from The News Journal
'They're Just Not Coming,' Fewer Patients Seeking Hospital Care
Meredith Newman, Delaware News Journal Published 5:50 p.m. ET May 27, 2020 | Updated 6:08 p.m. ET May 27, 2020
In the months since COVID-19 entered Delaware, the largest emergency rooms in the state have been quieter, eerie almost.
Beds that are typically filled are now empty. Doctors say they have never seen anything like it.
Fewer patients are being treated in emergency departments, particularly those suffering from potentially deadly heart attacks, doctors say. Hospitals attribute it to patients fearing they could contract coronavirus — a notion physicians say is not necessarily true.
Delaware is not alone, hospitals across the country are seeing significantly fewer patients in the emergency room.
One-third of those surveyed by the American College of Emergency Physicians and Morning Consult said they have actively delayed or avoided medical care because of coronavirus concerns.
"They're just not coming," said Dr. Kirk Garratt, medical director of ChristianaCare's Center for Heart & Vascular Health. "Either heart disease has gone quiet for some mysterious reason, or people are not accessing the health care that they need."
In the past week, Delaware hospitals have started to resume elective procedures and routine primary care services. Health systems postponed these procedures in order to make sure there was enough capacity to care for a potential influx of coronavirus patients.
Hospital executives had estimated that Delaware health systems were collectively losing $5 million a day. One of the main reasons, they said, was the significant decrease in patients.
At ChristianaCare, the state's largest health system expected to see an influx of patients, but the opposite has happened.
The big flood of patients to the emergency department never came, said Garratt, the hospital's chair of cardiology.
"I really think people are just afraid to have any contact with the health care system right now," Garratt said. "In my lifetime, I've never seen it."
The longer it takes for a heart attack patient to receive care, Garratt said, the more likely the person will die.
He said ChristianaCare and New Castle County EMS have worked in recent years to reduce the amount of time patients experiencing a STEMI heart attack — the most deadly type — receive life-saving care.
New Castle County paramedics now identify these situations and alert the ChristianaCare's cardiac team that a patient is on the way to the hospital.
Instead of bringing the patient to the emergency department, Garratt said, the patient is brought straight to the operating room for revascularization, a procedure that stops the heart attack.
The American Heart Association recommends “paramedic-to-revascularization” be under 90 minutes. ChristianaCare is averaging about 83.4 minutes, hospital officials said.
But in the past two months, New Castle County EMS has seen a 20% drop in the number of its advanced life support responses, officials said.
"Delays, when you're having a heart attack, is the worst possible thing," Garratt said.
Nationally, there's been a concern that the pandemic will result in a delay and decrease in the detection of serious diseases like cancer. That hasn't been the case at Nemours/A.I. duPont Hospital for Children, said Dr. Jonathan Miller, chief of primary care.
He said he knows of at least three cases of cancer that were detected "just as early as it would have in the pre-pandemic era."
Miller attributes this to the new precautions Nemours has put in place, which he believes have made parents feel confident to bring their child to the hospital. The health system has opened outdoor clinics, where patients can receive immunizations and physical exams.
There's also been a heavy reliance on telemedicine. In 2019, Nemours' network of primary care practices did a total of five telemedicine visits, Miller said.
In the first four weeks of the pandemic, the network did about 5,000 visits.
Nemours has seen "far less" cases of appendicitis in patients, though it's not clear why, he said. Due to social distancing, there has also been a significant drop off in the contagious diseases, he said.
Dr. Bruce Nisbet, director of emergency medicine at Saint Francis Healthcare, said he has treated several patients who have delayed care, and it's led to further complications and longer hospital stays.
And in some cases, it has resulted in death.
In one instance, Nisbet said, a man was having chest pains for a few days, and despite his family urging him to go to the ER, the patient didn't.
He later died in the hospital due to cardiac arrest.
Nisbet believes it's unlikely that a patient could become infected with the coronavirus in the emergency department. Saint Francis, like other health systems, has procedures to immediately separate possible COVID-19 infected patients as soon as they enter the hospital, he said.
Rooms are thoroughly cleaned after every patient and doctors and nurses wear personal protective equipment at all times.
While coronavirus is very serious, Nisbet fears other chronic medical issues have "gotten lost" with the intense focus placed on the pandemic. Conditions like diabetes and COPD need to be managed. If not, it can lead to worse outcomes, he said
"There are other serious issues," he said. "There’s been a little loss of perspective."