Home HEALTH E.R. Visits Drop Sharply During Pandemic

E.R. Visits Drop Sharply During Pandemic

by admin2 admin2
36 views
er.-visits-drop-sharply-during-pandemic

People even with heart problems are avoiding emergency rooms because they are worried about possible coronavirus infection, according to a C.D.C. report.

Credit…Misha Friedman for The New York Times

Reed Abelson

Emergency room visits in the United States have dropped sharply during the pandemic, underscoring concerns that people with serious medical conditions, like heart attacks, are avoiding hospitals, according to a new analysis released on Wednesday by the Centers for Disease Control and Prevention.

As the coronavirus spread across the United States this spring, visits to emergency rooms decreased by 42 percent over four weeks in April, compared with the same period in 2019. The declines were greatest among women and children 14 and younger, and in geographic areas like the Northeast.

While there have been a recent rebound in visits, the C.D.C. noted, the volume of visits remains significantly lower. Visits to the emergency room were down 26 percent in the last week of May, compared with figures from a year earlier.

While hospitals in hot spots like New York City were often overwhelmed by the numbers of seriously ill coronavirus patients, and admissions for infectious diseases and pneumonia climbed, there were drastic declines in the volume of patients who typically come to the emergency room for care.

2.5 million

2019

2.0

2020

1.5

1.0

0.5

March 13 declaration

of a national emergency

Jan.

March

May

July

Sept.

Nov.

2.5 million

2019

2.0

1.5

1.0

2020

0.5

March 13 declaration

of a national emergency

Jan.

March

May

July

“It was eerily quite,” said Dr. Thomas Balcezak, the chief clinical officer for Yale New Haven Health, who recalled walking through his hospital system’s emergency departments at the peak of the epidemic and being struck by the lack of patients.

In a possible sign that patients were coming in later and sicker, he pointed to the C.D.C.’s finding that visits for conditions like ventricular fibrillation had increased, suggesting that patients might have had heart attacks and initially stayed home before coming in with a worsening condition. “That’s worrisome,” he said.

The agency’s report highlights the monthslong decline in general care as the virus took hold and overwhelmed some hospitals. Across the nation, hospitals stopped performing elective procedures, whether a routine mammogram or a knee replacement, even if they were not experiencing a surge in virus patients. While they have slowly begun resuming care, many patients, concerned about potential infection, continue to avoid hospitals.

“Where are all the heart attacks and strokes?” asked Chas Roades, the co-founder and chief executive of Gist Healthcare, which advises health systems. He said that many patients were returning for rescheduled surgeries, but that hospital executives were reporting that people, worried about possible infection, continued to avoid their emergency rooms and urgent care clinics.

“This is a national concern that patients are worried that the hospitals, health care systems, physician offices could be more dangerous than grocery stores, hardware stores and other essential businesses,” said Dr. Balcezak, although he emphasized there was no evidence that the risks were any higher in hospitals.

In some cases, patients may be opting for virtual visits or some other alternative, said Dr. Stephen Klasko, the chief executive of Jefferson Health, who has seen the declines in visits across all of the system’s hospitals. But in other cases, patients are forgoing needed care, he said. “The real key here is virtual triage,” Dr. Klasko said, where someone who feels dizzy or has chest pain can find out if a trip to the emergency room is warranted.

Hospitals are taking numerous steps to ensure patients remain safe from infection, said Dr. William Jaquis, an emergency room doctor who is the president of the American College of Emergency Physicians. Emergency rooms are not only less crowded, he said, but they have taken a number of steps to screen patients for potential infection and to make sure both patients and providers wear masks. Patients who may be infected are treated in separate areas.

Congress has responded to the hospitals’ loss of patients and resulting revenue by providing as much as $175 billion in funds to hospitals and other providers, but much of the money has gone to the largest, most profitable institutions, compared with medical centers in rural communities or those that serve low-income patients.

While emergency room visits for minor ailments like stomach pains, earaches and sprained ankles have been far fewer this year, agency officials pointed to a more disconcerting drop in the number of people who arrived with chest pain, including those experiencing heart attacks. There were also declines in children requiring emergency help for conditions like asthma.

  • Updated June 2, 2020

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • How do I take my temperature?

      Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How do I get tested?

      If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.


“Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed,” the C.D.C. officials said. They added that people should be encouraged to reduce their potential exposure to infection by using telemedicine and other methods of triage to determine whether they need to go to the hospital.

But the officials also said the drop in emergency room visits could affect people’s ability to get care when they have no other alternative sources. People who use the emergency room “as a safety net because they lack access to primary care and telemedicine,” they said, might be disproportionately affected if they avoid seeking care because of concerns about the infection risk.”

“It’s made that access to care even harder,” said Dr. Jaquis of Yale. “We’re not seeing them in the emergency department.”

The analysis of visits from the National Syndromic Surveillance Program, which collects real-time electronic health data, representing nearly three-quarters of all emergency room visits in the United States, was published in an early release of the Morbidity and Mortality Weekly Report by the C.D.C.

You may also like

Leave a Comment