The novel coronavirus has been overwhelming healthcare systems around the world in a catastrophic way. Vital machines and medication are in short supply, and many healthcare workers are struggling to keep up with the influx of patients without the protective equipment necessary to keep them safe.

After nearly two months of government shutdowns and stay-at-home orders, a new concern is emerging: patients with non-COVID-19- related medical emergencies are avoiding the hospital, and in some cases, this is leading them to their death.

A Decrease in Hospital Visits

Doctors are now saying that people with serious and life-threatening illnesses are avoiding hospitals during the coronavirus pandemic. Whether they are staying away from hospitals out of fear of catching the virus, or if they don’t want to put more pressure on the already overburdened healthcare system, the number of hospital visits since the pandemic began has significantly decreased.

Dr. Jeff Shaw, a cardiologist in Calgary, Canada, recently took to Twitter expressing his concern.

“I lost the battle to save a patient last night because they waited too long to come to the hospital,” he said. “I know there is a lot of fear of hospitals now and concern about being turned away. If you are sick and need help, hospitals are safe and are ready to look after you.” [1]

He says he is concerned that there are many patients who are staying at home and avoiding treatment, even when they’re sick.

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“I’m afraid there could be patients who could have treatable issues that come in too late or get complications from issues that could have been prevented had they shown up earlier,” he said [1].

Dr. Shaw is not the only one concerned. After Dr. Comilla Sasson, an emergency medicine physician in Denver advised a patient during a telehealth session that she was showing signs of a heart attack and that she should get herself to a hospital, her patient said that she would rather die than risk getting coronavirus [2].

Sasson explained that every minute you delay, your chances of having a worse outcome increases. 

“If you get to the hospital within a few minutes [after a heart attack], we can open up that heart vessel and get blood flowing to your heart, but if you delay even a few hours, that could be the difference between life and death.” [2]

Dr. Dhruv Kazi, a cardiologist at Beth Israel Deaconess Medical Center in Boston, explained that his main concern is the patients who are experiencing more mild symptoms and choosing to stay home.

“Individuals who are having very extreme heart attacks are going to get help, but at the fringes you have people who have acute symptoms who are staying home,” said Kazi. “I am worried that these patients could suffer severe consequences weeks or months down the road that could have been avoided if we had intervened.” [2]

Kazi says that people who are experiencing the warning signs of a heart attack should not use telehealth to try and contact their doctor, but should call 911 and get to the hospital right away. He emphasizes that waiting until the problem is more severe could actually put more strain on the healthcare system.

Read: New Zealand’s aim to be the first country to completely eliminate COVID-19 is working

Non-Coronavirus Healthcare

Doctors want patients to know that even as they continue to treat COVID-19, they are still there to address other medical needs. In particular, if you have a chronic illness or diseases like diabetes or heart disease, you should keep your essential appointments with your doctor. You should also keep your appointments for neurological issues as well as pre and post-natal care. In some cases, virtual appointments may be an option, so you should speak with your doctor to find out what’s best for you [3].

It is sometimes difficult to know whether what you’re experiencing is an emergency or not, and what type of care you should seek. There are certain symptoms, however, that are best evaluated in an emergency room setting, and they include:

• Chest pain or difficulty breathing
• Weakness/numbness on one side
• Slurred speech
• Fainting/change in mental state
• Serious burns
• Head or eye injury
• Concussion/confusion
• Broken bones and dislocated joints
• Fever with a rash
• Seizures
• Severe cuts that may require stitches
• Facial lacerations
• Severe cold or flu symptoms
• Vaginal bleeding with pregnancy [3]

If you decide to get emergency care, you will be screened for COVID-19 before you enter the hospital in order to better isolate those with the virus. Most hospitals now have specific areas set aside for patients who have the virus, in order to keep those who don’t, safe.

“When in doubt, call 911,” says Ghazala Sharieff, MD. “It’s important that you get to the emergency room quickly and safely, especially if you are experiencing severe chest pain or severe bleeding, or if you feel like you might faint or have impaired vision,” [3].

An urgent care facility may also be an option for you, as opposed to an emergency room. These are same-day clinics that provide immediate treatment for a variety of medical issues that are not considered “true emergencies”. Symptoms that can be evaluated at an urgent care clinic include:

• Fever without a rash
• Vomiting or persistent diarrhea
• Abdominal pain
• Wheezing or shortness of breath
• Dehydration
• Moderate flu-like symptoms
• Sprains and strains
• Small cuts that may require stitches [3]

For other, non-emergency medical problems, telehealth is available. 

“Telehealth is a safe, convenient and cost-effective option for patients seeking care, especially during a crisis, for conditions that are not potentially life-threatening,” says Dr. Sharieff [3].

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The Consequence of Virus-Reduction Strategies

Dan Lane, a third-year medical student, and epidemiologist in Calgary, Canada, is currently leading a study that is determining whether patients who are arriving at the hospital right now are sicker upon arrival than they were before the pandemic started.

He says that the city has seen a thirty to forty percent decrease in the number of hospital visits over the last month, but those who are going to the hospital are in far worse condition than usual.

“If you had a patient with appendicitis, they may be coming in at a state where the appendix has already ruptured, as opposed to just sort of the beginning stages of the disease where it’s just causing abdominal pain and discomfort,” he said [1].

He said that while the social distancing orders that have been put in place by health officials are necessary to slow the spread of the virus, this could be one of the negative side effects of that strategy.

“In medicine, almost everything we do involves some sort of a tradeoff,” he said [1].

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