Fearing COVID-19, Patients Avoid Hospitals

Health care workers were confused by trends early in the COVID-19 pandemic.

Outside of hot spots like Seattle, New York and New Orleans, we did not see the throngs of COVID-19 patients we had expected. Outside of COVID-19 cases, many units in our hospitals were half-full or even empty. Some hospitals had to furlough staff.

While it was good the country had temporarily slowed the progression of COVID-19, it did cause many of us to ask, “Where are all of our usual patients? Where are the heart attacks and strokes?”

During the first five weeks of the pandemic, heart attack-related admissions were down between 40% and 60%, according to an informal online survey of U.S. cardiologists. People were not coming to the emergency room for fear of contracting the coronavirus.

On Aug. 7, JAMA Cardiology released a cross-sectional study of over 14,000 patients who had an acute myocardial infarction (a heart attack). Since the beginning of the pandemic, these patients have seen their mortality rate more than double.

The primary cause of the shift was not that the standard of care had changed or that hospitals were using new procedures or even that these facilities were overrun by COVID-19 patients. The reason was patients were afraid to seek medical attention.

The patients had experienced chest pain and weakness, but they were more afraid of the coronavirus than a heart attack. Therefore, they did not seek medical treatment at a physician clinic or hospital.

The results were their symptoms became worse, resulting in a significant hospitalization or even death.

The media has been an ally and an enemy in the battle against the coronavirus.

They have urged the public to wear masks and practice hand hygiene. They have quickly shared the number of new cases and have shown us where the latest hot spots were.

More importantly, they have reminded us that COVID-19 is deadly, especially for vulnerable populations.

In June, many media outlets reported the Centers for Disease Control and Prevention’s January-May COVID-19 statistics showing the virus was 12 times more deadly for people with chronic illnesses.

While this has been helpful in reminding the public to take this pandemic seriously, it has also generated a lot of fear because media outlets have failed to remind the public that physician clinics and hospitals are relatively safe.

Today, our hospitals are one of the safest places we can visit. Most of the nation’s medical facilities have instituted limited visitation policies, and everyone is screened for temperature and symptoms.

Because health care facilities have less visitors and they have retooled to fight COVID-19, most facilities have seen a significant drop in the transmission of various infectious diseases.

Our hospitals are cleaner and safer than ever, yet many vulnerable patients are still not seeking treatment for congestive heart failure, chronic obstructive pulmonary disorder or even cancer.

The result is people are coming to the hospital sicker, thus making it harder to treat them.

Not only does waiting to seek treatment increase the chance of death, it uses more health care resources as patients spend more time in intensive care and their length of stay is a lot longer.

What might have been treated with a medication adjustment at their primary care physician’s office has escalated, required advanced therapies and, in some cases, that the patience be placed on a ventilator.

Resources are becoming high in demand. More importantly, if the patient had made an appropriate appointment at their local clinic, these resources likely wouldn’t have been needed to treat their initial symptoms.

The decision on when to seek care has become a moral issue.

By not seeking treatment, chronically ill patients who delay care unknowingly drive up health care costs and add unnecessary strain to over-extended systems that are now seeing strain across the nation due to the rise in cases following the reopening of states following the nationwide lockdown.

These are factors that impact how health care is delivered to all of society, not just one patient.

In our society, where individualism is held up as an ultimate good, we often forget that we do not live in a solipsistic bubble. As John Donne said, “No Man is an island, Entire of itself.” What I do impacts others.

Freedom to make my own health care decision also comes with the moral responsibility to exercise that freedom in a way that does not waste resources for others.

In a free society, we have an obligation to take care of ourselves so scarce medical resources are used efficiently.

Yes, I have a right to seek medical attention when I am ready. That same right carries with it the implication that if I choose to wait, I must consider the resources I take away from others.

If a simple change in medications can keep fluid from collecting on my heart, then I have a moral obligation to seek treatment before I need an ICU bed that could go to someone else.

While this general principle is true, it is even more important as we continue to fight COVID-19.

Please do not be reckless in seeking treatment during this pandemic. If it is not safe to go to a local clinic, don’t.

Call your physician’s office and see whether she thinks it is safe for you to come in. Many clinics are treating people from their cars.

And if your symptoms could be life threatening, please go to the nearest emergency room.

I’m not seeking to give medical advice here. I’m simply urging us to think about the impact our health care decisions have upon others and the health care system as a whole.

I do not want to be responsible for taking up an ICU bed when I could have avoided it by getting help sooner and with a less significant intervention.

Early detection and prevention are better for you as a patient and for the health care system on the whole.

We need to rethink how we view our health care system. In order to ensure it is there to serve us in our time of need for generations to come, we need to be responsible by protecting the system and seeking treatment when it is appropriate at the appropriate level of care.

It is not simply about taking care of ourselves; it is about taking of everyone.