Rubin Lab

By David T. Rubin, MD, Professor of Medicine, University of Chicago Medicine

I’ve been thinking about what comes next, and how can we get ahead of this, and propose the following for consideration.

I believe that there will be three waves of illness from the COVID-19 pandemic.

  1. First wave: Illness and casualties from COVID-19.

We are in the first wave right now. We don’t know how big it will be or how long it will last. We are now in the mitigation phase. You know what to do:

  • Stay home.
  • Support your essential workers.
  • Be kind.
  1. Second wave: Illness from delayed care or avoidant care of existing medical conditions.

These patients may delay care for their conditions or delay refilling meds, or electively stop meds, and suffer subsequent complications of these medical problems.

  • Examples of the second wave:
    • Relapses of chronic immune conditions like IBD or rheumatoid arthritis.
    • Short-term complications from poor control of diabetes or hypertension.
    • There are many more examples of course.
  • Prevention of the second wave:
    • Adequate communications to all patients about this risk and about the importance of staying on medication.
    • Efficient shift to appropriate telehealth visits to maintain care.
    • Ongoing use of monitoring tests to keep track of the disease and drugs.
  1. Third wave: “Loss of Chance” due to delayed care and missed new diagnoses from avoidant or substandard follow-up care.

This means that diseases that may have been preventable or curable at early stages progress beyond easier treatment before they are found.

  • Examples of the third wave:
    • Skipping screening tests for colorectal cancer or breast cancer.
    • Delaying diagnostic tests after abnormal test results.
    • Progression of the missed or delayed diagnosis which changes the ability to prevent bad outcomes.
  • Prevention of the third wave:
    • Patients: don’t ignore new symptoms!
    • Providers: maintain meticulous lists of cancelled testing/procedures so they can be rescheduled as soon as appropriate.
    • MDs: clarify the criteria for time sensitive evaluations so this is minimized

Thoughts and comments are welcome.

Best wishes,

David T. Rubin, MD
Professor of Medicine, University of Chicago Medicine