MIAMI _ Respiratory illnesses and deaths aren't the only byproduct of the COVID-19 pandemic.
Dr. Sergio Segarra, chief medical officer and emergency room physician for Baptist Hospital in Kendall, tells a cautionary tale of the novel coronavirus' impact on emergency rooms _ and it's not about packing them to capacity.
Quite the contrary.
He tells of a patient presenting stroke conditions who waited three days before going to the ER "and knew they were having a stroke." By that point, it was too late to stem the brain injuries.
"If we rush those patients in we could try to break up the clot or withdraw the clot and could have done so much more as opposed to waiting three days and there was nothing to do except rehabilitation," Segarra said.
True, the number of COVID-19 positives and the number of deaths in South Florida and elsewhere is frightening.
By Friday, the Florida Department of Health confirmed nearly 40,000 positive results statewide and a death toll of 1,669. Miami-Dade's death toll of 468 is the most in the state.
As people see the numbers, many are apparently avoiding emergency rooms and urgent care centers out of fear they may catch the disease. Two months ago, people didn't hesitate visiting emergency rooms for broken bones, sprains, gashes, stroke and heart attack symptoms. Medical professionals say that has changed drastically.
"We are hearing a lot of people say they are delaying going to the hospital because they are afraid of contamination," said Michelle Blumstein, the associate director of trauma services at Nicklaus Children's Hospital near South Miami. "The message we want to get out is that a person shouldn't let fear stop them from getting care."
Delaying care has become a big problem in South Florida and across the country.
"That is hand-in-glove with the fear factor and the concern for the unknown," said Steven Sonenreich, president and chief executive officer of Mount Sinai Medical Center in Miami Beach. "The pandemic is something none of us have experienced and created a tremendous amount of fear, appropriately so. In the community, people were asked to self-quarantine and to help us as healthcare workers bend the curve."
The decline is "substantial in emergency room utilization," Sonenreich said.
Dr. Randy Katz, medical director of emergency services for Memorial Regional Hospital and medical director of Hollywood Fire Rescue, said the decline has been significant across Memorial Health system.
"I don't know whether it's fear or they think we are overwhelmed," Katz said. "Either way people are staying away."
Emergency room visits decline
In South Florida, visits to emergency rooms are down at least 35% or more, according to chief medical officers, and this 40% area figure mirrors national numbers, said Segarra at Baptist Hospital.
"We are keeping good statistics on COVID deaths," Segarra said. "What we are not keeping good statistics on are non-COVID-related deaths. By that I mean, the death wasn't related to COVID, but because of COVID they delayed care and seeking medical attention."
Segarra's stroke example is illustrative.
According to the Mayo Health Clinic, stroke treatment with drugs that can break up a clot have to be given within 4.5 hours from when symptoms first start if given intravenously. The sooner the better. "Quick treatment not only improves your chances of survival but also may reduce complications," according to the clinic.
Baptist also runs about 25 urgent care centers in the tri-county Miami-Dade, Broward, Palm Beach region, as well as in the Florida Keys. Segarra says the decline in usage is similar to what emergency room physicians have been seeing since March.
Gastroenterologists have not seen perforated diverticulitis in years like they are seeing now at urgent care and emergency room facilities, Segarra said.
"People would come in weary with abdominal pain and they had diverticulitis and they would be hospitalized or go home with antibiotics. But now they are waiting and waiting and it's perforating. Instead of it becoming a medical problem it becomes a surgical problem and as opposed to outpatient or a couple days in the hospital now it's surgeries," he said.
"We've seen delays in heart attacks," Segarra said. "I was talking to a cardiologist colleague and he told me the death rate in New York was up 800% because of sudden death. People were not going in. Thank God we never got into a New York-like situation but people are afraid and it's unrealistic."
Jackson Memorial has also seen a decline of 35% in visits to its emergency rooms and Miami-Dade Fire Rescue a 12% dip in calls _ "anecdotally," said Dr. Lilly Lee, Jackson's chief of emergency.
"And that is concerning because people are delaying and we will lose the opportunity to receive tPA clot busters" for stroke treatment, she said.
For Memorial in South Broward, there was about a 60% decline in April compared to the same month last year for pediatric patients, Katz said. Adult patients declined about 40% to 50% across the system. Katz fears the drop in patients can have long term affects.
"We are probably not going to know for months, maybe even years, what the true impact will be," he said.
Blumstein said for the children's hospital they have seen an increased number of parents holding off on taking their kids for fractures, lacerations and even head injuries.
She said in many cases waiting can only make the situation harder on the child.
"The best advice is if you are worried, you should go," she said.
Extraordinary safety protocols
Hospitals across South Florida, including Baptist, Mount Sinai Medical Center, Jackson Memorial, UHealth, Nicklaus Children's Hospital and Memorial Healthcare System, have all taken extraordinary safety measures to protect patients by separating COVID and non-COVID into separate wings of the hospital or in tents off site.
Environmental service teams sterilize rooms and floors and touch points like elevators and railings. Negative pressure rooms that suck impurities out of the air are used to house infectious patients and keep them away from those without the coronavirus.
Admitted patients are also tested for the coronavirus, Segarra said. "Even the staff is separated into staff taking care of COVID patients and staff not taking care of COVID patients so we don't cross contaminate, and that's not just in the emergency room but we've done that through the hospital."
Adds Lee from Jackson Memorial's medical emergency department, "We respect each other. We are protecting you and we are protecting us."
Katz said Memorial has gone to great lengths to make sure a visit to the hospital is minimum risk for catching COVID-19.
"There are plenty of practices in place that there is very little danger," he said. "I'd venture to say it's safer than grocery shopping in the general public."
When it comes to children, Blumstein said that the hospital has worked very hard to limit exposure. Anyone who comes in is screened and there is no longer a waiting room.
When should you visit an emergency room?
In addition to serious health challenges that won't heal on their own like heart attacks, strokes, most broken bones, or trauma injuries like deep cuts or concussions, people should not allow the fear of COVID-19 from getting to an ER or urgent care center stat.
But non-acute medical problems like mental health issues, sprains, gastrointestinal reflux and even refilling medications, should not be postponed either, Lee said.
At public health hospitals like Miami's Jackson or Manatee Memorial Hospital in Bradenton, ERs sometimes serve needs that are not emergencies but are also of vital importance.
"There is a population that doesn't have a primary care doctor and relies on us to refill and that concerns us if people are not getting their medication refills on diabetes or hypertension because that becomes a problem," Lee said.
"Gastrointestinal complaints with reflux is sometimes concerning because that can be an early sign of heart attack so we don't want people to ignore that. We are not seeing a lot of people coming in for that, or GERD (gastroesophageal reflux disease) or nausea or vomiting," she said.
"My advice is if you have family members with any concerning symptoms or a history we are constantly updating our infection control practices to ensure maximum safety so you should not be afraid to come in. You may be delaying care of another illness," Lee said.
Katz said the standard for going to the hospital before the pandemic should be the same now.
"We are open for business. It is not business as usual, but it is safe," he said.
Sonenreich of Mount Sinai also stresses the need to maintain a regular doctor-patient relationship and to take care of your health before it becomes a bigger problem.
"The most important message we've always communicated to the community is the importance of having a primary care physician-patient relationship," Sonenreich said. "The annual physical is arguably the most important diagnostic tool and much more important than the technology that has evolved over the last couple of decades."
Keeping that relationship going, and taking care of your health beforehand, is of paramount importance in the battle against the coronavirus.
"People who are obese or who have hypertension or diabetes have a real struggle if they get this disease," Sonenreich said.
"But with that, we encourage people not to ignore symptoms," Sonenreich said. "Better to be safe than sorry and to use the emergency department. "There's this journey we are on now and restoring people's confidence that our hospital and going to doctors' offices is safe."
