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Non-COVID emergencies take a back seat, putting patients at risk

“I would rather die than risk getting coronavirus right now.”

That’s what a patient told Dr. Comilla Sasson, an emergency medicine physician in Denver, after she advised the patient during a telemedicine visit that she was showing signs of a heart attack and should go to a hospital.

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“I asked if I could talk to one of her family members and she said ‘no’ — that she had already made up her mind,” Sasson told NBC News. It’s unclear what the woman’s diagnosis turned out to be, because she did not reach out to Sasson again.

In the midst of the coronavirus pandemic, medical emergencies unrelated to COVID-19 still occur. Sasson, who works at three hospitals in the Denver area, is among a number of doctors who worry that people experiencing warning signs of life-threatening conditions are delaying seeking emergency help out of fear of going to coronavirus-strained emergency rooms.

March 26, 202001:48

“Every minute that you delay, the likelihood of you having a worse outcome increases,” said Sasson, who is also vice president for science and innovation for emergency cardiovascular care at the American Heart Association.

She used a heart attack as an example: “If you get to the hospital within a few minutes, we can open up that heart vessel and get blood flowing to your heart, but if you delay even a few hours, that could be the difference between life and death.”

At the height of the coronavirus outbreak in Hong Kong, doctors observed the same trend that U.S. doctors are seeing now. In a letter in the journal Circulation: Cardiovascular Quality and Outcomes, physicians wrote that people who were experiencing symptoms of a heart attack waited to seek care after hospitals had suspended nonessential visits. Treatment for a heart attack, however, is essential.

According to Dr. Dhruv Kazi, a cardiologist at Beth Israel Deaconess Medical Center in Boston, putting off seeking medical care for potentially life-threatening conditions unrelated to COVID-19 is likely fueled by multiple factors: people choosing not to go to the hospital out of fear of contracting the virus, lack of transportation to the hospital, and citizens concerned about clogging the medical system.

“Whether it’s benevolence or fear of exposure, we need to address that,” he said.

Kazi is most worried about people who are experiencing acute symptoms that could snowball into a severe condition if left untreated.

“Individuals who are having very extreme heart attacks are going to get help, but at the fringes you have people who have acute symptoms who are staying home,” said Kazi. “I am worried that these patients could suffer severe consequences weeks or months down the road that could have been avoided if we had intervened.”

Most hospitals have instituted telehealth programs that allow patients to seek a medical evaluation remotely. In a situation that is not potentially life-threatening, these lines should always be used over showing up at a hospital, but people should still follow typical protocol for all medical emergencies during the pandemic, not just those related to the virus, Kazi said.

“I do not recommend that if patients are having warning signs of a heart attack or stroke that they should try and use telehealth to reach their doctor,” Kazi said. “These warning signs should result in a 911 call, and because EMS may be busy, calling 911 in a timely manner is even more important right now.”

Delaying care could also put more strain on the health care system in the long run.

“If people defer calling 911 for life-threatening emergencies or put off life-saving procedures because they’re afraid of getting exposed to the coronavirus in emergency rooms or hospitals, we can expect to see an increase in deaths among these people that is not reflected in COVID-19 death toll numbers,” said Kazi.

In New York City, the national center of the pandemic, 911 calls are at all-time highs, fleets of first responders are coming down with COVID-19 and wait times for ambulances have exceeded six hours in recent weeks.

But according to Oren Barzilay, president of the FDNY EMS Local 2507, which represents 4,500 first responders in New York City, call priorities, which determine where help is sent first, have not changed because of COVID-19. Low-priority calls are the ones experiencing these significant delays, not high-priority emergencies.

In fact, holding off on calling 911 until heart attack symptoms worsen could make it impossible for New Yorkers to get to a hospital at all. The Regional Emergency Medical Advisory Committee of New York City announced on Tuesday, March 31, that if an adult is in cardiac arrest and emergency responders are unable to restart their heart at the scene after 20 minutes, that person will not be taken to the city’s overburdened hospitals for further revival attempts, as is normally the case. This means seeking help when symptoms start is even more crucial.

“If anybody is experiencing a true emergency, we will always be there for you. We will never turn anyone away,” Barzilay said.

That goes for doctors working in New York City hospitals as well, though they are carefully weighing treatment options to keep emergency patients from staying in the hospital when possible, said Dr. Daniel Herron, the chief of general surgery at Mount Sinai Health System.

One example is appendicitis: “If a patient presents with abdominal pain which is strongly suggestive of appendicitis, which can be treated with surgery or with antibiotics, we would lean very heavily toward the treatment option that minimizes the use of hospital resources, which would be the antibiotic option,” Herron said. But “in cases where there is only a surgical option, then surgery is still available.”

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