On an average day before the pandemic, the emergency department at Saint Francis Hospital and Medical Center in Hartford would be busy with people coming in for heart attacks, strokes, trauma, injuries, common illnesses like the flu and bronchitis, and other less acute problems.
But Dr. Steven Wolf, chairman of emergency medicine at Saint Francis, said it’s been weeks since the emergency room has had that level of activity outside of COVID-19 cases.
“When the social isolation got very serious in mid-March, a lot of the less acute things started to disappear — people were afraid to come to emergency departments,” he said. “And then we started to see very, very sick people at that time. So, the volume went down probably close to 50% of what we normally had, but the patients we did get were extremely ill.”
For weeks, Connecticut hospitals have prepared for a surge of COVID-19 patients. Elective procedures were canceled, people dealing with less serious medical issues were encouraged to seek outpatient and primary care, health systems erected overflow sites — all of it was done to increase bed capacity and conserve personal protective equipment for a projected influx of pandemic patients.
And while Saint Francis and other hospitals continue to admit people who are seriously ill with COVID-19, they’ve also seen a significant drop in overall emergency department visits. Wolf said that’s worrying, because it means people who are experiencing symptoms of heart attacks and strokes, but not seeking emergency medical care out of fear of the coronavirus, may be more likely to die.
“We had stories from patients themselves that they had had symptoms for several days and didn’t want to go to the ER because they were understandably afraid of [COVID-19],” he said. “People were unfortunately toughing it out at home, and so I don’t think we’ll ever fully know, but in my mind, there’s very little question that people perhaps passed away at home [who] didn’t need to, because they didn’t seek care earlier.”
Hospital systems across the country have been reporting similar declines in emergency department visits. According to poll results released Tuesday by the American College of Emergency Physicians, nearly one-third of American adults said they have delayed or avoided medical care out of concern for COVID-19.
About 80% of respondents said they are concerned about contracting COVID-19 from another patient or visitor if they need to go to an emergency room. Others said they worried about being turned away from a hospital or doctor’s office when seeking care during the pandemic.
In Connecticut, Dr. Jonathan Gates, director of trauma at Hartford HealthCare, said trauma patients continue to come in, but the volume is down.
“We’re still able to take care of trauma patients as they come in the door,” he said during a media briefing. “We are set up in the emergency department in order to be able to do that and do it safely.”
Because of social distancing and stay-at-home orders from the state, Wolf said it made sense when injuries from car accidents or industrial accidents began to drop, “because there was less of all of that anyway, so that was explainable.”
But heart disease, cancer, respiratory diseases and stroke remain leading causes of death in the United States. Physicians said related medical emergencies haven’t stopped occurring because of the pandemic, and hospitals are still able to perform diagnostic testing, surgeries and other urgent care.
Wolf said at Saint Francis, people who come in through the emergency department are quickly put into private rooms, whether they’re suspected of having COVID-19 or not. Everyone — hospital employees and patients — is asked to wear face masks, and strict sanitation practices are in place.
“We’re making it as safe [an] environment as we possibly can,” Wolf said, “and it’s certainly not worth not coming in for possible stroke symptoms and heart attacks and abdominal pains — all of that can be very serious, and there’s no way to know without being seen for that.”
Kathleen Silard, president and CEO at Stamford Health, said Friday there’s been a noticeable reluctance among people to go to emergency rooms but also to other kinds of health care environments. And if they’re not getting health care now, she said that could lead to long-term consequences.
“People are perhaps neglecting the care that they truly need,” she said, “and [that] could create a surge and could create more prevalence of disease later on.”