South County residents avoiding emergency care due to COVID-19 in Boca Raton Tribune

Jun 8, 2020

As infected patients flooded emergency rooms in the throes of the COVID-19 pandemic, large numbers of should-be patients were avoiding hospitals.

Now, as Palm Beach County gradually reopens, patients are slowly returning and local health care officials are promoting their hospitals as the safest place to be, especially during a health crisis.

“It was a suspicion a month ago, it’s a reality now,” George Rizzuto, CEO of West Boca Medical Center, said last week. “People aren’t coming to us, and [they] are telling our physicians that they ignored, postponed or tolerated symptoms of heart, diabetes exasperation and other things because of fear of a hospital during this time. It’s very concerning for any healthcare worker and executive who cares about the community.”

These people are friends and neighbors who need to be seen for illnesses that prior to the coronavirus would have gone to the emergency room, health care providers said. They stressed that during a health emergency, every second matters.

Doctors say that by putting off procedures after suffering symptoms, the people could have serious problems down the road, including greater risk of dying.

Dr. Cory Harow, the medical director of the emergency department at West Boca Medical Center, said they are seeing an uptick in patients with more advanced stages of their maladies.

“We’ve seen people coming in with advanced infections, with really bad diabetes, which has really changed their blood chemistry and they’re going directly to the ICU,” Harow said.

Had they not prolonged the visit, they would have been treated and released, he added.

Hospital officials stressed their rigorous infection-control protocols that significantly reduce the chances of non-COVID patients being infected with the virus. 

“We understand that people have fears. There’s certainly reasons to be concerned about the coronavirus,” Harow said. “But we maximized the safety for all our patients.”

The hospital’s cleaning team sterilize each room for between 60 and 90 minutes after patients with the virus leave the room. 

“What you end up with is a treatment area, our emergency department, which is far safer for people than places they normally wouldn’t worry about going to like [the grocery stores],” he said.

Some patients may be staying home because they do not consider their symptoms as that serious. But doctors caution against self-diagnosing.

“The only way to know is to get in and get taken care of through an electrocardiogram and let’s see what’s going on, do some blood test and make a determination,” said Dr. Eric Lieberman, the regional medical director of cardiology at Delray Medical Center. 

Furthermore, he added, it doesn’t matter whether it’s small or large heart attack, both could be life threatening.

“Even a small heart attack can cause electrical instability, which can suddenly leads to someone’s death,” Lieberman said.

Health care providers said anecdotal evidence suggests that hospital admissions during the pandemic are down about 30 percent compared with pre-COVID levels, and compared with a year ago.

Prior to January, Delray Medical Center averaged between 50 to 60 heart attack patients, including 12-15 major cases a month, Lieberman said. 

“We clearly saw a reduction in the utilization of the cardiac lab here,” Lieberman said, adding that some of it was driven by the state mandate when elective procedures were shut down.

Overall, he said the returning patients are more comfortable after learning what the hospital is doing as well as knowing the consequences of waiting.

“The volume is gradually picking back up but it’s not what it was,” he continued. “There is still a lingering concern on the part of the patients about proceeding with elective procedures.”

The decrease has become a topic of discussion among cardiologists across the nation and world. A study in the American College of Cardiology journal described similar situations at nine medical centers that saw a 38 percent reduction in visits during COVID-19, Lieberman said

“Those heart attacks weren’t going away. They were there. Patients just weren’t coming in,” he said, adding that, “time is muscle” or everything, for someone suffering a heart attack.

“The quicker we get to you, the quicker we open up the blockage that’s causing the heart attack, the more muscle we save, the smaller the heart attack,” he said.

Heart attacks can have a range of symptoms. To one person, it may feel like pressure is applied to the chest. Someone else may sweat profusely or experience shortness of breath. 

“The classic symptoms are discomfort or pressure in the chest,” Lieberman said. “I am very cautions not to use pain because a lot of people do not receive it as a pain. They feel it as a pressure or a heaviness or a burning.”

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