High-risk patients struggle to cope with COVID-19

Carlos Rosales lives in Brentwood — one of Long Island's COVID-19 hot spots — and his medical condition makes him a target for the disease.

The 43-year-old has a surgical drain from his December liver transplant operation still in place because the hospital postponed the procedure to remove it. He takes medicine that suppresses his immune system so he doesn’t reject the new organ, stays indoors and worries about lost income and a denied disability claim.

His wife Kenia Rosales, 41, worries about him.

“They said it on the news, that transplants, their risk is higher,” she said. “It scares me, it worries me a lot after what we went through with him.”

The virus can strike anyone, and patients with severe COVID-19 infections include the young and the old, with or without underlying medical conditions. But the elderly and those with serious or chronic health disorders face a higher risk of severe illness should they get infected, according to preliminary studies by the Centers for Disease Control and Prevention and in studies from China, where the novel coronavirus that causes COVID-19 first took hold.

Immunosuppressed people such as transplant recipients, and people with diabetes and high blood pressure, lung disease, cardiovascular disease, or cancer, are more likely to need intensive care and intubation, and face higher risk of death than those with no such conditions.

So, when Kenia Rosales leaves their home to shop, she wears three pairs of gloves and a mask — and rushes to the bathroom to get out of her clothes when she returns. She lets no one visit and wishes she didn’t have to go out at all, “especially in Brentwood. It’s crazy right now, the virus is everywhere ... people are still working, risking their lives.”

Brentwood had nearly 1,500 confirmed COVID-19 cases, the highest toll of any community on Long Island, and double that of Hempstead, which had the second-highest number of cases, according to the most recent data.

Carlos Rosales, who worked for a company installing interior products such as lockers and partitions, said he tries not to worry about things he can’t control. “I’m just praying we can get through this and be free again,” he said.

Dr. Anthony Boutin, interim president and CEO of Nassau University Medical Center, said the disease isn't always predictable and that sometimes an elderly person expected to do poorly survives, while a young person does not. However, he said: "Most of the people who don’t do well are elderly with preexisting conditions. Hypertensive, diabetic, immunocompromised.” 

Melissa Passarelli is just 31 and figures maybe she could survive COVID-19. But she has type 1 diabetes and questions if she could survive in a hospital overwhelmed with COVID-19 patients.

Passarelli is the director of programs for Roslyn-based nonprofit Docs for Tots and knows her diabetes puts her at greater risk from COVID-19. In mid-March, she fled her Astoria, Queens, apartment and a city with a rising virus toll for her family home in Dix Hills. She works remotely and socially isolates, recoiling — politely — from neighbors who reach out to pet her dog. But after learning more about diabetics and COVID, “My anxiety went through the roof,” she said.

“I’m the only person in the world who knows how to take care of me and keep me alive,” Passarelli said. “There’s a lot that goes into a diabetic’s care, and everyone is unique.”

Passarelli added, “Especially now that we know how overrun hospitals are, the level of care I would need as a diabetic would be something I’m not sure I could expect.”

She created a presentation of her care requirements for an hourlong GoToMeeting video she used to train her parents and three close friends, in case she was hospitalized with COVID-19 and needed advocates. She’s also prepared a bag with a week’s worth of supplies and a printout of her training presentation.

“Honestly, I’m young. Could I survive COVID? Yes. But I’m concerned about preventable complications that might not be prevented due to the circumstances,” she said. “And that keeps me up at night.”

Her anxiety was at a high pitch Wednesday morning. Her blood sugar reading was “super high” and high blood sugar levels are now seen as an indicator of COVID-19 infection. She was able to bring it down, but she will be on high alert.

Dr. Richard Shlofmitz, chairman of the cardiology department at St. Francis Hospital, The Heart Center, and director of cardiology for all six Catholic Health Service hospitals, added that cardiac patients with weakened heart muscles are at a heightened risk of severe COVID-19 disease.

But those whose conditions were remedied, including those with stents, were not, he said.

One of his patients, Leo Wagner, 76, of Roslyn, has four stents, as well as a rare but controlled skin lymphoma, and is now home after more than a week under treatment for COVID-19 at St. Francis.

Wagner said he hadn’t thought about his risk for COVID-19 before he got sick. “I was just going about living my life,” he said. “It was the thing that was in China, and if you listened to the government, it wasn’t going to be a big deal here. I think me, like a lot of other people, weren’t paying attention or really focusing on it.”

Transplant patients are also being monitored carefully as high risk for the virus.

Dr. Lewis Teperman, chief of transplantation at Northwell Health, said, "We are calling our patients a couple of times a week and more people are getting sick." He said that while most of his transplant patients are doing relatively well at home, some have been hospitalized with the virus, and at least one has died.

Kevin McEneaney, 69, of Sag Harbor, knows well he has to be vigilant for the virus, but is used to managing risk after receiving a liver transplant six years ago and dealing with lung damage from a pulmonary condition. His wife does the shopping; he stays home, meditates, and tries to keep busy.

“I seem to be living on one and a quarter acres for some time now,” he said. “It goes through your mind that you’re very vulnerable. Normally, I’m a pretty sociable guy. I saw the gas company guy and I just watched him from afar ... normally, you just go to the mailbox. Now, I worry about what’s inside.”

He’s not sure he can sustain this isolation for months to come, saying at some point the mental health benefits of ending isolation will outweigh the risks. “I’ll look at the risk benefit analysis and make judgments," he said. "I’ll wear a mask and be more cautious than everyone else, but I’m going to live my life.”

That’s what Michael Hollander of Nesconset is doing, making few concessions to his heightened vulnerability to COVID-19 as a 70-year old cancer survivor with lung issues from his time volunteering on the World Trade Center pile after Sept. 11, 2001. He is also missing one of the two nerves connected to his diaphragm, making him short of breath at the top of a flight of stairs.

Yet he works five days a week at the Denny’s he manages in Centereach, serving takeout customers. And until this week, he was going out on non-COVID-19 ambulance calls at the Nesconset firehouse, where he volunteers as an advanced EMT. His fellow volunteers would say, “Michael, what are you doing here?” he said, but notes others there continue to volunteer with conditions of their own, including cancer treatment.

“I don’t think it’s invincibility. You know you could die, but it’s not a priority,” he said. “If you worry about it, the thought passes through but doesn’t stop. People who do what I do recognize the danger of what we do, but we’re trained on what to do.”

Boutin, too, has an underlying condition, asthma, and said his colleagues worry for him because they know how bad his asthma gets. “I’m a clinician,” he said. “I know I’m at higher risk, but when I go in to see patients, as long as I’m well protected, I feel OK.”

Dr. Joshua Miller, an endocrinologist who himself has diabetes as he treats COVID-19 patients with diabetes at Stony Brook University Hospital, said, "I think anyone in health care right now is a little more worried, but we’re doing what we do because it’s our jobs ... It’s what we do.”

For Domenica Tantiello, 60, of Plainview, it’s a given that life is precarious after 12 years of battling metastatic stage four breast cancer that has spread to her liver. She puts on gloves and a mask to get chemotherapy every three weeks, and said she doesn’t feel terribly afraid now.

“Having cancer, I could die tomorrow,” she said. “Everyone is going to die eventually. You just do the best you can.”

She paused and added, “I feel sorry for those who wouldn’t have died tomorrow, and this little beast is taking their lives.”