NC hospitals don’t want COVID-19 to keep you from getting treated for a heart attack
North Carolina may be starting to emerge from its spring coronavirus hibernation, but doctors and hospitals are still concerned too many people are not seeking help for non-COVID-19 health problems.
Last month, hospitals in the Triangle reported that the number of people showing up at their emergency departments with heart problems, strokes or other ailments had dropped as much as 50%. Doctors began to hear from patients that they had put off coming in because they were concerned about contracting coronavirus.
Those fears may be receding a bit. At Duke University Hospital, emergency room visits were down 39% on average in recent weeks but are off just 21% in the last five days. Visits at Duke Regional Hospital in Durham have seen a similar rebound but remain more than a third less than normal.
The pattern is the same at UNC Medical Center in Chapel Hill and UNC Rex Hospital in Raleigh. The emergency department at Rex is now seeing 120 to 130 patients a day, up from an average of 105 in April, according to Kim Boyer, the department’s clinical director. But that’s still less than the 180 to 200 it averaged before the coronavirus outbreak.
And more people are coming late to the emergency room, rather than acting when the pain starts, says Dr. Ryan Lamb, the medical director for emergency medicine at Rex. That means, for example, more people show up with a ruptured appendix rather than the less serious appendicitis, Lamb said.
“What we are seeing a lot less of is people presenting early enough for us to make a significant change in their health,” Lamb said. “Waiting two days to come in for your heart attack could lead to permanent damage, where if you come in within hours you can go home the next day essentially unaffected.”
Fear doesn’t explain all of the decline in emergency room visits. As businesses closed and people stayed home this spring, there were fewer injuries because of car crashes and other accidents, says Dr. Abhi Mehrotra, the medical director for the emergency department at UNC Hillsborough, which is seeing about a third as many patients on average as it did before the pandemic.
“As we’re starting to open up the economy and people are coming out, we’re now seeing a slight uptick in trauma,” Mehrotra said.
With unemployment at record highs, financial concerns may also influence people’s decisions about seeking health care, said Debbie Laughery, spokeswoman for WakeMed. Laughery said traffic at WakeMed emergency departments varies from day to day but is down overall.
“The concern still exists that people are delaying the care they need,” she said.
Hospitals work to create safe environment
Hospitals have taken numerous steps to reduce the risk of contracting coronavirus and make patients feel more comfortable. For starters, they keep patients suspected of having COVID-19 away from those who aren’t; WakeMed’s main emergency department, for example, now has a separate 14-bed unit for people with respiratory illnesses.
Lamb said at Rex the staff devoted to coronavirus patients remains separate, too.
“Most likely if you’re seeing somebody in a non-COVID area, that physician and that nurse are not going to be treating patients in our COVID area,” he said. “So we’re segregating as much as we can in that way.”
Hospitals say they now have plenty of masks and other protective equipment for both staff and patients. They’ve used the last few weeks to redesign their layouts and procedures to encourage physical distancing and reduce “touch points.”
WakeMed has developed something it calls On My Way, which allows patients to pre-register on their own computer or device before coming to an emergency department, reducing wait times and interactions with people and equipment at the hospital. WakeMed will begin testing On My Way at the emergency department in Apex next week, Laughery said, with the goal of eventually using it systemwide.
In March, hospitals in North Carolina began preparing for a flurry of coronavirus patients. They canceled non-urgent surgeries and procedures, reassigned staff and stockpiled equipment needed to handle people with a contagious respiratory illness.
Public health and hospital officials say that surge didn’t happen in large part because people stayed home and away from each other, curbing the spread of the virus. While hospitals remain prepared for an increase in COVID-19 patients as stay-at-home orders are eased, they have urged others not to put off seeking treatment if they need it.
Lamb recalled a phone conversation with the sister of a patient who arrived at Rex with severe respiratory problems unrelated to COVID-19 and who ended up in the intensive care unit.
“She asked me is it OK for him to be in the hospital and for us to treat him” during the coronavirus outbreak, Lamb said. “I was pretty shocked to hear that someone wouldn’t think that we would take care of somebody who was critically ill just because of what’s occurring with the pandemic.”
