcer, he couldn't hold out anymore. He struggled with debilitating chills, fever, and nausea as his foot was "swollen and rotting." When he finally saw a doctor, he was advised to proceed with the amputation. The choice was between life or death.
There were many cases similar to Miller's. But for patients with both diabetes and PAD, the progression is often faster. There are currently 1.5 million patients with diabetes who also have PAD. For these people, the nerve loss that comes with PAD dulls or eliminates the sensation of pain in the feet. And without pain, foot ulcers persist and fester.
Before the pandemic, these patients would have received regular foot care. And for those who have access to comprehensive care (which involves wound managers, vascular surgeons, and specialized podiatrists), the possibility of amputation can be decreased.
However, even before the pandemic, this type of care was typically not distributed evenly. More often than not, those in disadvantaged communities and people of color are less likely to receive fundamental preventive care.
While one might argue that telehealth can improve access to healthcare, it presents an even wider divide. According to physicians, if a patient struggles with a lousy internet connection, technology, poor lighting, language barriers, doesn't have family assistance, or doesn't have much hip flexibility, evaluating their feet on a screen is a near-impossible task.
Although telehealth was supposed to make healthcare more accessible, it's still accessible only to a select few.
Access to healthcare via telehealth isn't the only avenue where disparities exist. Access to amputation prevention measures is another one.
Availing specific procedures at the right time can increase a patient's chances of preventing amputation. For patients with PAD, prevention means getting procedures like bypass surgery and using balloons or stents to restore blood flow to the limb. These procedures provide dramatic benefits for wound healing.
But just like other healthcare services, access to these procedures has not been equally available across different communities in the US. And during the pandemic, access to these preventive procedures was even more challenging as most facilities were locked down, leaving people with the emergency room as a last resort.Many of the amputations performed in the past year could have been prevented. Although we have little control over many of life's circumstances, like the pandemic, a more equal and proactive healthcare system could have saved limbs.