One of the striking things about the COVID-19 pandemic has been the dramatic decrease in other major medical issues that usually keep our hospitals busy. The Inquirer reported on this phenomenon in mid-April, but it is clearly a national problem.
The cardiac causes of frequent hospitalizations, such as heart attacks, heart failure, and stroke are way down, and nobody knows why. The most obvious answer is that no one wants to seek medical attention right now.
People are waiting longer before calling their doctor, but logic says this would mean sicker patients arriving to the hospital for non-COVID-19 related issues, which has not yet happened. Where are all the patients? Doctor’s offices are mostly closed for non-emergency care, so presumably not as much preventive care is being done. Routine testing is being delayed. For example, many EKGs and echocardiograms for cardiac patients are being put off for several months until the COVID-19 crisis has abated. Many physicians and nurse practitioners are doing telehealth visits, which can make a difference in non-emergent situations.
Another reason for decreased volume in hospitals is the fact that almost all elective procedures were cancelled or delayed. This is temporary, and partially accounts for huge financial losses that hospitals are experiencing. We can expect this to quickly pick up as the country reopens for business.
Another reason why the shutdown may have reduced hospital volume could relate to how we manage stress. Life has slowed down, and this may reduce the effects of stress for many. Increased anxiety, and more smoking and drinking would have the opposite effect and increase the risk of hospitalization.
There are other possibilities why there are so few non-COVID-19 patients becoming critically ill, and looking into the reasons why may help improve our healthcare system in the future. One possibility is that this crisis has exposed a huge flaw in the way that we deliver routine health care. Our country, prior to this outbreak, spent almost 18% of our entire gross national product on health, compared to Canada and most of Europe, which spend around 10%. We already know that the return on this investment is low, as many countries in Europe have better markers of population health than ours. In a recent quality of care survey by US News and World Reports of over 20,000 people in 73 countries, the U.S. ranked only 15th.
This is at least partially related to extensive routine testing, which consumes enormous resources. Could cutting back on routine testing actually lead to better long-term health? Extensive elective testing can lead to abnormal findings that have nothing to do with the original presenting complaint. This can cause enormous expense and anxiety, which causes costs to spiral.
Sadly, terribly sick COVID-19 patients also may explain the paucity of other medical emergencies. It has been well established that risk factors such as hypertension, diabetes, smoking, and being immunocompromised add to the mortality risk of COVID-19. The same patients who develop severe symptoms from the virus are at high risk for heart attack and stroke, which might have occurred if they were not infected.
One other possibility is that the instruction to delay care may be adding to patients’ fear and further postpone care. As more time goes by, in this scenario, and we will see an increase in non-COVID-19 events.
There are lessons to be learned. Telehealth evaluations, with audio and video assessment of less sick patients is hopefully here to stay, should be less expensive than traditional office visits, and should impact care for the better. As we continue through this pandemic, if statistics continue to show decreased utilization of non-COVID-19 resources, with hospitals and doctor’s offices less busy, there will need to be a restructuring with more permanent efforts toward preventing future pandemics and away from the costly overutilization of our other resources.
In the meantime, if you have chest discomfort, sudden shortness of breath, bleeding, or neurologic symptoms, do not delay care because you are scared of going to the hospital. Time is of the essence when it comes to acute medical emergencies, lifesaving treatments are available only at the hospital, and any risk is greatly outweighed by the potential benefit – years added to your life.