Fears lead other patients to evade vital treatment

It was the call that Lance Hansen, gravely ill with liver disease, had been waiting weeks for, and it came just before midnight in late April. A liver was available for him. He got up to get dressed for the three-hour drive to San Francisco for the transplant surgery. And then he panicked.

“Within five minutes after hanging up, he started hyperventilating,” his wife, Carmen, said. “He kept saying: ‘I’m going to get COVID, and then I’m going to die. And if I die, I want my family there.’ I couldn’t believe what I was hearing.”

She promised she would wait outside the hospital, as patients’ families were barred from entering. She warned that he might not get another chance at a new liver

before it was too late. She told him he could die if he didn’t go. Still, Hansen, 59, refused.

In a world seeded with anxiety, fear is gripping not just people who are ill with the coronavirus but also those in urgent need of other medical care. Even as the number of COVID cases declines in many places, patients with cancer, heart disease and strokes, among others, are delaying or forgoing critical procedures that could keep them alive. And as the virus reignites in pockets of the country, people are ignoring symptoms altogether, afraid to set foot in emergency rooms or even doctors’ offices.

Under orders from their states, many hospitals canceled elective surgeries like hip replacements as COVID cases soared. Now most are gradually allowing the resumption of elective surgeries. But for these, as well as for more time-sensitive procedures like cardiac catheterizations, cancer surgery and blood tests or CT scans to monitor chronic conditions, doctors now find themselves spending hours on the phone trying to coax terrified patients to come in.

In a review of its claim and pre-authorization data for seven acute conditions, including heart attacks, appendicitis and aortic aneurysms, insurance company Cigna Corp. found declines ranging from 11% for acute coronary syndromes to 35% for atrial fibrillation in the rate of hospitalizations over a recent two-month period. In a study published Tuesday in The New England Journal of Medicine, Kaiser Permanente reported a drop of nearly 50% in heart attack admissions in its Northern California hospitals.

At the University of Rochester Medical Center in Rochester, N.Y., emergency room visits dropped by 50%, and many of the patients who do come have waited too long to seek treatment. They “are presenting late with strokes and heart attacks,” said Dr. Michael Apostolakos, the system’s chief medical officer. “Or they’re not showing up until they can barely breathe from heart failure.”

In Newark, N.J., emergency medical services teams made 239 on-scene death pronouncements in April, a fourfold increase from April 2019. Fewer than half of those additional deaths could be attributed directly to COVID-19, said Dr. Shereef Elnahal, president and chief executive of Newark’s University Hospital.

Declining crucial, potentially lifesaving treatment might seem irrational. Mental health experts explain that anxiety affects the part of the brain involved in thinking and planning for the future. It arises when that part, the prefrontal cortex, doesn’t have enough information to accurately predict what lies ahead, causing the brain to spin scenarios of dread.

Enter panic.

“If you have anxiety and then you exacerbate that by watching the news and reading social media, that’s where you get panicked,” said Dr. Jud Brewer, a psychiatrist and behavioral neuroscientist at Brown University. “And the rational, thinking parts of the brain stop functioning well when we’re panicked.”

Panic, in turn, can lead to impulsive behavior and dangerous decisions, Brewer and others said.

“People are saying: ‘So I’m having a heart attack. I’m going to stay home. I’m not going to die in that hospital,’” said Dr. Marlene Millen, a primary care physician at the University of California, San Diego. “I’ve actually heard that a few times.”

Most hospitals and outpatient clinics have made changes designed to keep patients and staff members safe. Many are testing patients and certain workers. In many hospitals, COVID patients are kept in separate units. Masks are usually mandated for both patients and clinicians. Cleaning protocols have been turbocharged. As a result, experts say, the risk of acquiring COVID when going into a hospital is very low.

But one of the common safety measures — banning visitors, even close family members — is a huge reason for patients’ fear and apprehension.

“The hospital was an ominous, nerve-racking and scary place for patients even before COVID,” said Dr. Lisa VanWagner, a transplant hepatologist at Northwestern Medicine in Chicago. “Now you take a stressful situation like a pandemic and you tell people that they cannot have their normal support system while they’re in the hospital, and that really magnifies those fears.”

Health system administrators are redoubling their efforts to convince patients that it is safe to come into hospitals and outpatient clinics, even as testing for hospital personnel and patients remains spotty.

“Our goal is to spend almost all our marketing dollars over the next year around the safety of our institution,” said Dr. Stephen Klasko, chief executive of Jefferson Health, a 14-hospital system based in Philadelphia.