Don’t stay away: Avoiding treatment because of COVID-19 can lead to ‘very bad outcomes’

Emergency room visitors who register a fever are directed to a separate waiting area at the Bayhealth Hospital, Kent Campus. Delaware State News/Marc Clery

DOVER — Ignoring present medical concerns only adds complications in the future.

Without immediate treatment, a cast-worthy bone fracture may later need surgery instead.

Ignoring belly pain that’s undiagnosed appendicitis could bring an abscess requiring a more extreme procedure, IV-administered antibiotics and a potential prolonged hospital admission.

If stroke or heart attack symptoms emerge, it’s imperative to visit an emergency department quickly.

As non-COVID-19-related emergency room visits drop nationwide, physicians worry about the ramifications of people delaying treatment. Some would-be patients are staying away for fear of exposure to the virus, health professionals said, and they worry the scenarios outlined above will happen way too often.

Bayhealth has seen a precipitous drop in emergency department visits since the coronavirus pandemic arrived in Delaware.

For the past month or so, Bayhealth staff have been hearing concerns from would-be patients as the pandemic continued.

Bayhealth Medical Director of Emergency Services Dr. Kelly Abbrescia estimates arrivals are down 50% and those who do come likely have minimal waiting time at most.

Early this week, without describing specifics, Dr. Abbrescia said two delayed arrivals led to “very bad medical outcomes.”

A recent poll from the Morning Consult and the American College of Emergency Physicians found that 29% of adult Americans said they have avoided or delayed medical care due to concerns about contracting COVID-19. The national poll was conducted April 18 to April 20 and involved 2,201 adults.

“Despite all the uncertainty around us, the emergency department remains the best place for you to get medical care any time you need it,” said ACEP President Dr. William Jaquis in a press release.

“Emergency physicians are expertly trained for these situations and have protocols in place to keep their patients protected even in the midst of a pandemic.”

Also, the poll indicated, 73% of respondents are concerned about overstressing the health care system and 59% are worried about access to a physician if treatment is needed, with lower-income adults among the most concerned.

“If you think something is nothing when it is something then that’s a big problem,” Dr. Abbrescia said.

“Delays can lead to very bad medical outcomes. We’d much rather take time checking someone who turns out OK as opposed to not seeing someone until they arrive in a far worse condition.”

More admissions required

Bayhealth said it’s now seeing a higher number of patients needing admission from the emergency department.

While about 26% of patients arriving at the Kent Campus site have generally been admitted in the past, that has climbed to 32% this month.

Admissions at the Sussex Campus in Milford have risen from 18% to 23% in the same span.

There’s a similar trend for patients treated at Bayhealth’s emergency department in Smyrna, officials said.

To encourage social distancing, some chairs are covered in the Bayhealth Hospital, Kent Campus Emergency Department non-COVID-19 patient waiting area.

In Sussex County, Beebe Healthcare has seen a dip in arrivals and “It is safe to assume people may be afraid and putting off care for chronic issues that could result in an ED visit during a normal time,” said President and CEO Dr. David Tam.

Dr. Tam’s message to the public urges that “Now is the time to take care of yourself and continue to watch your health, especially if you have a chronic medical condition. I understand the fear of visiting an office, but please remember that getting your health care is an essential reason for leaving the house when needed.”

Beebe opened its COVID Positive Care Center in Georgetown Monday and Dr. Tam said, “This provides a centralized location for COVID-19 positive patients to receive the face-to-face care they need to help manage the disease and keep them out of the emergency department as well.”

At Bayhealth’s Kent Campus in Dover, six physician shifts run each day, joined by rotating physicians assistants and nurses. Care teams are separated for COVID-19 responses only and other issues, with social distancing and sanitized surroundings always at the forefront.

“My concern has always been having enough staff ready to handle what might be a sudden large scale emergency,” Dr. Abbrescia said. “I never thought that we’d be putting out a call for people to come in and see us.”

While first responders and health care workers were justifiably lauded for their long hours meeting the rush of COVID-19 cases, the public perception may have skewed the notion of just how many resources are available for other issues.

“Maybe we got the message out to the public too well,” Dr. Abbrescia said. “We’re here to help and prepared for all types of cases, not just coronavirus-associated ones.”

Arrivals at Saint Francis Health Care in Wilmington are down about 50%. Emergency Medicine Physician Dr. Jaime Roques said that a typical Monday caseload is around 120, and 63 were seen this week.

“Wait times are consistently below our average of 30 minutes because of the lower volume,” Dr. Roques said.

According to Dr. Roques, “The drops in ED patient volume are most likely due to patient concerns about exposure to COVID. We have seen an increase in patients who present at the ED with conditions that, if they had come in sooner, would have been less complex to address.”

On a typical day in Dover, Bayhealth staff evaluates 15 to 20 people with potential COVID-19 concerns, and 10 to 15 at the Sussex Campus in Milford. Not all arrivals test positive, and the medical staff is tasked with looking for clues. Arrivals may not be admitted if oxygen levels are sufficient and chest X-rays are negative.

The Centers for Disease Control and Prevention recently added six new symptoms to the COVID-19 checklist: chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of smell or taste.

“Detecting the virus can be very challenging, especially with the newly added symptoms,” Dr. Abbrescia said.

Inside the Bayhealth Emergency Departments, there are separate waiting rooms for possible COVID-19 and non-Covid arrivals, along with triage areas. About 25% of space is allocated for coronavirus responses, 75% for other issues. Hospital floors are separated as well. On the Kent Campus, there are 40 beds available, a three-bed fast track and four trauma/resuscitation beds.

All rooms in the ED are private and are cleaned and disinfected between every patient. For children who need to be seen in the ED, a parent is able to remain with them.

Dr. Abbrescia repeated a plea: “Please do not delay in coming to us for your urgent medical needs or calling 911 for a medical emergency. We want to make sure that you or your loved one get the care needed when it’s needed most.”

Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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