CORONAVIRUS

Fearing coronavirus, patients avoid seeking emergency care

Hospitals concerned for poorer outcomes from heart attacks, strokes

University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo tak
University of Iowa Health Care complex, which houses University of Iowa Hospitals and Clinics, is seen in this photo taken on Friday, April 18, 2014, in Iowa City, Iowa. (Gazette File Photo)
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As the nation has grappled with the coronavirus pandemic, public health officials’ message has been resounding and clear: Stay home.

But some local health care officials say they are finding those in need of necessary and emergency medical care are avoiding hospitals, leading to even worse clinical outcomes — and possibly even death — for Iowans.

Nationwide and across the globe, hospitals have seen a dramatic decline in the number of patients with cardiovascular emergencies, such as heart attacks and strokes.

The reality is that it’s not that those emergencies are occurring less often, but those patients are choosing not to go to the hospital, said Dr. Theresa Brennan, chief medical officer for the University of Iowa Hospitals and Clinics.

“We believe patients are avoiding coming in because of a concern for COVID-19, when their medical needs really should prompt them to come in,” Brennan said.

According to a national poll from the American College of Emergency Physicians, 29 percent of adults said they have “delayed or avoided medical care” because of their concerns for contracting COVID-19.

Patient volume at UIHC’s emergency department is down 35 percent, according to hospital officials. In April, the emergency department — which averages about 4,500 visits per month — saw only 3,000 patient visits.

UIHC is not alone in this trend.

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March 2019 compared to March of this year shows UnityPoint Health-St. Luke’s Hospital’s emergency department had a 17 percent decrease in patient volume. However, comparing April 2020 to last year, St. Luke’s experienced a 36 percent decrease in its emergency department volume.

At Mercy Medical Center in Cedar Rapids, patient volume had declined 18 percent in March compared to the year before. By April, volume had dropped 40 percent from the year before.

Not only is it the declining patient volumes that have led officials to this conclusion, but also the fact that patients they do see are sicker and are at a more advanced stage in their symptoms, said Dr. Enrique Leira, head of the UIHC Comprehensive Stroke Center.

“There may be some selection bias,” Leira said. Patients “want to feel their symptoms are milder, so they don’t come.”

Time matters for heart attack, stroke outcomes

Compared to the average patient volume over the past 18 months, patients presenting themselves to the UIHC emergency room with chest pain in April were down 33 percent.

“In our in-patient units, particularly our cardiovascular units, we’re seeing patients that are coming in sicker on average than what routinely we would see,” said Brennan, a cardiologist. “We believe this is likely related to people postponing their medical care.”

Brennan said clinicians don’t have any data yet on long-term outcomes for these patients delaying medical care, or whether this trend has resulted in more deaths.

Some patients do experience increasing symptoms that eventually lead to a heart attack or stroke, Brennan said. If a provider can address those symptoms early on, they more likely can prevent the cardiovascular emergency.

“The outcomes for patients having heart attacks is worse than those who don’t,” she said.

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The number of stroke patients UIHC providers have cared for has decreased somewhere between 30 percent and 50 percent, officials say.

Leira said strokes especially are time-dependent emergencies, adding that a long enough delay could mean treatment no longer is effective or the patient is no longer eligible.

Those who already have had a stroke are at higher risk for experiencing another one, so clinicians have invested effort in educating those patients and their families.

“If they don’t take the step of calling 911 and showing up to the hospital, there’s nothing we can do to help,” Leira said. “Communication was always important for stroke, but I think at this particular time, when the pandemic is causing so much concern and fear and impacting whether patients go to the hospital, I think the value of communication is as strong as ever.

911 call centers reflect trend

With businesses closed and hundreds of Iowans working from home for the past several weeks, the decline in emergency department visits may be tied to the fact that the roads are emptier. Less traffic would mean fewer accidents.

St. Luke’s Hospital only saw half the total trauma cases this past month compared to the year before, hospital officials say.

The emergency department reported a 49 percent decline in trauma cases from April 2019 to April 2020. In March 2020, the hospital saw a 35 percent decline in trauma cases from the year before.

However, data from UIHC shows trauma “activations” — the most severe cases that require the highest level of response — are up for this year compared to March and April of last year. Officials did note it is consistent with volume the hospital typically sees during summer months.

911 dispatch center data confirms what hospitals are seeing. The Johnson County Ambulance Service reports its call volume was down 10 percent in both February and March, and 28 percent in April.

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Linn County dispatch received fewer than 5,000 911 calls in March, making it the first March in five years that dispatchers saw fewer than that many.

The Area Ambulance in Cedar Rapids also has witnessed a decline in call volumes during the pandemic.

The fall in emergency care comes at a time when routine health care visits have been put on hold. This, coupled with extra expenses related to COVID-19 preparation, have caused a financial loss that could top $100 million across the University of Iowa Health Care system through the end of the current budget year.

In April alone, UIHC lost about $22 million due to pandemic-related expenses and revenue drops, driven largely by fewer visits to its main campus and clinics, and with curtailed elective surgeries compounding patient fears.

Both Leira and Brennan urged patients to call 911 if they are experiencing any emergency, including cardiovascular events such as heart attacks and strokes. They emphasized, with the widespread COVID-19 mitigation efforts and other infection control measures in place — including patient and staff screenings and mandatory personal protective gear use among employees — the hospital may be one of the safest places a person can be.

“Our goal really is to make sure that they feel safe when they come here,” Brennan said. “The number of things that we’ve put into place to improve their safety, as well as the safety of our staff, and help them feel safe when they come, so that they know that coming here is the right thing to do.”

Comments: (319) 398-8469; michaela.ramm@thegazette.com

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Our most important Coronavirus coverage is free to the public.

If you believe local news is essential, especially during this crisis, please donate. Your contribution will support news resources to cover the impact of the pandemic on our local communities.

All donations are tax-deductible.