N.H. Doctors Worried People Avoiding The ER Out Of Fear Of COVID-19
In preparation for a potential surge of coronavirus patients, hospitals around the state cancelled elective procedures and closed down or limited other wings of their facilities.
Hospital emergency rooms remain open, but patients, even those with serious health conditions, don’t seem to be using them.
NHPR's Rick Ganley spoke with Dr. Mary Valvano, chief of emergency medicine at Portsmouth Regional, about what she's seen in her ER.
Note: This transcript has been lightly edited for clarity
Rick Ganley: Has it been really busy for you?
Mary Valvano: So it depends on how you define busy. We have definitely had a lot going on, but it is very fortunately for us, not masses of patients dying with [COVID-19]. It's more masses of activity, trying to prepare the hospital for weeks and weeks to be ready for the unknown patients who are coming our way.
Rick Ganley: So you don't see a surge yet, but you're still anticipating that there could be one?
We're not really sure what's coming. Initially, we did have a big surge of a bunch of people who were legitimately sick and who wanted to be evaluated, but they weren't super sick needing to be in the ICU. And then we kind of had a bit of a plateau where we're still seeing a little steady state of people with the virus in addition to fewer actual emergency patients than we expected. And then we're still not sure what's going to come. We think that we may be getting some overflow from the areas of the country that are really seeing a lot of sick patients. And in our area, that seems to be Massachusetts.
Rick Ganley: Yeah. So hospital emergency rooms around the state are reporting a substantial decrease in the number of people that are coming through the door seeking immediate treatment. What are you seeing in Portsmouth?
Mary Valvano: Yeah. So it's even a bigger problem. It's nationally. My colleagues across the country have seen the same thing. We just don't see the same sick emergency patients in the same numbers that we're used to, and that's the case in Portsmouth. We're down about a third of the normal patients that we would see on a day to day basis, which is super surprising.
I mean, of course, you'd expect that you wouldn't see some people because they're not out driving around. They're not getting in as many accidents. Maybe they're making better decisions about their lives. So they're not having bad outcomes. But what we're very surprised with are the fewer patients with heart attacks, and strokes, and gallbladder attacks and kidney stone attacks, kind of the emergencies that don't seem to care about social distancing. We're surprised that we're not seeing those patients, and it really worries us.
Rick Ganley: So what do you think they're doing? Where are they going for treatment?
Mary Valvano: Honestly, we're worried that they're staying home without any treatment. And we know this is a fact because we've been seeing a lot of patients, for instance, who have had heart attacks but aren't coming in until days later. I had a sweet guy who came in a week or so ago and he'd had his heart attack on Monday. And he even had a defibrillator in place that was supposed to shock his heart back if it stopped working and his defibrillator had gone off. And he waited two days to come in, until Wednesday, because he was scared of the virus.
Rick Ganley: So what happened with him?
Mary Valvano: He'll be okay, but he didn't get the same chance that he would have had for us to intervene and save as much of his heart muscle as possible. And so we're worried. Cardiologists across the country are worried. We're certainly worried in New Hampshire about all these people who are staying home. And we seem to notice that they've got kind of two big themes for why they're staying home. One is that they're afraid of getting the virus in the hospital, and the other is that they're afraid of imposing on us because they think that we're far too busy taking care of people who are sicker than them.
And we just want to reach out to these people and tell them that's not the case. First of all, the ER is probably the safest place you can be as far as not catching the virus, because we've got all of these experts who are trained in how to clean rooms in between. We've been super careful about limiting visitors and anybody who comes into the hospital is screened for symptoms, and given a mask and hands are cleaned. And I don't think that the risk of getting the virus in the hospital is at all similar to where you're going to risk it in the public, say, a grocery store.
Rick Ganley: Well, let me ask you, how is your hospital separating potential or confirmed COVID-19 patients from those with other severe conditions who may be coming through into the ER?
Mary Valvano: Yes. So we're definitely doing that. We've done that for weeks now. We were very fortunate that the hospital is incredibly responsive, and we're very lucky that it's part of a big hospital organization, [HCA Healthcare]. So they've got a lot of support. And so within the very early stages of this, we put up a special cohort area for patients who are suspected of having the virus in the emergency department. And then we even expanded that. So in the ER, we have separate spaces for [COVID-19]-type patients. And in the rest of the hospital, they have also been designating and isolating specific floors and parts of the ICU for [COVID-19] specific patients.
Rick Ganley: And so far, you just haven't seen a surge where you're overwhelmed at all?
Mary Valvano: No, not really. I mean, honestly, in the initial days, we had a lot of people, but they weren't super, super sick people. They were people who, like most of the population, have basically cold symptoms, kind of flu-like illness and aren't going to die from this. And that's what most of the world is going to experience, you know. Seventy-five percent of the world's going to have this infection within a year. And most people will have mild flu-like illnesses. Unfortunately, then there's going to be probably at least 5 percent or so, or maybe more, we're not really sure of the numbers yet, who are going to be super sick.
Rick Ganley: For the past decade, we've heard health policy professionals talk about avoiding using emergency rooms, if you can, because they drive up the cost of health care. They aren't the ideal setting for lots of conditions. Does that messaging not hold up during a pandemic when many primary care practices are closed or virtual only?
Mary Valvano: Well, we still like to see people for emergencies. That's our specialty. That's what we really do best. You know, we're kind of experts at saving lives. So people who come for emergency care get the best care. And as far as being a surrogate for primary care, it's never been a great use of the emergency department for the reasons that you stated and for other reasons. I mean, it's just not what we do well.
Fortunately, a lot of the primary care offices have been so adaptable, and now they're doing a lot of telehealth and a lot of them are available to see their regular patients. So we haven't seen people coming who are not able to get care elsewhere. You know, a couple sporadic but very, very minor. And so we would encourage that people still not be afraid to contact their primary care doctors. I think that some people think that, well, everybody's closed and no one's available, so they're not making the phone call. But in Portsmouth, the offices have been really good at ramping up and being available for them.
Rick Ganley: And of course, your message too is, if you need help right away, go to the ER.
Absolutely. Yeah. We're still able to take care of everybody. They shouldn't be afraid to come in. We want to be there for them. And, you know, it's what we do. It's what we've always been ready to do, and being on the front lines of the virus doesn't mean that we can't take care of people for their other emergencies.