Fear of Calling
"Our paramedics are noticeably not as busy," reports Marc Breckenridge of Huron Valley Ambulance.
From the June, 2020 issue
Breckenridge, HVA's spokesperson, emails that "overall, 9-1-1 call volume is down about 35 percent." The same pattern plays out at St. Joseph Mercy Hospital's emergency department. Within weeks of the stay-at-home order, "the visit volume at our emergency room dropped dramatically to less than 50 percent of where we were at the same time last year within weeks," says David Vandenberg, St. Joe's chief medical officer. By mid-May there had been some recovery, but they were still down by "30 percent of our normal volume."
It's about the same at the Michigan Medicine emergency departments. "For the four weeks after the March 24th stay-at-home order, patient visits decreased by half in the adult emergency department and two-thirds in the pediatric emergency department," writes Robert Neumar, Michigan Medicine's chair of emergency medicine. By mid-May, "patient visits [were] 75 percent of baseline in the adult ED and 50 percent of baseline in the pediatric ED."
"A lot of factors" keep folks away, Vandenberg believes, but the biggest by far is the fear "there're patients there that have Covid." Others include the sheer difficulty of being hospitalized now with enforced isolation, increased tests, and restricted visiting.
In mid-May Covid-19 was accounting for about 25 to 30 percent of HVA's calls. But their calls for heart attacks and strokes were much lower than normal--"which is concerning because those kinds of common medical issues don't simply disappear because there's a pandemic," Breckenridge writes. "We're worried because it seems like more people are delaying calls to 9-1-1 until the last minute ... and possibly until it's too late ... for fear of going to the hospital during a pandemic."
"Our volume of critical ill presenting patients is definitely down," says Vandenberg. "Heart attacks [and] strokes are clearly down. It's very dangerous. We want to reassure people that the hospital is safe. People need to recognize that it's far riskier to stay at home with chest pain [and] shortness of breath."
The good news is "our total volume
of [Covid] patients is about a third of what it was," says Vandenberg. "There was a time when we were admitting as many as twenty-five patients with Covid [daily]. We've been coming down and in the last eight or ten days, it varies anywhere between zero and ten patients."
Neumar reports about the same at the U-M. "Over the past week the number of patients visiting the ED that have tested positive for Covid-19 has ranged from 0-1 in the pediatric ED and 0-5 in the adult ED. Overall, that is less than 2 percent of total ED visits."
"We're on the downside of that peak," Vandenberg says. "The whole community socially distanced at a higher percentage than the model expected even in the best-case scenario."
The bad news is the near-certainty of a second wave. "It'll be rural where they don't really have enough health care," says Vandenberg, "and that second wave will wind up back in our hospitals anyway."
"It's really important to realize we have to live with this," Vandenberg stresses. "The hospital has to be able to [care for] all patients, not just Covid patients." To do that, they're masking all physicians and patients when they're interacting, plus screening every employee and visitor.
"We're feeling optimistic that we've weathered the stormy days and we feel like it's probably going to make us stronger in the long run."
More possible good news: 9-1-1 calls about opioid overdoses also are down. It's possible that drug supplies have been interrupted by the shutdown--but also possible that users are as scared of Covid-19 as folks who might be having heart attacks and strokes.
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