The scene at Piedmont Atlanta Hospital’s emergency room is unlike anything Dr. Sean Sue has ever seen in his nearly 30 years practicing medicine.
It’s quiet. Very quiet — in the throes of a COVID-19 pandemic. On some days, there are more physicians than patients.
Looking out at the emptiness, “You’re thinking, where are all of the patients?” said Sue. “Where are the patients having heart attacks, strokes, diabetic ketoacidosis?”
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Those conditions have not disappeared. The frightening answer, according to emerging data and surveys, is that large numbers of should-be patients are staying home, avoiding medical care for fear of infection.
Warning signs like chest pain and shortness of breath — which not too long ago might have warranted a trip to the ER, just to be on the safe side — are being ignored.
But Georgia health care workers don’t need statistics to tell them that. They are seeing it play out in person.
A patient in Rome with a leaking lung delayed coming to the ER until it progressed to collapse, according to the CEO of Floyd Medical Center. A patient with a nascent heart attack waited days before coming to a Wellstar hospital, causing irreversible heart muscle damage, according to the health system’s chief cardiology officer, Dr. Barry Mangel. One of Mangel’s own patients called complaining of shortness of breath and leg swelling, but refuses to come to the doctor’s office. Rebuffing Mangel’s pleas, the patient, who suffers from congestive heart failure, asked instead for treatment he can do at home.
“That’s a sad state,” said Kurt Stuenkel, CEO of Floyd Medical Center. “I mean, if you’ve got chest pain or numbness in a limb or other conditions that you normally would come in for, you should come in.”
Piedmont, Emory and other hospitals stress they are taking precautions to prevent the spread of the virus. And, while it’s unknown how many have died not of the coronavirus, but from fear of it, the data so far is disturbing.
A study by Yale researchers and The Washington Post found that the number of U.S. deaths in the first weeks of the pandemic soared well past the number that would have been expected, even with known COVID-19 deaths included.
That could be attributed to several factors, including some deaths caused by the coronavirus not being categorized that way. But surveys also show people are putting off all kinds of medical care. A new poll commissioned by the American College of Emergency Physicians found four in five adults reported they are concerned about contracting COVID-19 from another patient or visitor in the emergency room.
The poll also found that, because of the virus, nearly a third of Americans are delaying or avoiding some type of medical care, not just the kind that’s provided in emergency rooms. Women are postponing annual mammograms. Families are canceling well-child checkups and vaccinations, and even skipping newborns’ first doctor appointments.
Some Georgia hospitals not caught in coronavirus hot spots are reporting sinking patient volumes.
There are some positive reasons, too. Because of shelter-in-place orders, people aren’t driving, so car crashes have plummeted. Staying at home also means that fewer people are suffering other traumas. But those numbers don’t account for the whole drop.
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Wellstar’s emergency room visits are down 40% to 50% from normal, said Dr. Vik Reddy, Chief Medical Officer of Wellstar Kennestone Hospital. Many other hospitals report similar numbers. At Piedmont Atlanta’s ER, a typical 24-hour-period will bring 180 patients. In recent weeks, the number has dropped to closer to 80 patients.
And the anecdotes are everywhere.
Dr. John Sy, an emergency medicine doctor in Savannah and president of the Georgia chapter of the American College of Emergency Physicians, said he is hearing about more ambulances responding to homes where first responders find the person is already dead.
In some rural or under-served communities, Sy added, emergency physicians are seeing fewer patients but report that those who do come in are more seriously ill or injured, which may mean they are putting off necessary treatment.
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The issue is so serious that the American Heart Association and other heart organizations are creating new hotlines, writing op-eds and using Instagram posts to encourage people to get necessary treatment.
Sue said a woman recently arrived at the ER four days after suffering a stroke. The delay in care, Sue said, likely resulted in complications that could hamper her ability to use her right arm and hand. Another woman put off getting a wound checked for two weeks and now will need surgery.
Dr. David Wright, professor and chair of the Department of Emergency Medicine at Emory, wants to get the message out: “We are not COVID departments, we are emergency room departments.”
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Piedmont, Emory and other hospitals sanitize deeply. They are requiring entrants to wear masks. They’re limiting visitors. They’re distancing patients from each other, and trying to separate suspected COVID-19 patients from the uninfected.
Many doctors’ offices are taking similar precautions. And, while some appointments can be put off, others shouldn’t be.
“I am concerned families are delaying or canceling what could be very needed medical care,” said Dr. Hugo Scornik, a Conyers pediatrician.
He and other pediatricians also worry children are not staying on track with the recommended immunization schedules. PCC, a Vermont company that develops medical record software for pediatricians, has estimated the number of shots given to kids dropped by as much as 40% in early to mid-April.
That puts children at risk for measles, whooping cough and other life-threatening illnesses.
The canceling of newborn check-ups is also alarming. These checkups are critical and allow doctors to pick up on potential problems, including weight loss, umbilical cord infection and jaundice, which should be monitored and treated early.
“Parents may delay calling us and something that may be caught early could become more serious,” Scornik. “If a parent is unsure whether to bring their child in, or whether it’s safe, my advice is to call your pediatrician, and a lot of times we can problem-solve the situation.”
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Today’s empty waiting rooms may portend tomorrow’s crises.
“We’re afraid there’s going to be a surge of non-COVID-19 patients who are ill, who didn’t seek care for the last two to three months,” said Stuenkel.
Sue, the doctor at Piedmont, has similar concerns.
“Is this the calm before the storm?” he wondered.
