Where have all the patients gone?

As COVID-19 overwhelms hospitals and dominates headlines, people are less likely to seek emergency care

The picture painted early during the COVID-19 pandemic was not a pretty one:  Emergency rooms overwhelmed by COVID-19 patients in some areas. Ventilators in short supply. The sick lining hospital hallways waiting to be seen by overworked clinicians. All the while, an infectious disease hangs in the air. 

It is a terrible scene to consider. Certainly one to avoid, if at all possible. However, data is beginning to show that people suffering from other life-threatening conditions are also avoiding visits to the ER, even when the situation is critical. Chest pains, stroke symptoms, inflamed appendixes and inflected gall bladders are endured at home out of fear. 

As John Puskas, a cardiovascular surgeon at Mount Sinai, told the Washington Post: “Everybody is frightened to come to the ER.”

COVID-19 has created a secondary epidemic in which people are effectively risking their lives to avoid risking their lives. Imagine a family member enduring a heart attack at home with no medical attention. It’s a terrifying thought. But it is happening with alarming regularity all over the country.  A recent piece by Tomislav Mihaljevic, MD, Cleveland Clinic,  and Gianrico Farrugia, MD, Mayo Clinic, and highlighted by Becker’s Hospital Review, believe delayed care may have been responsible for as many deaths as COVID-19.

Dr. Andrew Garrity, the medical staff president at Eastern Idaho Regional Medical Center (EIRMC) in Idaho Falls and the medical director for Air Idaho Rescue, recently described the issue in an op-ed for the Post Register. He noted that the EIRMC Emergency Department experienced a 42 percent reduction in patient volume in April. But that’s only part of the story. Among the people who do come to the ER, inpatient admissions have increased by 41 percent over last spring. That means that those who are seeking care in the ER right now are sicker, often because they delay that care until it is impossible to avoid a trip to the hospital. 

Air medical services have seen far fewer patients these past two months as well. Industrywide, transports are down about 40 percent. While the decline has been steeper in urban COVID-19 hotspots, it also holds across rural America, which is home to about 46 million people (more than 15 percent of the U.S. population). Those who live in these areas are more likely to die from heart disease, unintentional injuries, and stroke than people in more urban areas.

As many states begin to emerge from their shelter in place orders, it is important to remember that we are still in the beginning stages of dealing with the novel coronavirus. A vaccine will not be readily available for an undetermined amount of time, and wearing masks while practicing social distancing precautions are not going away any time soon. During the continued and uncertain fight ahead, it is important that people understand they cannot allow fears about COVID-19 lead to other life-threatening consequences. 

Hospitals, air medical services, ground EMS, clinicians and other healthcare personnel have learned a great deal about keeping patients and themselves safe since the virus entered our lives. Within the air medical industry, for instance, flight and base crews are fully equipped with personal protective equipment (PPE) like masks, gloves, and protective suits. They follow strict procedures to prevent contamination, including disinfecting aircraft and equipment between uses. This preparedness mirrors that of the emergency departments to which patients are transported.  

For healthcare professionals, it is perplexing to know that people are needlessly suffering alone through emergencies when treatment is readily available to them. Public communication and community outreach are effective tools to combat the widespread misconception that emergency departments should be avoided. Social media, interviews with local press, and public service announcements are examples of ways hospitals and emergency services can make sure people understand these resources are available and safe.  

The steep drop in ER visits by people suffering from heart attacks and strokes is so alarming that the American College of Cardiology released an emphatic statement in April from doctors who represent organizations like the American Heart Association, the American Academy of Neurology and the American College of Emergency Physicians. It reads, in part:

“You might think a hospital is the last place you should go now. That's why we – the leaders of major national organizations dedicated to saving people from heart disease and stroke – feel it's necessary to say this loud and clear:

Calling 911 immediately is still your best chance of surviving or saving a life.

It is SAFE for EVERYONE to call 911.

It is SAFE for ANYONE to go to the hospital.”

Delayed care is not only an issue for adults. Yale Medicine reported at the end of April that the overall daily volume at Yale New Haven Children’s Hospital Pediatric Emergency Department was down by about 75 percent. The department’s daily census was between 120 and 130 patients before the pandemic and is now between 30 and 40 patients. 

Marc Auerbach, MD, a Yale Medicine pediatric emergency specialist, stressed that parents should not hesitate to bring their child to the ER when necessary, saying: “It’s important to call 911 and use the emergency department when your child has a significant injury or illness. We are still here and functioning, and doing our best to keep families safe in the ED.”

Doctors all over the U.S. agree that delaying care during an emergency should never occur. While COVID-19 has directly taken tens of thousands of lives, it is indirectly impacting countless others. Avoiding emergency care for fear of being exposed to the virus is counterintuitive when you are suffering from urgent health problems. Emergency personnel – from air medical and ground EMS crews to ER doctors and nurses – are well-equipped with PPE and are well-trained in keeping patients safe from infectious disease.  

If you or a loved one are severely injured, or are showing signs of a stroke or heart attack (chest pains, difficulty breathing, fatigue, slurred speech), never hesitate to call 911 and seek the medical care you require. The entire emergency care framework stands ready to treat anyone in need, even amid the unprecedented challenges we currently face.

JaeLynn Williams is CEO of Air Methods, a leading air medical service in the U.S. 

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