Fewer people are going to Triangle emergency rooms, and that could be a bad thing
As hospitals in North Carolina prepare for a rush of COVID-19 cases, their emergency rooms have become less busy with non-coronavirus patients — and that has doctors worried.
Their concern is that people who should be going to a hospital are avoiding it, perhaps out of fear of contracting COVID-19 or burdening the health care system unnecessarily. Dr. Abhi Mehrotra, who helps oversee emergency departments at UNC Health hospitals in Chapel Hill and Hillsborough, said non-coronavirus traffic at emergency rooms across the UNC system is down 40% to 50%.
The exact reasons for the decline are a mystery.
“I don’t know yet what’s the cause behind patients not seeking care,” Mehrotra said in a video press conference Monday. “We don’t think that magically there’s been a significant change in the illness factors in our community — that the number of heart attacks, strokes, appendicitis have gone down over this period of time.”
Mehrotra said the patients who are showing up at emergency rooms tend to be sicker, suggesting that people are putting off treatment until they can’t avoid it any longer.
“That’s one of the things that concerns me, is that patients are not seeking care that need to be,” he said.
Doctors are particularly worried that people with symptoms of a heart attack or stroke are choosing to stay home. At Duke Health’s three hospitals in the Triangle, admissions for strokes are down 34% in recent weeks and admissions of cardiovascular patients are down 65%.
Dr. Manesh Patel, chief of cardiology for Duke Health, said those cardiac patients who do show up tend to be further along in their heart attacks, putting them at risk of heart failure or cardiac arrest. Heart attacks and strokes are both treated most successfully if caught early, and doctors worry that people who talk themselves out of seeking help right away will only face more serious problems later.
“What we tell people is time is muscle,” Patel said in an interview. “The more time spent at home, the more time your heart muscle is dying.”
In advance of the coronavirus outbreak, hospitals deliberately reduced the number of patients they would handle by postponing non-urgent surgeries and procedures. That allowed them to save equipment, staff and hospital beds they might need for COVID-19 patients.
But hospitals can’t easily control the flow of patients to their emergency rooms. With images of overcrowded hospitals in New York and other places hit hard by COVID-19, the relatively quiet emergency rooms in the Triangle are a surprise.
“We didn’t expect this when all of this started, that’s for sure,” said Jim Palombaro, president of Wake Emergency Physicians, which staffs WakeMed’s seven emergency departments in Wake County.
Some decline in emergency room visits might be expected in a world where people are being urged to stay home. When hospitals and epidemiologists are able to go back and account for the decline, it may be that fewer car accidents and sports or other injuries will explain some of it.
Visits to WakeMed’s pediatrics emergency room in Raleigh are down 60%, Palombaro said, and much of that could be fewer injuries and illnesses that might have been passed from student to student at schools.
‘A heart attack for two days’
But Palombaro, like others, says he fears the decline in adult visits to ERs means people aren’t getting the timely health care they need. He recently saw a man who hesitated to come to the hospital even though he had been having chest pains for two days.
“He had been having a heart attack for two days,” Palombaro said in an interview.
Palombaro and other doctors say they understand that people might be worried about visiting a hospital at a time when restaurants and even parks are closed to reduce the spread of coronavirus.
But they say hospitals have taken unusual precautions to prevent the spread of the virus among staff and patients. They’re screening and testing most suspected COVID-19 patients off-site and are keeping them separate from non-COVID patients in emergency departments and in hospital wards.
“Our main message is that hospitals are safe,” said WakeMed spokeswoman Kristin Kelly. “Don’t delay care if you have symptoms other than COVID-19, especially when time is critical.”
Patel, at Duke, said he and other doctors now talk about an “unmeasured pandemic,” the deaths and serious illnesses that might have been prevented had coronavirus not been around. Francis Castiller, director of critical care at UNC Rex Healthcare, said hospitals may find themselves dealing with two surges of patients during the COVID-19 outbreak.
“It’s across the board — strokes, heart attacks and emergency surgeries. We’ve seen drops in all of those things,” Castiller said. “Our concern is we’ll have a surge of all of those in the coming weeks once those diseases run their course.”
This story was originally published April 21, 2020 at 5:30 AM with the headline "Fewer people are going to Triangle emergency rooms, and that could be a bad thing."
