Inside Medicine. What Are You Seeing? [COVID-19 medical news]

Parents Forum Parent Cafe
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2361

I heard about this 28 year old (hospital) resident dying of Covid back in Sept when it happened. Here’s an update:

https://www.forbes.com/sites/miriamknoll/2020/10/20/a-28-year-old-physician-died-from-covid-19-her-death-exposes-the-harsh-realities-of-medical-training/#37db2bbe10a8

As the parent of a soon-to-be resident, I shudder at the thought of him dying from anything he were to catch on the job, but it’s really a “hit when down” if the parents are still having to pay off debt and medical bills as the author of the article writes.

“Losing a daughter is a tragedy no matter what the cause of death. And yet, the “why,” “how,” and “what could have been different” of the aftermath compounds the family’s grief. After burying their daughter, Dr Fagan’s parents are now dealing with hospital bills and student debt, from an illness their daughter arguably caught while caring for patients in the hospital’s emergency room. Their GoFundMe account has raised nearly $200,000 to date to help cover the costs.”

The second to last paragraph says this:

“Regaring Dr Fagan’s medical bills, Ms. Mejia said their hospitals do not bill patients who are diagnosed with Covid-19, whether they have insurance or not, for testing or hospital care related to the treatment of Covid-19. The hospital confirmed that she was not deployed to the ER due to Covid-19 and that the sequence of her ER rotation was planned.”

How does this match what they are paying off? Anyone know? Is is mainly the loans from med school even though it says hospital and student debt? IMO, even loans from med school need to be forgiven for something like this.

2362

The question would be, did the parents co-sign any of the loans?

2363

I know legally it matters, but to me, it shouldn’t matter. If someone in health care dies on the job, due to the job, the minimum that should happen is any loans cease to exist. Med school is super expensive.

2364

I read the article and I guess I wonder. If the student passes away, loans are forgiven. Even plus loans, I thought. If they converted them or had private loans, the rules are different. But a reason not to convert plus loans to private is the protection of forgiveness.

The other thing is that yes, I think that with hospital bills, survivors are not responsible. Most of the time.

I was confused by the article. It says that the parents are responsible and have started a go fund me. Is the author sure that the parents are? Conventional wisdom seems that they aren’t. They do have to inform the student loan providers and the hospital that she did die and produce a death certificate.

It doesn’t mitigate the parents grief. And I am sure that it’s terrible to send in death certificates and be reminded about her death over and over again.

I for one would like to see more concrete evidence. Because it isn’t the norm for the parents to be on the hook. Especially for debt the daughter incurred in her name only.

I was very cautious about how I phrased things. But I checked again, in the case of death, federal student loans are discharged. It would also be very unusual for the parents to be responsible for her hospital bills also.

2365

I work for a Texas state medical school and we have had 2 internal medical residents have to be hospitalized with Covid. Exposed while caring for patients. They are employees of the medical school and workman’s comp covers their medical bills.

2366

I agree the article stops short and doesn’t address to whom the student owed money. Probably the med school loans? The article seems more about the working conditions for residents/interns.

There’s lots about death discharge via google. My bolding and asterisk:

"If you have federal government loans, yes. This means that your estate will not have to pay back those student loans. Survivors can apply for a death discharge to cancel a borrower’s federal student loans.*

Parent PLUS loans may be discharged if the student for whom the parent received the loan dies. Also, the death of both parents with a PLUS loan (assuming both took out the loan) is grounds for the “death discharge.” The death of only one of the two obligated parents does not cancel a PLUS loan.**

There is no administrative discharge for private student loans if you die. Private loan debts will be handled the same way as other debts. That means that they will be part of your estate. This estate settlement process (also called probate) varies by state. Some private lenders will use their discretion and agree to discharge loans when a borrower or co-borrower dies."

  • Survivors meaning the executor. Not meaning survivors are responsible for the debt. ** If only one parent signed for the Parent Plus, his or her death is sufficient to request a discharge.

Any amount discharged for a Parent Plus loan is taxable.

2367

I went back and reread the article. It seems to me that this article should be classified as an opinion piece and not a news article. The writer seems to try and make the argument that residents should have disability and death insurance. She may have a point.

But to be fair, it’s a once in a century pandemic. I think that hospitals do have a plan for extreme emergencies but may have not thought about offering residents death insurance benefits. In the future, maybe they can offer disability and death insurance as part as their benefits package. That’s what my husband’s company does for all of their employees. They have the choice to purchase those benefits.

My husband works for an essential business. In the case of an extreme emergency, he has been trained to do jobs to keep things running. As are all members of management. This pandemic was an extreme emergency. As trained doctors, they were able to do the jobs that were needed at that point. Not just the job that they were hired to do.

I think this article was high in opinion and low on fact.

2368

My H was fed employee and had low cost life insurance—believe he may have had some minimal disability coverage too. I can see why it would be good if employers provided some, especially if the jobs involve risk of significant health harms and potential death. Not all people (especially when younger) prioritize these items.

2369

Federal (grad) student loans are discharged upon presentation of a death cert. (Now if she chose to refi with a private lender…)

This too, is questionable. A resident is a FT employee of the heath care system, and by law, has to have health insurance. Even if its a high deductible plan, any bills would hit the out of pocket max pretty fast.

2370

A side bit of info
https://www.kevinmd.com/blog/2019/05/questions-about-physician-disability-insurance-answered.html

I do agree it’s an opinion article. And that “dealing with hospital bills and student debt” is entirely vague. This could even just mean, as executors, stepping through a process, on behalf of the estate.

2371

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It seems since she passed away due to her work she would be covered by worker’s compensation.

Such a heartbreaking story nevertheless. I hope her family can find peace.

2372

Every hospital offers it own benefits package and all or nearly all residency programs do offer disability insurance, but the coverage is limited and does not include long term benefits. (D2 is cancer survivor so we spent a lot of time reviewingher benefits package w/r/t health insurance and disability insurance.)

Residents also are offered life insurance–but it’s an optional benefit. They have to sign up for it and agree to have premium deducted from their salary. (Plenty of residents don’t take life insurance because they’re not making a ton of money and need every penny to pay for their living expenses and loan repayment.)

2373

And file this under scary stuff is happening…

Utah hospitals are so overwhelmed by the surging number of Covid patients that starting this week, doctors will be forced to start rationing medical care.

In the past 2 weeks, Utah ICUs have been running at 125% of capacity and the two largest hospital systems in the state have already opened overflow ICUs–which are both also filled.

https://www.sltrib.com/news/2020/10/25/with-coronavirus-cases/

2374

@Creekland

This resident’s death was discussed at length in the Pre Med forum several weeks ago with after she died.

IIRC, the GoFundMe was to pay for the family travel expenses and loss of income. The resident was training in Houston and the family lived in Buffalo, NY. They were seeking funding to help pay for plane fare, hotels and meals while the parent(s) visited their daughter in Houston… Since there is an elderly family member in the household who require significant care taking, the resident’s parents took turns flying down to Houston, staying for a week or two, then switching off. I believe her father exhausted his vacation and had to take unpaid leave so they also needed money to help cover their household expenses as well.

2375

This one is a bummer - though it does mention T cells might have an effect, not just antibodies. I’m still hopeful treatments in development will eventually keep the bad cases of the virus far less lethal/bad.

https://www.bbc.com/news/health-54696873

"Levels of protective antibodies in people wane “quite rapidly” after coronavirus infection, say researchers.

Antibodies are a key part of our immune defences and stop the virus from getting inside the body’s cells.

The Imperial College London team found the number of people testing positive for antibodies has fallen by 26% between June and September.

They say immunity appears to be fading and there is a risk of catching the virus multiple times.

More than 350,000 people in England have taken an antibody test as part of the REACT-2 study so far.

In the first round of testing, at the end of June and the beginning of July, about 60 in 1,000 people had detectable antibodies.

But in the latest set of tests, in September, only 44 per 1,000 people were positive.

It suggests the number of people with antibodies fell by more than a quarter between summer and autumn."

2376

However, the study used overlapping groups, and indicated that it is possible that those who had had the virus were not participating as often as those who had not. In other words, clearly antibodies would not be found as often in a random group of people including more of those who never had COVID versus the original group with many who did have it.

2377

Here’s a compilation of stories the AMA (American Medical Association) sent out this morning if anyone wants to look at those in more depth:

Coronavirus deaths, cases continue to rise across much of the country

The AP (10/26, Pane, Stobbe) reports deaths from coronavirus are increasing each day in the U.S. and overall cases are increasing in 47 states. The AP adds that “average deaths per day across the country are up 10% over the past two weeks, from 721 to nearly 794 as of Sunday, according to data from Johns Hopkins University.”

Bloomberg (10/26, Levin) reports the record spike in cases “started with young Americans,” but “is increasingly finding older communities at elevated risk of severe illness.” According to the latest CDC data, “counties with the largest 65-and-over populations are now recording on average 18.9 daily cases per 100,000 residents, 67% higher than a month ago.

Researchers say non-coronavirus hospitalizations have decreased, suggesting people are avoiding seeking health care due to the pandemic

CNN (10/26, Mascarenhas) reports two research letters published in JAMA Internal Medicine suggest that people are delaying seeking health care during the pandemic as indicated by a decrease in non-coronavirus hospitalizations. The findings of the researchers in New York and California “are consistent with previous research showing a decline in non-coronavirus-related hospitalizations across the country since COVID-19 took hold.” To view the letters, click here and here.

Children account for 11% of coronavirus cases in the U.S., pediatrics group says

CNN (10/26, Christensen) reports the American Academy of Pediatrics said that children account for 11% of SARS-CoV-2 infections in the U.S., which represents a 14% increase during the past two weeks. AAP “says about 792,188 children have been infected in the U.S. as of October 22.” The AAP adds that this is likely an undercount, “because not all states report data in the same way.”

Among health care workers, nurses in particular at high risk for contracting COVID-19, CDC study indicates

The New York Times (10/26, Abelson) reports, “Among health care workers, nurses in particular have been at significant risk of contracting COVID-19, according to a new analysis of hospitalized patients by the Centers for Disease Control and Prevention.” Nearly “6% of adults hospitalized from March through May were health care workers, according to the researchers, with more than a third either nurses or nursing assistants.” Furthermore, approximately “a quarter, or 27%, of those hospitalized workers were admitted to the intensive care unit, and 4% died during their hospital stay.” The study examined “6,760 hospitalizations across 13 states.”

Coronavirus cases among health care workers leading to staff shortages in rural areas

Kaiser Health News (10/26, Houghton) reports coronavirus cases among health care workers are making it harder to staff hospitals in rural areas that are struggling to treat growing numbers of patients with COVID-19. For example, “in Montana, pandemic-induced staffing shortages have shuttered a clinic in the state’s capital, led a northwestern regional hospital to ask employees exposed to COVID-19 to continue to work and emptied a health department 400 miles to the east.” Meanwhile, “in North Dakota, where cases per resident are growing faster than any other state, hospitals may once again curtail elective surgeries and possibly seek government aid to hire more nurses if the situation gets worse, North Dakota Hospital Association President Tim Blasl said.”

Health care providers bracing for more cyberattacks alongside uptick in coronavirus cases

The Hill (10/26) reports health care providers “preparing for a fall wave of coronavirus cases are bracing for more cyberattacks after hackers seeking to take advantage of the pandemic launched several successful attacks this year that severely disrupted patient services.” Cyberattacks “have been widespread around the world, hitting health care groups during the worst public health crisis in a century,” and “experts say the attacks have involved both cyber criminal groups and nation states looking to target COVID-19 research and sow chaos.”

2378

Among this morning’s medical news updates (that med school lad receives):

Research Suggests Some Survivors Of COVID-19 Have “Autoantibodies” That Attack The Body Rather Than SARS-CoV-2

The New York Times (10/27, Mandavilli) reports researchers found that some survivors of COVID-19 have “autoantibodies,” which attack the body rather than SARS-CoV-2. This immune system response “may exacerbate severe” cases of COVID-19, and also may help explain the symptoms of so-called “long haulers,” who can suffer from problems months after their initial infection and even after the virus is no longer in their bodies. The findings were posted on the preprint server MedRxiv.

ETA: Since that one hits close to home, I did look up the link:

https://www.nytimes.com/2020/10/27/health/covid-antibodies-autoimmunity.html

One quote from the article (sigh):

“If the autoantibodies do turn out to be long-lasting, she said, they may result in persistent, even lifelong, problems for Covid-19 survivors.”

2379

I think there would be a genetic component to the development of autoantibodies. HLA typing might indicate propensity. A basic ANA test/rheumatoid panel would be helpful.

Again, this is how my daughter got type 1 diabetes: molecular mimicry from coxsackie.

@Creekland I hope your son gets answers- and that he improves.

2380

This also came in the lad’s email, addressed to all in the system - very sobering indeed:

"This has been a sobering week, as we’ve experienced jumps in both COVID+ cases and hospitalizations. Our hospitals are actively working on surge plans so that we can accommodate a spike in cases while still safely providing care to non-COVID patients.

But perhaps most disheartening has been the recent number of COVID infections we’ve experienced among our faculty and staff. In the past eight days alone, 48 faculty and staff are COVID+ across our health system – the highest number of employee infections over a short period of time since the pandemic began. Many of these infections resulted from attending social gatherings outside of work, and some from simply sharing lunch with a co-worker. Some resulted in exposures to patients and other staff who now need to be quarantined, placing added strain on an already stressed workforce.

We understand that everyone is experiencing “pandemic fatigue.” We all want this to be over, and return to some sense of normalcy. And with low COVID numbers over the summer, combined with weather that provided the ability to see friends and family outdoors, it’s understandable to see some complacency creep into what were previously great habits.

But as health care workers, we have a special obligation – especially during a pandemic – to make sure we are able to care for our patients. With signs pointing to a potentially treacherous COVID resurgence, we all need to reach down deep, and get our second wind to see us through the rest of the pandemic. You can do that by remaining vigilant and continuing to follow the safety practices designed to protect yourself, your patients, your co-workers, your family, and our community:

Always wear a mask and eye protection when at work. Always mask when in public.

Be mindful when taking meal breaks with others. Only take your mask off to eat, and stay six feet apart.

Avoid large indoor gatherings – difficult to maintain, especially with the holidays coming up, but so essential to keep prevent the spread of COVID.

This pandemic is a marathon, not a sprint. Thank you for activating your second wind so we can keep everyone as safe as possible."