Since the coronavirus pandemic gripped the United States, Americans have been told to avoid emergency rooms and hospitals if possible. But now there are reports from across the country that suggest the warning may be in fact too effective, as some patients experiencing urgent health problems are not seeking the treatment they need. PBS NewsHour science correspondent Miles O’Brien reports on the medical and economic consequences.
Americans have gotten the message: Stay away from emergency rooms and hospitals, if you can.
But there are reports all around the country that say the message may be working too well. Some patients who probably should go to the hospital for an urgent health problem are not.
Miles O’Brien has the story. It’s part of our regular segments on the Leading Edge.
A historic pandemic may be raging, but at the EvergreenHealth Hospital in Kirkland, Washington, the emergency department is quiet, eerily quiet.
Registered nurse Holly Nelson is the manager.
Right now, our volumes are low, about 50 percent of what we normally see. And this is a very uncomfortable feeling, having it like this, because we’re used to just anything come through the doors, and, even the first weeks of COVID, being hit hard and not knowing what to expect.
Twenty-five miles to the north, at the Providence Regional Medical Center in Everett, the story is the same, empty waiting rooms, empty halls.
Physician Ryan Keay is medical director.
We normally see 240 to 250 patients a day. Now we might see 140 to 180 patients a day, so very, very different volumes.
Did that surprise you?
It did. I have been on phone calls with medical directors from all over the region and all over the country, and some places report 25 percent decrease in volume in the emergency department. Some places report 40 percent decrease.
It’s a global trend. In the U.S., the numbers are dramatically down at hospitals nationwide, not just in COVID-19 hot spots.
Jeff Tomlin is CEO at EvergreenHealth.
There is something going on. Yes, people are choosing to stay away. We even found that for stroke and even some of our heart attacks, there are less cases coming in now, which doesn’t make a lot of sense, because you would think that there would be the same numbers that we have gotten used to over the years.
It’s a mystery health care professionals can’t solve definitively at the moment, but they fear the root of this massive drop in volume may be fear itself.
Cardiologist Harlan Krumholz is a professor at the Yale University School of Medicine.
I think it suggests a behavioral pattern, one in which people are toughing it out. It’s highly likely that this is because people are experiencing fear and are afraid to come to the hospital.
It’s kind of stunning to me that someone, when they assess their own personal risk, would try to ride out a heart attack at home, when the concern is, you might pick up coronavirus by going to the emergency room.
I felt that way too. And yet I think maybe we have underestimated the kind of fear that now is pervading society, that’s keeping people at home, that are making them think that the hospitals aren’t safe places to be.
It’s easy to see what kindled that fear.
Almost everybody is on oxygen, and almost everybody is a COVID patient.
Scenes like this of overrun hospitals all over the world staffed with health care providers facing critical shortages of personal protective equipment.
But all the mitigation, social distancing and staying home has changed that picture dramatically. And, meanwhile, hospitals have found new ways to make their facilities safer. This engineer is testing to ensure air is not flowing out from rooms occupied by COVID patients.
The term of art is negative airflow. He is part of a team that sprung into action when the crisis first hit at Evergreen. Almost overnight, they modified the HVAC system to prevent the spread of airborne pathogens throughout the hospital.
Dr. Francis Riedo is the medical director of infection control and prevention.
It turned out that the engineers here, who are unsung heroes in this process, could turn the entire critical care unit, which was built in 1976, into a negative flow unit.
We have, at this point, been able to convert almost a third of our hospital beds into negative flow by engineering modifications.
But the question that bothers health care professionals most is: what are the outcomes for those who choose to stay home, despite symptoms of a serious illness?
Dr. Krumholz believes they represent a sizable proportion of excess deaths outside hospitals that epidemiologists are tracking in the midst of the pandemic.
My hunch is that it may be a good third of the toll of people dying out of the hospital, maybe because of preventable illnesses that are not the direct results of the virus, but actually indirect result of people being fearful about getting care.
The lingering impact of the pandemic and the fear have profound consequences for the U.S. health care system.
Hospitals canceled elective procedures in order to create greater capacity for a surge in COVID-19 patients. With the disease curve flattening in many locations, executives like Jeff Tomlin are drafting plans to resume this part of their business.
After all, procedures are how hospitals make their money. Just in March, 43,000 U.S. health care workers lost their jobs.
We have almost zero procedural revenue. And so that will be a challenge for not just us, but health care organizations across the country, because you’re increasing your expenses, and then you almost have zero revenue stream in terms of how to compensate.
I think this is going to be a fine dance with the community, with government, with businesses, because we’re going to have to prove that we can safely care for people as they come back in. We have to get back to work.
For now, the emergency rooms are largely quiet, except for patients with COVID-19. And hospitals now wonder, once they open their doors wider, who will be willing to come in? It’s a question many other businesses will face as well.
For the “PBS NewsHour,” I’m Miles O’Brien in Kirkland, Washington.
Banner image credit: PBS NewsHour/PBS FRONTLINE.