California’s hospital emergency departments are strangely quiet places
these days.
Before the coronavirus hit, tens of thousands of people across the state
sought emergency help each day. But in the weeks since the virus began
its spread throughout the U.S., those numbers have plummeted by a third
to a half, according to physicians overseeing emergency departments in
hospitals across Los Angeles County and elsewhere in California.
The steep decline comes amid drastic measures hospitals have put in place
to prepare for what health officials fear could be a wave of patients
infected by the coronavirus like the ones that have overwhelmed hospitals
in New York City and elsewhere.
So far, the numbers of people sickened by the virus in California have
been manageable. But now doctors and health officials are increasingly
worried that steps taken to keep hospitals at the ready, along with a
widespread public fear the virus is rife in emergency rooms, have left
people who are in immediate need of lifesaving help unwilling to seek
treatment.
“Where are the strokes and the heart attacks? Where are the diabetics
having complications?” said Dr. Larry Stock, an emergency physician
at Antelope Valley Hospital. “These cases didn’t just vaporize
with the virus. I worry people are suffering at home because they’re
afraid our emergency rooms are radioactive.”
Physicians and health officials are amending their urgent warnings about
the virus to stress that emergency departments are not overrun and can
treat people safely. The full effect of what Stock dubbed “corona
collateral damage syndrome,” and what another emergency physician
called “a virus of fear,” has not yet been tallied as hospitals
and state agencies begin to gather comprehensive figures.
But from interviews with more than a dozen physicians working in rural
and urban hospitals around the state, a portrait emerges of how emergency
care in California has been upended by the virus. They worry people are
dying at home from conditions that could have been treated and others
who survive will now suffer from serious, chronic conditions resulting
from their failure to seek help.
Before the coronavirus made inroads in the state, the emergency department
at Hoag Hospital in Orange County typically treated about 90 stroke victims
each month, said
Dr. David Brown, a neurologist who directs the hospital’s stroke program.
Since state and county officials issued orders last month largely instructing
residents to remain at home, the number of stroke cases coming to the
hospital has dropped by half, Brown said. Overall, the number of patients
coming to Hoag’s emergency department has fallen by half as well,
hospital figures show.
Similarly, Centinela Hospital Medical Center in Inglewood, which used to
have about 180 stroke patients in its emergency department each month,
has seen those cases fall by 50%, the hospital’s emergency department
director said.
And at the Ronald Reagan UCLA Medical Center, stroke cases also have dropped
by half, while the number of people being treated for heart attacks is
down 30%, said Dr. Greg Hendey, chair of the emergency department. Stroke
patients at Cedars-Sinai Medical Center in Los Angeles have declined by
15%, according to the head of the emergency department.
The physicians interviewed, who work in Southern California as well as
in Visalia, Sacramento and Fresno, said emergency cases at their hospitals
were down 30% to 50%. At Kaiser Permanente, which operates a large network
of hospitals around the state, emergency department patients have fallen
off by more than half, a Kaiser representative said. The number of people
being transported by ambulance to hospitals in Los Angeles County is down
between 20% and 30%, a county official said.
Seeing the brutal toll the coronavirus has taken in New York City and other
hot spots, where infected people swamped hospital emergency rooms, California
officials have implored the public to take its deadly potential seriously.
And they have hammered on the importance of not seeking help at hospitals
unless absolutely necessary in order to leave them able to handle a possible
surge in cases here.
The public push has been effective. And with people staying home, the number
of car accidents, shootings and other trauma cases coming into emergency
rooms is down, while people with non-urgent ailments have stayed away as well.
But lost in that messaging, physicians and health officials now worry,
was an important caveat: If you’re having a medical emergency, you
should still go to the hospital.
“It’s fear,” said Dr. Carrieann Drenten, an emergency
physician in Sacramento. “People are afraid to come in because the
emergency department is seen as this haven of infection and sickness.”
Patients who resisted seeking help and then came to the hospital days late
underscore the problem, physicians said.
Brown, the neurologist at Hoag Hospital, recounted an elderly woman who
arrived at the hospital last week. She had remained at home for four days
despite having weakness on one side of her body and difficulty speaking
— both telltale signs of a stroke.
Asked why she had waited, the woman told doctors she had been afraid she’d
be exposed to the coronavirus at the hospital, Brown said.
Had the woman come in right away, Brown said, doctors probably would have
been able to give her medications that can prevent lasting damage if they
are administered soon after a stroke or perform a procedure to remove
the blood clot causing the stroke.
As it was, there was little to be done for the woman, who suffered permanent
brain damage and paralysis, he said.
And a 43-year-old man who suffered a heart attack was lucky to be alive, said
Dr. Dipti Itchhaporia, a cardiologist and director of disease management at Hoag.
Despite several days of chest pain, the man told his wife he would not
go to the emergency room because of the virus. As the pain worsened, he
dug in his heels, but agreed to see Itchhaporia at her office. Seeing
he had a blocked artery doctors commonly refer to as “a widowmaker,”
Itchhaporia sent him to the hospital, where she cleared the artery.
The apparent problem is nationwide, according to a study of nine major
cardiac centers around the country. In March, as the coronavirus spread,
the number of patients who underwent critical artery-clearing procedures
such as the one Itchhaporia performed dropped 38% compared with an earlier
period, the study found.
Doctors and health experts also worry about people with injuries or illnesses
that would not be critical in the moment but can become major problems
if allowed to fester. Physicians interviewed offered gruesome accounts
of patients arriving days after suffering lacerations, skin infections
and ruptured appendixes.
The fear of contracting COVID-19, the illness caused by the coronavirus,
is largely misplaced, doctors said.
If a hospital has implemented widely used safety measures such as screening
patients for symptoms of the illness before they enter the emergency department,
cleaning thoroughly and isolating anyone who shows signs of the virus,
the risk is low, they said.
Health officials are now trying to spread that message. Dr. Christina Ghaly,
director for the Los Angeles County Department of Health Services, last
week urged people to get help if they are having an emergency, saying
they “do not need to be worried” about getting infected. Hospitals
and medical associations have put out similar messages.
The effect of people forgoing treatment could be deep and long-lasting.
Physicians said they believe people are dying in their homes and expect
to see a rise in cases of congestive heart failure, major strokes and
other chronic problems that are the result of people failing to be treated
during the current crisis.
“Down the road, we don’t want to look back and see high mortality
rates in cases we could have helped if people had come in,” said
Dr. Sam Torbati, co-director of the emergency department at Cedars-Sinai.
“We need to bring the pendulum back to a reasonable spot.”
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