Many emergency rooms have seen a huge increase in patients with fever, cough, shortness of breath, and other signs of possible pneumonia stemming from COVID-19 lately.
“However, ER physicians have also noticed a startling decrease in patients coming in for serious non-COVID issues, such as heart attack and stroke.” (Forbes.com) Because of the “Stay at home” orders during this pandemic, it’s understandable that there would be less accidents, injuries, etc., thus some drop in ER volume.
But, where are all the patients with inflamed appendixes, bowel obstructions, heart attack symptoms, stroke symptoms, and infected gall bladders? They are nowhere to be found, and it’s very unlikely that there has suddenly been a decline in these types of cases.
In a Gallup online poll taken between March 28 and April 2, people with different conditions were asked if they needed treatment at a doctor’s office or emergency room right now, how concerned would they be that they may be exposed to the coronavirus. 86% of heart disease patients said they would be either “very concerned” or “moderately concerned.” The figure was 83% for patients with high blood pressure.
Doctors are worried that “the pandemic has produced a sub-epidemic of people who need care at hospitals but dare not come in.” (WashingtonPost.com) People are worried about going to the hospital and being exposed to COVID-19, because as we’ve all heard, people with other health conditions who contract COVID-19, have an increased risk of serious complications.
Here are some interesting statistics:
“MUSC (Medical University of South Carolina), a major stroke center, averaged 550 calls per month over the past four months about possible stroke patients from the 45 to 50 emergency rooms that refer patients. But it has seen just 100 in the first half of April, said Alex Spiotta, director of neurovascular surgery. Phone calls from patients to MUSC’s telestroke program dropped from as many as 20 daily to about nine in mid-April.”
At the University of Miami-Jackson Memorial Comprehensive Stroke Center, between February and March, stroke patients went down almost 30%.
A recent NRC study (National Research Corporation) found that “53% of consumers have delayed care for themselves or someone in their household during COVID-19, and 60% of consumers think there is an elevated risk when visiting their providers.” (ThinkReviveHealth.com)
A Second Health Crisis?
Is there a second health crisis looming, that will appear once the Coronavirus is finally on the decrease? Will this take place due to patients delaying necessary medical care, with conditions that are nonurgent at the time, but because of the delay, become life-threatening?
This is exactly what Dr. Evert Eriksson, trauma medical director at the Medical University of South Carolina (MUSC) fears will happen. He says too many patients are “trying to tough it out at home, fearful about going to the hospital because of the virus.” For example, he’s seeing many patients coming to the hospital with ruptured appendix, whereas previously they would have gone to the ER before the rupture took place. He says 70% of patients presenting with appendicitis right now are “late presentations.”
One patient in his 20’s ignored the increasing pain in his stomach, only using over-the-counter painkillers. By the time he finally went to the ER, “he had developed a large abscess, that was gnawing through the muscle in his abdominal wall.” Had he gone to the hospital 10 days earlier he would have needed a fairly routine surgery, and maybe a one-night stay in the hospital. Instead he had a lengthy and difficult stay in the hospital. Doctors had to operate, and then use antibiotics to control the widespread infection before they could even begin to address the appendix itself. Dr. Eriksson said, “That’s going to be a wound-care challenge for him moving forward.” The patient had said he held off because he was scared of contracting COVID-19 at the hospital.
Chris Kwolek, a vascular surgeon has also seen an increase in patients that are waiting to go to the hospital. He said when people have problems with circulation in their feet and legs, and put off getting care, Dr. Kwolek has to resort to amputation, being unable to restore blood flow at that point.
Megan Stobart-Gallagher, an emergency physician states, “Patients who come in with non-COVID-19 stuff are dying at higher rates.” This is because they are waiting so long before seeking medical attention. He notes that a 15-year-old patient who presented with pneumonia died within 24-hours of arriving at the hospital. (Inquirer.com) Pneumonia is an unusual cause of death for a patient that young.
What are health professionals doing to help prevent the next health crisis?
Cardiologist reports showing a recent sudden drop in heart attack patients spurred the American Heart Association to “launch a new media campaign, urging people to call for help at the first signs of heart attack or stroke.”
Some cardiologists are checking in with patients through telemedicine visits. The American College of Cardiology launched a “Cardiosmart” campaign, reassuring patients and encouraging those with symptoms to call 911 for urgent care and to continue with medical care through telemedicine when possible.
Hospitals are protecting patients by requiring all staff to wear masks, increasing cleanings, and separating patients with symptoms. They are doing all they can to inform their local communities that their ER’s are safe, and “to reassure patients that they have the appropriate equipment, expertise, and protocols to keep all patients safe — both those with COVID-19 and those without.”
One group of hospitals issued flyers stating, “If you are having an emergency, we are ready to care for you.”
With heart attacks and strokes, every minute counts. Any small delay in seeking medical care could cause more permanent damage. William A. Gray, a cardiologist says the major message for heart patients has to be staying home during a heart attack or heart failure is not a good place to be.
Dr. Harlan M. Krumholz says, “People with chronic conditions need to know that avoidance of needed care could ultimately be as big a threat as the virus itself.” (ReachMD.com)
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