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After a long career as a registered nurse, Melani Autin was the first person to advise people to follow the advice of doctors.

But that was before the pandemic.

Autin was recovering from a heart attack and open-heart surgery when Louisiana’s first coronavirus case was discovered; officials were tallying hundreds of cases and dozens of deaths daily by the time she was released. Those figures, combined with horror stories from friends at West Jefferson Medical Center, scared her so badly she canceled follow-up doctor visits, said Maxene Alexander, her cousin.

“She went from unflappable to honestly terrified to leave the house,” Alexander said.

Melani Autin and Maxene Alexander

Melani Autin (right) with her cousin, Maxene Alexander. Autin was recovering from open heart surgery during the first wave of the coronavirus pandemic in Louisiana but fears of catching COVID-19 kept her from attending follow-up appointments and prevented her from receiving in-home therapy. She died in June 2020.

Recovery from open-heart surgery is difficult in the best of circumstances. Autin didn’t have those: Her physical therapy appointments were cancelled and she began to have balance problems, though she shrugged off suggestions to go to the hospital.

It wasn’t until June, when she began having breathing problems, that she agreed to be taken in. And by then it was too late. She died at 72.

“It’s a conversation family members need to start having with each other, in a gentle loving way,” Alexander said. “Stories like this are more like cautionary tales.”

The coronavirus took nearly 7,800 lives in Louisiana last year, the biggest reason the state saw its deadliest year ever. But preliminary state data suggests at least another 3,700 people who died of natural causes should be counted as indirect victims.

022821 Natural vs Covid deaths

The deadliest year: Even if coronavirus deaths are not counted, deaths from natural causes rose in 2020, which experts say may be attributable to patients’ hesitancy to seek care and limits to health care resources. When COVID-19 deaths are included, the increase is much larger.

President Joe Biden ordered American flags lowered at federal buildings for the next five days.

Some, like Autin, may have avoided treatment over fear of exposure. Others may have sought care but been unable to get it.

“COVID unwrapped all of the failings of our healthcare system,” said Dr. Jim Aiken, an emergency room doctor and LSU Health professor.

That’s particularly true in a state like Louisiana, where the population already is dealing with higher rates of health problems. Preliminary numbers suggest that deaths from chronic conditions, such as heart disease, were significantly higher in 2020.

Experts who study disasters say this is common, and that indirect deaths can take an even larger toll than those directly attributable to the crisis, said Mark VanLandingham, a professor at Tulane University’s School of Public Health and Tropical Medicine.

A pandemic or other disaster is “going to move people away from care” who otherwise would have gotten help for a worsening condition, but “they’re delaying going into the doctor and seeing people,” VanLandingham said.

Flu numbers this year are the lowest in decades. 

The potential for this problem was evident early in New Orleans, where officials went from scrambling to get additional ambulances to handle a surge in calls at the start of the pandemic to pleading with residents to call 9-1-1 if they were suffering from medical emergencies that weren’t related to the virus. The number of people seeking treatment for heart attacks and strokes plummeted.

Aiken remembers thinking in April and May that there weren’t as many patients coming into the ER for things like heart attacks and strokes.

At the same time, calls for deaths at home rose.

“We were used to getting three or four per day, but we were getting nine,” said Aiken.

When very sick people did come in during surges, exhausted doctors and nurses couldn’t always give them their full attention.

For some, deciding whether to call 9-1-1 could be wrenching, as coronavirus restrictions meant family members could not follow their loved ones to the hospital.

Charles Brown will never forget the date his mother, Hazel Dean, was diagnosed with the coronavirus: June 2.

At 86, Eloyease Lybrand of Metairie relied on oxygen tanks and a panoply of medications. She had been hospitalized multiple times before the pandemic, but always bounced right back, asking her granddaughter Brie Lybrand – her caretaker, whom she raised – to shop the sales at the malls on the way home.

Brie spent her time constantly watching over her Gam, sleeping in the same bed with her and making sure that someone else was there if she needed to step out. But when Eloyease began to have trouble breathing while recovering from a hospitalization, the two were left with an impossible choice. Eloyease was mostly deaf and afraid of being separated from Brie, who knew all her medications and would be her only way of communicating with doctors.

“She said, ‘Whatever happens, do not leave me alone. I’ll die here, don’t bring me to the hospital,’” Brie said.

They turned to hospice care, which offered limited medical assistance but wouldn’t require Eloyease to be alone, with the hope she would recover. But Eloyease died at home, in Brie’s arms, last Easter.

“I feel like it’s my fault; I know it wasn’t, but they shouldn’t have separated caregivers,” said Brie, who believes her grandmother would still be alive if they had been able to go to the hospital together.

“I think putting all these crazy restrictions … people don’t want to be alone, I think it boils down to that,” she said. “I feel trying to get people in solitude and keeping them inside and putting people away, that’s what’s really killing people.”

Eloyease and Brie Lybrand

Eloyease Lybrand and her granddaughter, Brie Lybrand. Eloyease Lybrand died during the coronavirus pandemic after having difficulty breathing. Brie Lybrand said that because of rules that were in place at the time, she would have been unable to accompany her grandmother to the hospital.

Patricia Kissinger, a Tulane University infectious disease epidemiologist, knows some of the problems from some personal experience. In April, she had to be rushed to the hospital by ambulance in a life-or-death situation. Her husband was told he couldn’t come, and for hours, he didn’t even know where she had been taken.

“I think anybody who had to go through a catastrophic health event at that time probably did not get the care they required and probably had worsened outcomes,” Kissinger said.

While the statistics for 2020 are grim, they are likely not the end of the problem. Those who got by with less care may have seen their conditions worsen in ways that could shorten their lives. Stress has likely taken a toll. And the long-term effects of COVID are still relatively unknown, meaning the virus itself may continue to contribute to higher death rates among survivors.

“I just think COVID is a huge disrupter; it’s an enormous disrupter,” Kissinger said. “We don’t even know how impactful it was on deaths because it’s not documented as well as it could be. I do think we’re going to see the ramifications of this go on for some time in the future.”


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