Coping with disease and disability in the time of coronavirus

(CNN)Sassy Outwater-Wright has fought off cancer three times in the last 33 years, losing most of her eyesight to a rare form of the disease at the age of three.

And now, at age 37, she's fighting a fourth cancer -- this time in her brain.
As a result, Outwater-Wright is no stranger to navigating the byzantine corridors of the healthcare system, and she guides others who've lost their sight in her role as executive director of the Massachusetts Association for the Blind and Visually Impaired.
    As someone who relies on touch to navigate the world, the potential threats to her existence have multiplied now that the novel coronavirus might be waiting on the next door knob or window sill.
      In the midst of the pandemic, those who live with disability or contend with a chronic illness are now at a double disadvantage.
        Home deliveries of goods are much harder to arrange, even if stores have what people need in stock. And leaving the home for each life-sustaining visit to a doctor to treat a condition begins to feel like playing Russian roulette.

        'You're forced to face your own mortality'

          "It's terrible to have cancer in the time of corona," Outwater-Wright said. "I still have to go to the hospital for my conditions. Each time, we're putting our health and the lives of our loved ones at risk."
          She worries that she could be exposed to coronavirus if she see a healthcare worker who's seen 20 other patients that day, one of whom could be an asymptomatic carrier of the virus.
          And she worries where her brain tumor diagnosis might place her on the triage list if she contracts Covid-19 and needs a ventilator.
          In some hospitals, doctors must find ways of identifying which patients are should be prioritized for the scarce number of ventilators available. One increasingly used system for doing that -- developed by Dr. Douglas White, a professor of critical care medicine at the University of Pittsburgh -- operates under two larger sets of criteria: save the most lives and save the most number of life years the patient is expected to have should they receive treatment and survive.
          Outwater-Wright welcomes blind Boston Marathon runners and their guides at a dinner for the Massachusetts Association for the Blind and Visually Impaired.
          When looking at the number of life years a patient may have left, this point system would de-prioritize patients with medical conditions associated with a life expectancy of less than one year and less than five years.
          These guidelines don't discriminate against those living with disabilities, so Outwater-Wright's visual impairment doesn't make her less eligible for a ventilator should she need one. But as a patient living with brain tumors, Outwater-Wright is worried about what could happen if she falls ill, seeing as how one's expected life span following Covid-19 is a factor.
          Recent news reports detailing those criteria have left her feeling horrified.
          "A lot of the medical modeling coming out is focusing on who's not going to get resuscitated," she said. "Every time your phone pings with a news notification, you're forced to face your own mortality."

          When cleaning supplies and support are scarce

          Jennifer McNary is a single mother and a consultant raising four children with rare or respiratory diseases in Newton, Massachusetts.
          Her two oldest boys, Austin and Max, who are ages 21 and 18 respectively, suffer from Duchenne muscular dystrophy, a terminal progressive muscle-wasting disease that requires them to use wheelchairs to get around. Her 12-year-old, James, suffers from primary immune deficiency, and her youngest, 9-year-old Norah, has asthma.
          Each of them would fare poorly if infected with coronavirus. Many with Duchenne's are expected to live only into their 20s, due to the disease affecting the lungs and respiratory system in its later stages.
          "They're one pneumonia away from lung failure," McNary says.
          Because germs can live on cardboard and other household products, McNary has for years been in the habit of wiping down everything that comes in the house or heavily disinfecting it. Her 12-year-old "doesn't have an immune system," she says.
          But with Lysol wipes and household cleaning supplies now scarce, she's getting nervous. In February, she had a panic attack at a store.
          Their family normally requires two full-time care assistants and a nanny. Now, because of social distancing guidelines, they're down to just one person helping out about halftime.
          She and her children hadn't left the house in 25 days as of April 7, getting everything they need via deliveries from Amazon or CVS. This is a life or death matter for her family.
          If one of her children gets Covid-19, they could likely require a ventilator. If ventilators, ICU beds or other supplies become scarce, the medical guidelines used in many hospitals would potentially de-prioritize her sons because they're unlikely to survive long after a possible hospitalization.
          "I will do everything I can to make sure they don't go to a hospital, even if they have Covid," McNary said.
          Still, she says, as long as they get through this, there could be a silver lining in this crisis, particularly with mainstreaming the kinds of telehealth services and at-home learning her children rely on.
          "Lots can be done over the phone," she says.
          Each of McNary's conditions children has a condition that could make them very vulnerbale if infected by the coronavirus.