The silent sub-epidemic: Patients are staying away from the ER, even in emergencies

Some physicians believe that behind the COVID-19 pandemic is a silent sub-epidemic of people who need care but are too scared to visit emergency rooms, according to The Washington Post.

Hospital admissions for certain health issues — inflamed appendices, infected gall bladders, bowel obstructions, chest pains and stroke symptoms — have dropped, according to some physicians and preliminary research. Some physicians predict they will soon see more patients who delayed care until symptoms became unbearable.

A majority of the reports about fewer admissions are anecdotal, but physicians who spoke to the Post said it's unlikely cases have declined for most conditions.

Charleston-based Medical University of South Carolina's general surgery floor, which has 20 beds, had as few as three people for two to three weeks, Evert Eriksson, MD, trauma medical director at MUSC, told the Post. The census is now back above 20 people.

"I would say 70 percent of the appendicitis on my service right now are late presentations," Dr. Eriksson said. "What happens when you present late with appendicitis is we can't operate on you safely." 

In the case of severe heart attacks, evidence in a report to be published in the Journal of the American College of Cardiology on nine high-volume cardiac catheterization labs found a 38 percent drop in patients being treated for a blockage of one of the major arteries that supplies blood to the heart. The report compared treatments delivered in March 2020 to those from between January 2019 and February 2020. 

Such results are counterintuitive, with stress caused by the pandemic likely to lead to an increase in heart attacks, physicians said. 

"We should have higher incidences of these events, but we are seeing dramatically fewer in the hospital system," said John Puskas, MD, cardiovascular surgeon at New York City-based Mount Sinai. "That has to mean they are at home or in the morgue."

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