A Pandemic Within The Pandemic: Limb Amputations During The COVID-19 Crisis

Nearly two years after the start of the COVID-19 pandemic, researchers are beginning to uncover the effects the public health emergency had on diabetic vascular care.

Early COVID-19 Surges and Amputation Rates

The first confirmed case of COVID-19 in the United States occurred in January 2020 and quickly spread throughout the country. By March, COVID-19 was declared a pandemic by the World Health Organization, and the country began its infamous “lockdown,” where nearly all non-essential work and travel came to a halt. During this time, cases of COVID-19 rose dramatically. In an effort to reduce exposure to the virus and conserve precious supplies, many hospitals and medical offices canceled non-urgent procedures and transitioned most routine visits to virtual appointments.

As researchers begin to study the health effects of the pandemic lockdown, data suggests that the decision to postpone or cancel non-urgent procedures may have been detrimental to the health of hundreds of Americans with diabetes and peripheral vascular disease.

According to studies from two hospital systems, the rate of lower extremity amputations has increased significantly since the start of the pandemic. The first study from Ohio reported that patients were ten times more likely to require an amputation during the pandemic, and major amputations (below the knee or higher) were three times more likely. In San Francisco, the number of below-the-knee amputations nearly tripled from pre-pandemic rates.

In addition to rising amputation rates, these studies noted that more patients presented to the hospital with severe wound infections than before the pandemic. One large study of nearly 60,000 people across North America found that more patients who required an amputation presented with an uncontrolled infection during the pandemic.

Is Lack of Healthcare Access to Blame?

During the COVID-19 health crisis, patients had more uncontrolled wound infections, more complex vascular interventions and were more likely to need a major limb amputation.

But why?

Researchers believe that limited access to preventative foot care is a leading cause of the rise in lower extremity complications during the pandemic. One study noted that procedures to treat claudication—pain caused by poor blood flow to the legs and feet—fell by 71% during the first COVID-19 surge, and procedures to treat chronic limb-threatening ischemia (CLTI) dropped by nearly 16%.

Although not considered urgent, these procedures may help restore vital blood flow to the legs. By halting these procedures, many high-risk patients are more likely to experience significant complications like infections and tissue death, which may require treatment with limb amputation.

Patients had limited access to regular foot and wound care during this time, with many providers transitioning to a virtual platform. While telehealth has many uses and benefits, some healthcare specialties require hands-on assessments to be most effective. Researchers believe this interruption in care played a significant role in increasing rates of amputations and other vascular complications during the pandemic.

What Does This Mean for You?

Preventative care is more important now than ever before. Although the burden of COVID-19 is improving, many healthcare systems continue to suffer staffing shortages and backlogged appointments, making it difficult for patients to see their providers in person. Some patients may have waited too long to seek medical attention for foot wounds, leading to severe infections, hospitalization, and even amputation.

It is crucial for you to take preventative measures to protect your feet from ulcers and infected wounds during this turbulent time in healthcare.

• Wear proper fitting, close-toed shoes.
• Keep your feet hydrated with a diabetic-safe moisturizer.
• Make sure your feet are thoroughly dry before applying socks and shoes, especially between your toes.
• Check your feet daily for new wounds, and notify your doctor right away if you notice signs of infection.

Advances in remote monitoring technology are also helping people with diabetes combat the complications of neuropathy and peripheral vascular disease. Temperature monitoring socks from Siren can notify you and your healthcare provider of the earliest signs of foot complications, often before symptoms begin. Learn more about how Siren socks can help prevent unwanted surgeries and amputations at our website www.siren.care.