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Waiting too long

For some Americans worried about the coronavirus, delays in seeking emergency medical treatment have become life-threatening

Waiting too long

Sebastien Vuagnat/AFP via Getty Images

In normal times, Tri-City Medical Center hosts a busy emergency department in San Diego County, seeing 60,000 emergency patients annually. But recently, fewer people have been visiting the ER—even though the hospital had only seven COVID-19 patients as of May 4. Tri-City’s ER volume has dropped more than 40 percent from pre-pandemic levels.

Eric White, an ICU nurse at the hospital, says one woman had been suffering from respiratory failure but worried, “I’m afraid I’ll get COVID-19 if I go.” Although she finally did arrive to the ER for treatment, she eventually left the hospital on hospice care.

“If she had come a few days earlier, she would have had longer to live,” White says.

Amid the spread of the coronavirus, medical workers at hospitals and clinics have noticed the disconcerting trend: Fewer patients than normal are showing up in emergency rooms. 

Four hospitals in Western New York reported that visits to their emergency rooms were down by 60 percent in April. In Detroit, Mich., Dr. Robert Klever of Detroit Receiving Hospital told the Detroit Free Press his emergency department was seeing an average of 102 patients a day, compared with 192 a day before the state’s stay-at-home order began. (The order does not prohibit ER visits.)

It’s an ironic reality at a time when the coronavirus continues to circulate in communities across the United States, infecting more than 1.2 million Americans since February. Many have become sick to the point they must seek emergency care. In outbreak hot spots like New York City, news reports have described overwhelmed hospital systems, overworked doctors, and intensive care units overflowing with COVID-19 patients.

Yet in many other places, hospitals and clinics have actually seen drastically fewer patients than usual. While hospitals have steeled themselves for an influx of COVID-19 patients, their ER workers often see fewer patients than usual complaining of non-virus-related maladies.

Isn’t that a good thing? Yes, at least in some cases: With millions of Americans staying at home under no-travel orders in recent weeks, for example, traffic accident injuries appear to have dropped significantly. In California, the Road Ecology Center found that vehicle collisions fell by 50 percent under the state’s stay-at-home order, with about 200 crashes per day resulting in injuries or fatalities, down from 400 per day previously.

But ER visits for other life-threatening ailments not directly related to traffic have also dropped significantly. Doctors believe it is largely due to people’s fear of visiting the hospital and catching the coronavirus from medical staff or other patients.

“There’s been so much fear that nobody wants to go to the hospital unless they absolutely need to,” said Laura Chow, a doctor in Austin, Texas, who treats head, neck, and lung cancer patients.

Chow said that early in the pandemic, two very sick cancer patients called her office, but “despite our best efforts to get them to go to the emergency department, they frankly refused.” The patients finally came hours later, but at that point they were so sick that both died.

Other doctors have reported a dearth of heart attack patients—a trend that seems to be occurring in multiple countries.

In Spain, for example, treatments for a serious type of heart attack known as a STEMI have fallen by 40 percent.  In Austria, hospital admissions for heart attacks and similar serious heart conditions dropped 39 percent between the first and last weeks of March.

In the United States, the situation is similar. The Journal of the American College of Cardiology logged a 38 percent reduction in STEMI treatments at U.S. hospitals.

Some doctors have speculated reduced pollution (because of fewer cars on the roads) or reduced work-related stress may have reduced the frequency of heart attacks. But fear of visiting the emergency room during a pandemic seems to be a major factor—one that some patients have admitted to.

According to the Detroit Free Press, Klever knew of at least one recent heart attack victim who died after waiting too long to call 911. He said that city ambulance statistics from the past month show at-home deaths have increased fivefold, with 147 people dying at home this year, compared with just 27 such deaths at this time last year.

“That’s the collateral damage of people who are afraid to come to the emergency department,” he told the newspaper.

Early figures indicate at-home deaths have risen elsewhere as well. NBC News reported that in 2019, New York City’s 911 calls for cardiac arrest averaged 69 a day, with 27 deaths. During the same period in 2020, cardiac calls averaged 195 a day, with 129 deaths.

While some at-home deaths may be COVID-19 cases involving people who did not die in a hospital, they do not all appear to be so. They add to concerns that people are dying of not only COVID-19 but other treatable conditions.

Early reviews of mortality data in the United Kingdom and the United States show a significant increase in “excess deaths” during March and April. Excess deaths are those that exceed the total deaths that would be expected in a region based on normal trends from previous years.

The Yale School of Public Health and The Washington Post estimated 15,400 excess U.S. deaths this year between March and early April, only about half of which could be explained as known COVID-19 cases. A similar New York Times analysis counted 23,000 excess deaths in New York City alone since mid-March, with about 4,000 of those not recorded as COVID-19 deaths. It’s not yet clear which of those additional deaths may have been unrecorded COVID-19 cases and which were due to other causes.

Whatever the case, medical groups are urging Americans not to hesitate to seek emergency care, and noting that hospitals have put careful safety measures in place to prevent the coronavirus from being transmitted to ER patients.

The American College of Cardiology ran a recent ad listing heart attack and stroke symptoms—chest pain, difficulty breathing, numbness, confusion. The ad included a stark reminder: “Heart attacks and strokes don’t stop during a pandemic.”

This story has been updated to correct the description of Tri-City Medical Center’s emergency volume in comparison with other hospitals in San Diego County, and to correct the date on which Tri-City Medical Center was caring for seven COVID-19 patients.

Daniel James Devine

Daniel James Devine

Daniel is managing editor of WORLD Magazine and leads WORLD's investigative unit, the Caleb Team. He is a World Journalism Institute graduate and a former science and technology reporter. Daniel resides in Indiana. Follow him on Twitter @DanJamDevine.

Daniel James Devine

Charissa Koh

Charissa is a WORLD reporter who often writes about poverty fighting and prison reform, including profiling ministries in the annual Hope Awards for Effective Compassion competition. She is also a part of WORLD's investigative unit, the Caleb Team. Charissa resides with her husband, Josh, in Austin, Texas. Follow her on Twitter @CharissaKoh.


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    Posted: Fri, 05/08/2020 06:46 am

    When health care doesn't cost you anything people will go to the ER. Maybe there are fewer people because the border is closed due to the virus.

    We have been watching Doc Martin. The UK show. People go to the clinic for anything because it's "free" health care. Some show up because they are lonely and would like to share some tea and a chat with the doc or receptionist. I remember when I worked at the University and had health care. People on that health care would go to the doctor for anything because it was basically free. Maybe a small co-pay.

    I am on Medicare. There is nothing free or cheap about Medicare. You pay while you work and then you pay again out of your Social Security when you "retire". And then you pay again when Medicare says they aren't paying for that blood test the doctor ordered. The recent blood test the doctor ordered for cholesterol cost us $70. Or you pay the doctor what Medicare won't pay the doctor. It's amazing what little they pay the doctors. So the doctors or blood clinic make you sign a paper that says they can hire a collection agent to get the rest of the money they want. WHY DO PEOPLE THINK MEDICARE FOR ALL is a good thing? 

  • VolunteerBB
    Posted: Fri, 05/08/2020 02:50 pm

    Agreed.  Many people go to the ER for things that are not an emergency, even with the "doc-in-a-box" facilities everywhere.  Now they are too afraid to go for the simple things.  They don't worry about paying the ER bill because they are on medicaid or they will just throw the bill in the trash.  BTW the ACA was supposed to eliminate the huge ER goers and costs, it didn't happen.  I've read many articles how just as many if not more visit the ERs in our country for minor things, also because they don't have regular doctors.

    I realize the point of this article were people with real problems that should have gone to the ER and were too afraid.  Well, just look at how many lives have been lost at nursing homes, places where there is a self-imposed lockdown, these people are not going anywhere, yet the virus came to them...from healthcare workers or other workers coming into the facilities, not family members or visitors.  Sad when you cannot trust the people taking care of you in that vulnerable situation.

  • RC
    Posted: Fri, 05/08/2020 09:43 am

    The problem is that the media and others, have manufactured so much fear around Covid-19 that it is has become the number one killer of humanity, in people’s minds.  Even if people have high risk factors, age, lower immunity, respiratory and other related diseases, etc. that does not a guarantee that they will die if they get Covid-19, but that is exactly what most people think.

    I believe that they are going to find that a small percentage of the population has some genetic, or other inherent weakness, that allows Covid-19 to be a killer to them. That is why perfectly healthy people have been killed by it and why the 94-year old women who was recovering from a serious stoke, got Covid-19 with pneumonia and yet recovered.  The healthy person had that weakness and the 94-year old did not. This is also why they are discovering so many asymptomatic people who are not getting sick. They are all lacking that weakness and I bet many of them have some of the risk factors of those who are getting hospitalized for Covid-19.

    Anne Graham Lotz said it best, fear and panic is more of the problem than Covid-19.