Dr. Laura Forman, chief of emergency medicine at Kent County Memorial Hospital, is used to seeing about 200 patients a day come through the hospital’s emergency department.
Over the past two months, those numbers have dropped by nearly half, to about 100 to 120 daily.
“People have been staying away; they’re worried they’ll get COVID-19 while they are here, which is an unfounded fear,” Forman said.
In an unexpected twist, the COVID-19 pandemic, which took hold in Rhode Island at the beginning of March, is to blame for a
precipitous drop in emergency room visits in the Ocean State and across the country.
“This has been probably the biggest surprise of the whole COVID-19 episode,” said Dr. Jeremiah Schuur, Lifespan Corp.’s chief of emergency medicine.
Hospital planning for a potential surge of COVID-19 patients was done with the assumption that health systems would already be nearly full of other patients, as they are under normal circumstances, Schuur said.
But that hasn’t turned out to be the case.
‘We’re worried that people are staying at home with chest pain and stroke symptoms.’
DR. TIMOTHY J. BABINEAU, Lifespan Corp. CEO and president
Although hundreds of patients, particularly at Lifespan hospitals, have been treated for the virus, Rhode Island hasn’t seen the number of cases or the surge of more than 2,000 to 4,000 hospitalizations predicted in a model released by the R.I. Department of Health in mid-April.
“Ironic doesn’t even seem like the right word; it’s almost paradoxical,” Schuur said of the position that hospitals have been pushed into by the pandemic.
While front-line medical staff are risking exposure to the virus, that same illness is keeping other patients away. People suffering from heart attacks, strokes, appendicitis and other pressing conditions just aren’t showing up like they used to.
Rhode Island Hospital, Lifespan’s flagship hospital and the state’s only Level 1 trauma center, normally sees about 285 emergency room visits daily. By late April, that had fallen to between 160 to 180, Schuur said. At The Miriam Hospital, also owned by Lifespan, normal numbers of roughly 230 emergency patients per day dropped to about 150, Schuur said.
The 55% drop in volume in Lifespan’s emergency rooms, reflected across the state and region, means a drop in revenue that’s worrisome to hospitals, but it’s also hard to explain.
Dr. Timothy J. Babineau, Lifespan’s CEO and president, called the plummet “inexplicable” in late April.
The presence of COVID-19 in the state cannot keep other unrelated medical conditions from happening, he said.
“We’re worried that people are staying at home with chest pain and stroke symptoms,” he said. “Our emergency rooms are safe. We’re here, we’re open.”
Decreased revenue caused by light patient volume has already temporarily shortened shifts and reduced staff at some hospitals. Kent Hospital has trimmed its emergency room staff “lightly,” Forman said. Brown Emergency Medicine, a group that supplies staff to many Lifespan hospitals, has begun to withhold 10% from the salaries of some doctors and administrative staff, said Schuur, the group’s president.
Babineau has said the COVID-19 crisis will not lead to more cuts within Lifespan, although the health system has furloughed about 1,000 employees partly due to low hospital occupancy.
At Charlton Memorial Hospital in Fall River, some nurses and technicians are being sent home early, and doctors and other providers are seeing pay cuts, said. Dr. Brian Tsang, chair of the department of emergency medicine at Charlton and Tobey Hospital in Wareham, Mass.
A top concern, doctors say, is the seriously ill patients who are staying away or delaying a hospital visit.
Over the past two months, emergency visits for some have become more urgent because help was not sought right away.
“The acuity is up. Anytime someone comes in and needs to be immediately intubated, or is in cardiac arrest, that raises the question could they have come in sooner,” said Dr. Ryan Carter, chairman and medical director of the Westerly Hospital Emergency Department.
The hospital’s typical volume of about 50 emergency patients per day has dropped to about 25 to 30.
Westerly’s relatively low rate of COVID-19 cases has meant the hospital has treated just a few dozen people infected with the virus, but fear of COVID-19’s presence in a medical environment lingers, said Dr. Craig Mittleman, regional director of emergency services for Lawrence Memorial Hospital, which is owned by Yale New Haven Health System, Westerly Hospital’s parent company.
“When the COVID-19 pandemic became an issue, there was national pressure for patients to stay away from emergency rooms with minor complaints,” he said. “The concern was the [people with] minor complaints could potentially infect all the front-line hospital staff. We’re sort of through that first phase, and some people misinterpreted that as stay away from emergency departments completely – that got overrepresented with people.”
Waiting too long for a hospital visit is significantly more dangerous than potential exposure to COVID-19, Tsang said. People who try to ride out heart attacks can end up with lifelong congestive heart failure, and many who suffer strokes will have irreversible brain damage if not treated with anti-clotting drugs within about three hours.
“There’s a limited time we have to treat you,” Tsang said. “A heart attack can feel like heart burn. Normally we would see 40 patients a day with chest pain, and two of them might have a heart attack. Now we’re seeing a fraction of [people with chest pains], maybe five or six.”
At Charlton, where daily emergency visits usually total about 190, doctors are now treating about 100 people. At New Bedford’s St. Luke’s Hospital, which is owned by Charlton’s parent company, Southcoast Health, visits have dropped to about 130, down from 230.
“We’re seeing people that finally come in because they can’t wait any longer,” Tsang said. “It makes the treatment more difficult, there’s complications that can’t be reversed, it’s detrimental to their health.”
Doctors are quick to point out that hospitals’ preparation for COVID-19 includes protection measures for patients. Those with the disease are treated in negative-pressure rooms, which are specially outfitted to keep COVID-19 from becoming airborne, and anyone suspected of having the virus is evaluated in areas separate from other patients.
Cleaning practices and use of personal protective equipment have also improved.
“Honestly, you’re much more likely to get COVID-19 going to the grocery store” than from a hospital, Forman said.
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