Christine McCarthy, a nurse for over 20 years and a palliative nurse for the past year, sits for a portrait on an empty hospital bed at Massachusetts General Hospital in Boston on Apr. 2, 2020. Here at the states largest hospital, staff are coping with unprecedented realities in this coronavirus pandemic and deeply worried about what is yet to come. There is an odd juxtaposition inside this normally bustling world-renowned hospital: Expanded intensive care units are packed with COVID-19 patients, while other floors and places such as family waiting rooms are deserted, quiet.

Erin Clark | Boston Globe | Getty Images

Dr. Rod Hochman said his brother-in-law “was petrified” of going to the hospital for a necessary doctor’s appointment, fearing he would catch the coronavirus.

The CEO of Providence St. Joseph Health in the Seattle-area, Hochman was eventually able to convince his relative to go by suggesting he take the first appointment in the morning and wear a mask.

His brother-in-law isn’t the only patient afraid to go to the hospital in the middle of the Covid-19 pandemic. Emergency room and other doctor’s visits at Providence’s 51 hospitals are way down, reflecting a broader trend across the U.S. as people steer clear of hospitals for sometimes necessary and emergency care, even for mild heart attacks. Physicians worry that patients with severe illnesses may suffer permanent damage by avoiding the ER. 

‘Too good to be true’

At Providence, the volume of heart attack patients fell by about 50% in March compared with the same month last year, Hochman said, adding that the notion that people have just stopped having heart attacks is “too good to be true.” He and other physicians suspect patients that have mild heart attacks or strokes — that would have normally sent them to the emergency room in the past — are seeking treatment from family doctors, outpatient clinics or foregoing it altogether as Covid-19 patients inundate hospitals across the country.  The consequences could last years, he said.

“The big question is are we going to see a lot more people that have bad outcomes from heart disease, from stroke, from cancer because they’ve put off what they should have had done but were too afraid to come to the hospital,” he said.

Injuries are down

Emergency room visits are likewise down by about 50% across New York City Health + Hospital locations, according to data shared with CNBC. The decline isn’t just being driven by fear of catching CV-19. Injuries across the country have fallen as most people stay home under some sort of quarantine order. There’s also public confusion over the cancellation of elective procedures, doctors and hospital administrators told CNBC.

“In my almost 30 years of practicing dermatology, I’ve never seen anything like this,” said Dr. Fayne Frey, a dermatologist in Rockland County, New York, about 20 miles north of New York City, the largest Covid-19 outbreak in the country. 

Since the coronavirus outbreak began to hit the state hard in March, her patients have been flooding her office — but not for the usual acne treatments or Botox. She said she’s seen a surge of patients who need emergency care but want to avoid going to the hospital. 

Frey’s dermatology practice has remained open as an essential business and as patient visits have dropped, especially for elective procedures, she’s seen an unusual uptick in patients that would normally seek treatment at a hospital.

Last week, a patient with a deep, six-inch laceration came into her office needing stitches, Frey said, adding that the patient said she didn’t want to go to a hospital during the coronavirus pandemic. Frey’s also seen staph infections, shingles, badly infected cuts and rashes that would normally land a patient in the emergency room, Frey said. 

Fear

“I’m seeing people who don’t want to go to the emergency room,” she said. “I just think there’s an overall fear right now of going near urgent care centers and emergency rooms because that’s where people with a cough and fever will go.”

It’s not just fear that’s keeping people out of the hospitals, Hochman added, but also misunderstanding. On March 19, Washington Gov. Jay Inslee ordered physicians to halt all elective surgeries to free up equipment and personnel for Covid-19 patients. However, there are exceptions, including scenarios where delaying a procedure would cause harm to the patient. Hochman said he’s concerned people think hospitals are closed to non-coronavirus patients. 

“If I have a mass in my groin and I need to have a biopsy, I’m not sure that’s elective,” he said. He also said preventive care is down, including colonoscopy screenings for cancer and mammograms, which could have long-term public health consequences like a jump in cancer rates a year or so down the road. 

“We’re possibly going to see a blip in other disease entities as a consequence of doubling down on Covid-19,” he said, adding that it will take years to fully understand the consequences.

Stay-at-home orders

The drop in non-coronavirus patients is a trend seen all over the U.S., according to the American Hospital Association, which identified stay-at-home orders as the  primary cause. The group represents more than 5,000 hospitals and health networks.

“Across the country, our members have observed a decline in patients who need non-Covid-19 emergency care,” the group said in a statement. “An influencer of this trend is stay-at-home orders, which have resulted in less incidents such as accidents and other injuries.”

However, stay-at-home orders probably don’t account for the entire drop in visits, said Dr. Usamah Mossallam, vice president of Henry Ford Health, which runs five hospitals in Southeast Michigan. It makes sense that blunt trauma like car accidents and work-related incidents are down due to such policies, he said. However, Mosallam said he’s also observed a major drop in other emergency visits.

“We believe a lot of this is fear of coronavirus,” he said, adding that he’s concerned that people with illnesses like asthma that require ER attention are staying home instead and that could be causing long-term damage.

‘Heart attacks don’t stop’

Dr. Christopher Freer, director of emergency medicine at RWJBarnabas Health, which has 11 emergency departments across New Jersey, echoed Mossallam’s point. 

“Even with coronavirus, we still have healthy people who get an illness and need to go to the emergency room,” he said. “Heart attacks don’t stop.”

RWJ normally has about 280 emergency visits per day, he said, adding that this past weekend, they were down to about 180 per day. He said they’re still seeing the most severe patients like stroke victims and appendicitis patients, but people with mild injuries have stopped coming in, for the most part.

It has one welcome side benefit: it’s helping to free up hospital beds that U.S. and state officials have projected will soon be overflowing with Covid-19 patients. Instead of the wartime triage scenarios predicted by U.S. health officials, emergency rooms in some parts of the country are relatively empty. 

‘Dog that doesn’t bark’

Cardiologist and health care researcher Dr. Harlan Krumholz at the Yale School of Medicine in New Haven, Conn. said that despite the Covid-19 patients flooding some hospitals, many emergency wards remain quiet. It’s difficult to know just how many people aren’t seeking emergency care, he said.

“It’s like asking have you seen the dog that doesn’t bark,” he said. “The hospitals aren’t nearly as full as they were before.”

U.S. hospitals need to get the message out that they are safe, Krumholz said, and that there are systems in place to protect non-coronavirus patients. If people delay care by waiting to go to the hospital until symptoms have developed into a serious illness, it could be too late to prevent long-term damage or even death, he said.

“If you’re having trouble speaking or you have weakness in one of your arms or legs, these aren’t things to tough out,” he said. “More people are dying at home and some of them are dying of things that aren’t directly related to the virus.”

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