By Hansa D. Bhargava, MD
May 6, 2020 -- As COVID-19 causes serious illness across the nation and deaths are mounting, many people who used to go to the doctor have stopped for fear of catching the disease.
Others may be putting off preventive care, increasing their risk down the road.
Emergency room doctor Megan Ranney, MD, says that although the flow of COVID patients is tremendous, the volume of patients who have non-coronavirus health problems is down around 50%.
While that might seem like a good thing as it frees up resources for COVID patients, Ranney says it's concerning because people aren’t coming in when they need care. A recent survey from Emergencyphysicians.org revealed that almost a third of adults surveyed delayed or avoided going to the ER when sick.
"We are seeing a lot of patients that are coming in too late," says Ranney, who works at Brown University/Rhode Island Hospital. "For example, stroke patients that have already become worse and it's too late to give the TPA, which can slow down the progress of the stroke."
"People with diabetes are waiting at home with higher blood sugars longer than they should; this means that many need hospitalization or even ICU care."
And Ranney says her colleagues have seen patients who have been in pain because of appendicitis, some with an appendix that has already ruptured by the time they come in.
For problems like heart failure and other heart disease, cancer, and diabetes, experts agree that it is essential to reach out to doctors and be seen when you have health problems. Telemedicine can work for routine checkups and maintenance. But doctors worry that some of the patients they're not seeing may be suffering in silence at home, with grave consequences.
Prashant Kaul, MD, tells a story about heart patients who may be suffering at home, with grave consequences.
"We have definitely seen a significant reduction across the country in the number of patients presenting to the hospital with heart attacks," says Kaul, director of the Cardiac Catheterization Laboratory at the Piedmont Heart Institute in Atlanta. "The reduction is anywhere from approximately 10 to 40%. ... The most likely explanation for this is that patients are afraid of coming into the hospital to seek medical attention. It seems they would rather stay at home, despite severe symptoms."
Senior citizens also appear to be avoiding hospitals and doctors’ offices. A recent survey from the University of Chicago and several foundations showed that 55% of U.S. adults over age 70 had disrupted care.
Almost 40% delayed or canceled medical treatment, and 83% say they're expecting to self-isolate for several months to come.
"A delay in presenting to the hospital can lead to severe and potentially life-threatening complications," Kaul says. "Many cases have now been reported of patients waiting too long at home before coming into the hospital and ultimately presenting with unsalvageable heart muscle damage. In some other cases, patients have fared even worse and have died before reaching the hospital."
In an article published on April 29 in The New England Journal of Medicine, the rate of out-of-hospital heart attacks has risen by 6.5 % during the COVID-19 pandemic.
Doctors and nurses are doing everything in their power to help and to make sure that the risk for COVID-19 exposure is minimal, Kaul stresses. Offices and hospitals are making sure all patient areas are clean and sanitized, and doctors and nurses are using PPE vigilantly.
Emergency rooms are also doing their part. Emergency doctors "around the country are doing everything in their power to make sure patients are protected," Ranney says. "We are religious about washing hands, we segment off any potentially COVID patients (based on symptoms), we are putting masks on every patient; and doing very best to make sure they aren't in contact with COVID-19."
Plus, she says, "Your risk of getting COVID-19 in the ER is probably much less than in the grocery store since we are taking every precaution possible."
When to See Your Doctor
If you have heart disease, make sure that you check in with your doctor for any symptoms like chest pain, fatigue, or shortness of breath on exercise or climbing stairs, and even if you're just not feeling like yourself. Remember to continue taking your medications, and reach out if you need refills.
"Patients should be reminded that they should not delay in calling 911 if they are having any symptoms suggestive of a heart attack, such as sudden chest pain or shortness of breath," Kaul says.
If you have diabetes, make sure you are taking your prescribed medications and monitoring your blood sugar levels. If you are having any symptoms, like high or low sugar levels, more thirst, going to the bathroom more, feeling unwell, or if you are worried, call your doctor right away.
Immunizations and the Lack of Them
In an office in Atlanta, Renee Alli, MD, worries about her patients who are not showing up for vaccines. Her practice is making sure that patients under 4 are getting the vaccines and has worked to reassure parents that their office is sanitized frequently. They also provide masks to patients and employees as they enter the clinic.
"Less than 5% of patients who get serious COVID infections are under 17; but parents may not know that. Many parents are choosing not to come in for sickness or immunizations," Alli says.
Sally Goza, MD, president of the American Academy of Pediatrics, echoed the concern about vaccinations, including those given through the Vaccines for Children Program, a federally funded effort to help lower-income families get free vaccinations. The program has seen a decrease in requests for vaccines in some states.
"We are very worried that we will have another measles outbreak and this would be devastating to children," Goza says. "Whooping cough could really harm infants and cause them to have respiratory problems. Meningitis could be an issue for infants as well, if they don't get their vaccines."
Getting a measles infection may also lead to an immune memory "loss." One study published last year in Science showed that it can cause 20%-50% of immunity to be wiped out, leading people to be more prone to getting other infections. Just this week, the World Health Organization said there may be a link to better outcomes from COVID-19 infection for those who are immunized with MMR, or the measles, mumps and rubella vaccine.
Goza says she talked to a mom of a 1-month-old who was going to come in for vaccination, but then called to say was too scared. She was a first-time mom and was worried about her baby. Goza met her before the office opened, to make sure she felt safe. "We will do whatever it takes to get it done," she says.
"Pediatric offices have gone far to make sure parents and the kids are safe. We are all wearing masks, separating the sick and the well, and even having patients wait in their cars," Goza says.
She also mentioned grocery stores as a comparison.
"I feel safer at my office than I do at the grocery store, even with the sick patients that are coming in," she says. "Doctors want to help their patients and will go the extra mile, so please call your doctor's office and they will make it work, to get those critical vaccinations done, so your child doesn't get a serious illness."
Reviewed by Brunilda Nazario, MD.
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