Daily Local News (West Chester, PA)
Patients delay ER trips over pandemic fears
A few weeks ago a patient of one of Dr. Andrew Waxler’s colleagues died of a heart attack in a hospital emergency room.
His colleague, Waxler said, insists it didn’t have to happen.
“He had symptoms for a week and waited until 1 a.m., until he couldn’t breath,” Waxler said. “He was on death’s doorstep.”
The patient, like far too many others, hadn’t wanted to go to the emergency room, Waxler said. Inundated by warnings about the deadly COVID-19 pandemic sweeping across the world, he considered it too risky.
“There have been cases like this all over the state, all over the country, all over the world,” said Waxler of Wyomissing. “People are making the decision to not come in. And that’s actually COVID causing the indirect effect of both harm and also death that should not have happened.
“It’s not that the patients don’t know any better, they’re sort of overwhelmed with fear over this virus.”
Waxler — who is a clinical assistant professor of medicine at Penn State College of Medicine, president of the Pennsylvania chapter of the American College of Cardiology and governor of the American College of Cardiology representing eastern Pennsylvania — said there have been countless stories about heart attack and stroke victims getting help too late after delaying trips to the emergency room because
of COVID-19 fears.
The trend first started becoming obvious about five or six weeks ago, Waxler said, with hospitals reporting much lower than normal numbers of heart attack and stroke patients coming to emergency rooms.
“At first that seemed like a good thing, but then we started noticing there were more people coming into the hospital late,” he said. “They would say they had tightness in the chest for three days, and we’d say, ‘Why didn’t you come in?’ they’d say, ‘Oh, heck, I’m not coming in to the hospital, I don’t want to catch that terrible virus.’”
The situation, Waxler said, is the sad consequence of three months of warnings about social distancing and other measures to prevent the spread of coronavirus.
“Every time you turn on the TV, turn on the radio, everybody is preaching about social distancing,” he said. “I don’t really think anyone is to blame. I think this is just an emotional, psychological reaction that people are terrified of this virus.”
The warnings to social distance and stay at home were particularly targeted toward those with underlying medical conditions, often times the same people most at risk for a heart attack or stroke.
“We literally said everybody should stay in their house and social distance, but, my goodness, if you have any pre-existing condition you should definitely stay home,” Waxler said.
Part of patients’ fear likely came from the medical community, Waxler admitted. In the early days of the coronavirus crisis there were constant warnings about hospitals getting overrun, about shortages of supplies and staff.
But, Waxler said, there perhaps should have also been more of an emphasis on telling people that if they are having a serious medical issue they should still come to the emergency room.
“We probably contributed to creating this fear, but, remember, creating that fear probably saved lives,” Waxler said. “What I find frustrating is that patients social distanced from the emergency room. We told them to social distance from their friends, from big parties.
“People have taken what we said and went too far with it.”
Waxler said hospitals across the nation are, in fact, safe, and that people should not be afraid to go there if they need to. And if someone is showing signs of a heart attack or stroke, they shouldn’t delay.
“There’s an infinitesimally small chance you’ll get COVID at a hospital,” he said. “But every minute that goes by is more damage to a person’s heart. The same is true with a stroke, every minute is more damage to the brain.
“It’s tragic that people are having irreversible heart damage or death, or irreversible stroke damage or death, when there’s a good chance it could have been reversed had they come to the hospital.”
Waxler said he hopes people heed his warning, and as Pennsylvania continues to reopen from its coronavirus shutdown people realize the importance of treating serious medical issues quickly.
“Heart attacks and strokes sort of take priority,” he said. “If we can save one person with that message then it’s a home run.”
Reading Hospital
Berks County, and Pennsylvania as a whole, has been doing a very good job at social distancing, said Dr. Charles Barbera, Tower Health vice president of pre-hospital and unscheduled care.
The medical community has done well educating the public about the risks of COVID-19, of the steps they need to take to stay safe. But now, another lesson is in order.
“We need to now educate people that COVID is not the only health risk out there,” he said.
Barbera said Reading Hospital has seen the same trend that is happening nationally, with its emergency room seeing fewer heart attack and stroke victims over the past three months.
According to data provided by the hospital, the emergency room saw a 23.9% decrease in heart attack cases in March compared to March of last year. There was a 28.4% decrease in April and a 25.4% decrease in May.
For stroke patients, the decreases of the previous year were 5.6% in March, 38.5% in April and 15.9% in May.
Part of the reason behind those drops, Barbera said, is fear of the coronavirus.
But Reading Hospital and other medical facilities across the country are actually pretty safe, Barbera said. They’re going above and beyond with precautions to stop the spread of the virus.
“We have the supplies and we have the procedures we need to keep patients and our staff safe,” he said. “We’ve kind of perfected it to make sure we limit the spread of COVID from patients to staff and from staff to patients.”
Some of those procedures include taking the temperatures of anyone who enters the hospital, testing patients who show any symptoms of COVID-19, social distancing and wearing masks. And in the emergency room patients are immediately separated into two areas depending on whether they’re a potential coronavirus case.
“The hospitals are actually a safe place for COVID,” Barbera said. “Hospital transmission for the disease is very, very low, if it happens at all.”
Barbera said it’s particularly important to get the word out about the safety of hospitals now. That’s because the other factor leading to fewer emergency room visits is that those at risk of heart attack and stroke have likely not been taking part in activities that may put them at risk.
The state is slowly reopening, Barbera said, and the weather is warming. That means people will be back to work, back to mowing the lawn, back to going for runs under the hot sun.
“Those are the kinds of things where you need to pay attention to your body,” he said. “Getting life back to normal still means being cautions, and it really means paying attention to the signs your body is telling you.”
St. Joseph hospital
The message was much the same from officials at Penn State Health St. Joseph in Bern Township.
Dr. Jeffrey Held, vice president of medical affairs at Penn State Health St. Joseph, said there has been about a 40% decrease in the number of people being evaluated for stroke and heart attack during the coronavirus crisis, but the mortality rate for those cases is increasing.
“We noticed sicker patients coming into the hospital that normally we would have seen earlier in their disease state,” Held said.
What hospital officials realize, and what the data showed, was that people with serious illnesses were delaying going to the hospital. Held said it was a case of warnings about overloading the hospital system and patients’ fear of COVID-19 trumping concern over stroke and heart attack symptoms.
“Is has been clear people have over-heeded the message and avoided coming to the hospital,” he said.
Held and Sharon Strohecker, vice president of clinical services and chief nursing officer at Penn State Health St. Joseph, said people shouldn’t be concerned about heading to the emergency room if they’re sick.
Strohecker said St. Joseph has taken a number of steps to protect patients from COVID-19.
Patients are met outside the emergency room and evaluated, including having their temperatures taken. Anyone with symptoms of coronavirus is taken to a separate area from those facing other issues.
The hospital has also been using intensive cleaning protocols and strict visitation guidelines, Strohecker said.
“I think my biggest message would be please come,” she said of patients concerned about an emergency room trip. Held said much the same. “If you are ill, we are prepared to care for you,” he said.
Held said the hospital is far better prepared to deal with COVID-19 and other health issues than it was when the pandemic first began. Procedures and protocols that they were trying to figure out on the fly back in March have now become standard operations.
“We basically hardwired a lot of this to go forward,” he said.
Putting off a visit to the emergency room, Held said, can have devastating effects, particularly for those experiencing a stroke or heart attack.
“For heart and brain, for stroke and heart attack, time is tissue,” he said, adding that the longer you stay at home with symptoms the more damage is done. “If you have the symptoms and you are concerned about it, come to the hospital.”