En español | In a trend that is alarming medical providers, adults fearing contact with COVID-19 are staying at home instead of going to hospital emergency rooms when they have serious symptoms of life-threatening conditions such as heart attack and stroke.
Doctors say the resulting delays in treatment are causing complications and long-term health problems such as irreversible brain and heart damage, disability, amputation and fatalities.
Since the coronavirus pandemic hit, the number of patients visiting emergency rooms nationwide has dropped by 40 to 50 percent, says William Jaquis, M.D., an emergency medicine physician in Aventura, Fla., and president of the American College of Emergency Physicians.
"We are afraid that patients could potentially die at home,” Jaquis warns.
Older adults are especially at risk because they are more likely to have cardiovascular disease, diabetes and other chronic medical conditions that make putting off emergency care especially risky, doctors say.
Dale Criner, M.D., an emergency room physician in Memphis, Tenn., says paramedics there are reporting an increase in the number of cardiac calls they've responded to where the patient died before they arrived.
"When they talk to the family, it turns out the patient had chest pain or shortness of breath for a few days but was too afraid to come to the hospital,” he says. “It's heartbreaking."
Getting to the hospital quickly is critical for patients suffering heart attacks or strokes, when heart and brain cells can die by the minute. Other serious conditions — such as acute appendicitis and infections — can also cause long-lasting damage if treatment is delayed.
Virus fears are top, but not only, motivation to stay home
It's not surprising that people are reluctant to go to the ER, given news stories of hospitals overwhelmed with coronavirus cases and deaths, as well as those preparing for an upcoming surge.
"People are terrified,” says Barbara Blasko, M.D., an emergency medicine physician in Southern California. “They think that every hospital is overrun by COVID-19 and people in body bags, when that's completely false. The first thing everyone says when they get here is, ‘I didn't want to come.'”
A Gallup survey conducted March 28 to April 2 found that over 80 percent of Americans would be concerned about exposure to coronavirus if they needed “medical treatment right now.”
The poll found that younger and older adults are almost equally concerned about picking up the virus, even though adults age 65 and older are at higher risk for severe illness from COVID-19.
Not everyone is avoiding the ER out of fear. Doctors note that some older patients have said they stayed away because they didn't want to burden already overworked medical providers during the pandemic.
Jeremy Finkelstein, M.D., emergency medicine medical director at Houston Methodist Hospital, says his department has seen an increase in older patients who come in after they have already completed a stroke, when it's too late for clot-busting medicine.
"Now they have a leg without feeling or a speech deficiency,” he says. “When we ask them, ‘Why didn't you come in two days ago?’ they say, ‘I know you're busy and overwhelmed with COVID. I didn't want to bother you.'”
Dangerous consequences of delayed care
Stroke and heart attack patients aren't the only ones at risk. ER doctors from across the country have heartbreaking stories of a variety of patients who put off care because of COVID-19.
In Memphis, a patient who had a mild urinary tract infection ended up in the intensive care unit on a ventilator because she waited too long to get care and the infection got out of control, Criner reports.
In Houston, an older adult with diverticulitis avoided the hospital for so long that he ended up with a bowel perforation — a surgical emergency, Finkelstein says.
And at Rush University Medical Center in Chicago, a patient who fell and hit her head waited more than a week before coming in, despite a severe headache, reports emergency medicine physician Yanina Purim-Shem-Tov, M.D. By the time she came to the hospital, the patient had bleeding in her brain that required immediate surgery and put her at risk for long-term memory problems.
Purim-Shem-Tov adds that other physicians around the country have been sharing similar stories on medical social media sites. One of the most haunting: A patient with a soft tissue infection in her leg let it go for so long that the limb had to be amputated.
Every minute counts during heart attacks and strokes
The American College of Cardiology last week launched a campaign to urge patients with heart attack and stroke symptoms to call 911 and get treatment despite the COVID-19 pandemic.
If you get to the hospital quickly after a stroke, doctors can administer clot-busting medication or do an artery-clearing procedure that can save your brain and prevent long-term disability. In a heart attack, research shows restarting blood flow quickly is key.
"If we can open the artery within 60 or even 90 minutes, we can save the muscle and you can walk out of hospital and have a completely full recovery,” Purim-Shem-Tov says. “If you wait, heart muscle dies. You will have reduced cardiac function and you may end of up with congestive heart failure."
Yet cardiologists report that even patients with known heart issues are reluctant to go to the hospital.
Cardiologist K. Dale Owen Jr., M.D., CEO of Tryon Medical Partners in Charlotte, N.C., says one of his patients stayed up all night chewing nitroglycerine tablets for his chest pain because he was too scared to go to the ER. He called Owen the next morning, and Owen had to talk him into going to the hospital.
"I told him, ‘Your risk of heart attack is tenfold your risk of COVID,'” Owen recalls. “If you're having a pending heart attack, you're at much greater risk at home than you are in the ER.”
Hospitals taking precautions
Doctors recommend calling 911 and going straight to the ER if you have any of these red-flag symptoms: acute chest pain, shortness of breath, fainting, weakness, difficulty speaking, changes in vision, acute headache or abdominal pain that's severe or does not resolve in a few hours.
They are trying to allay fears by reminding patients about the many measures hospitals are taking to prevent the spread of infection, including screening patients at the door, giving everyone a mask, and isolating COVID-19 patients in separate wings or areas.
"I tell patients this is the best time to go to the ER,” Blasko said. “We have such strict screening that people who have even one symptom associated with COVID are separated and put in different areas. And because we have no patients, there's no wait — you'll probably get seen immediately.”