AKRON, Ohio — Doctors and health officials are worried that people trying to avoid contracting coronavirus at emergency rooms meant they avoided the ER for true emergencies.
That may have resulted in more serious ailments for untreated or delayed treatment or even death, they fear.
“I feel very strongly that we’ve got people that are scared and afraid they think the emergency department is full of COVID-19 patients and are not safe,” said Dr. Michael Hughes, president of Summa Health’s Barberton Hospital and an interventional cardiologist.
The hospitals have done a good job of isolating and protecting patients and staff from COVID-19 positive patients, Hughes said. Patients and workers both have masks. The anticipated surge of COVID-19 patients also did not flood area hospitals, Hughes said, adding that Summa took down mobile tent units it had set up outside its emergency rooms recently.
However, an analysis of emergency department visit data from Summit County Public Health shows the fear of ERs could be true.
In 2019 during the six weeks from March 15 through April 25, there were 35,878 visits to all Summit County emergency rooms. This year, there were 20,412 visits, a 43% drop in the visits from the previous year. The drop began the week of March 15 with a 31% drop in visits and peaked the week of April 4 with a total of 2,993 visits compared to 6,148 the same time a year ago, a 51% decline.
A look at emergency room visits from the first of the year through March 15 showed visits to ERs were up 2,630, or 4 percent.
Dr. Erika Sobolewski, Summit County Public Health medical director, has also been urging residents to use the ER when needed in the agency’s weekly press briefing.
“Summit County hospitals are taking every precaution to isolate individuals with suspect COVID-19 from other patients in the emergency department,” she said.
“If you’re experiencing life-threatening medical issues such as trouble breathing, radiating arm pain, chest pain, shortness of breath, arm numbness, facial drooping, slurred speech or abrupt-vision loss, these are serious symptoms and need immediate medical attention,” Sobolewski said.
“Delaying life saving medical attention to limit exposure to COVID 19 can result in unnecessary deadly consequences.”
Hughes, who is in charge of all cardiovascular services for Summa, said the latest data systemwide in Summa’s ERs shows a 28% drop in acute heart attack care and a 17% decline in stroke cases this March compared to March 2019.
“That’s pretty consistent across the country” with some figures showing 30% to 50% declines for emergency cardiovascular and stroke care, Hughes said.
“I think there’s a lot of people not coming in,” he said. “There can be very subtle signs and symptoms of acute heart attacks, especially in women.” According to the American Heart Association, heart-attack symptoms for women can include uncomfortable pressure in the chest, pain or discomfort in one or both arms, back, neck, jaw or stomach; shortness of breath without chest discomfort and other signs such as breaking out in a cold sweat, nausea or lightheadedness.
It’s not just heart attacks or strokes that concern Hughes. Severe abdominal pain could lead to a burst appendix, if untreated.
Cleveland Clinic Akron General emergency departments also “initially saw a decrease in patient volume, expecting that surge was going to come from all of these COVID patients, but it never really came,” said Dr. Steven Brooks, chair of emergency medicine and hospital chief of staff.
The staff noticed the condition of those fewer patients “was more severe because people are waiting to come in or they could have come in earlier in the disease process,” said Brooks.
“The percentage of patients being admitted is significantly higher than we had in the past,” Brooks said, adding that in the last week or so, volumes in the ERs seem to be coming back up.
Hughes said the pendulum swung too far from patients “seeing the emergency department as a primary care physician access point to people avoiding it when they have an emergency situation.”
Early on during the COVID-19 pandemic, “appropriately so, we told people to stay away from the emergency department if they had mild to moderate symptoms. We knew 80% of the folks would do fine without needing hospitalization,” Hughes said.
‘“I think what got lost in the translation was the folks with (other conditions such as) diabetes and heart failure, those folks have a much higher predisposition to develop urgent or emergency intervention or care.”
The problem, Hughes said, is a lot of the symptoms of COVID-19 such as shortness of breath or fatigue are very similar to complications of chronic obstructive pulmonary disease or heart failure.
“To expect a layperson to understand the difference between an acute heart attack and COVID is asking a lot,” he said.
It also doesn’t help that some of the symptoms of COVID-19 have been evolving, he said. The latest list of symptoms from the Centers for Disease Control include cough and shortness of breath and then at least two of the following: fever, recurrent chills, sore throat, headache, muscle aches, loss of taste or smell and a swollen or discolored toe.
Hughes said while he believes ERs are safe, “if you are scared and if there is a deterioration of your chronic condition, you should call 911. EMTs can come to your house to evaluate the patient. They can check the amount of oxygen in their blood or do an EKG if you’re having a heart or evaluate you for a TIA or stroke.”
Said Brooks: “Waiting is the wrong answer every time. If you have a health concern and it doesn’t seem to be clearing up, you need to be checked out.”
“Delays in receiving care for strokes or heart attacks can lead to permanent disability or even death,” he said. “We need to see these patients sooner than later.”