People are now dying because the coronavirus has made them frightened to come to hospital emergency rooms for other problems, Israeli doctors say.
“Just yesterday, several seriously ill patients came to the emergency room very belatedly,” Dr. Guy Lahat, joint director of the surgery ward at Ichilov Hospital in Tel Aviv, tweeted on Wednesday. “One died of septic shock because he waited at home with a urinary blockage; the second stayed at home with prolonged internal bleeding in the digestive tract (for six days!) until he lost consciousness.”
The hospital later issued a statement assuring the public that its emergency room is prepared to treat patients without exposing them to the coronavirus, in the hopes of encouraging people who need hospitalization to come.
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The cases Lahat described aren’t unusual these days. The endless news coverage of the coronavirus and the warnings that people should stay home – particularly the elderly, who are at high risk – has deterred them from getting proper treatment for other illnesses.
Hospitals do want to discourage non-urgent visits so they can focus resources on the coronavirus. But they’ve seen a dramatic drop in emergency room visits by people who actually need them, including people with heart attacks who arrived only belatedly or skipped important tests. Patients have also stopped taking regular medications because they’re afraid to go to a pharmacy to fill their prescriptions.
Moreover, since prolonged stress can cause illness, “we’re afraid of an ugly wave of serious illnesses and deaths the day after the coronavirus crisis,” one senior doctor said.
Dr. Avi Irony, who runs the emergency room at Sheba Medical Center at Tel Hashomer, said he’s seen “a significant drop in emergency room visits. If in 2019, we averaged 340 emergency room visits a day, today we’re at 220. And on weekends the number drops from 220 to about 150.”
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About half of ER patients are first referred to a special room for coronavirus testing, he said, either because they have symptoms – sometimes including stomach ache or diarrhea, and not just cough or fever – or because they’re from someplace with a high incidence of the disease. These patients are kept in the emergency area for an average of nine hours, rather than the normal five, because of the need to wait for test results.
The same is largely true at other hospitals.
Prof. Ronen Rubinstein, the head of the cardiovascular institute at Wolfson Medical Center in Holon, said the number of ER visits by heart attack patients has dropped by more than a third.
“Our fear is that people are staying home and not coming for treatment, or coming later than usual,” he said. “And with heart attacks, time is critical.”
He said the hospital has started calling regular patients a day in advance to make sure they’re coming for necessary tests, and is also offering telemedicine. “About two-thirds prefer not to come to the institute physically,” he said – which is the right decision in less urgent cases, but not in others.
Catheterizations have declined by about 40 percent, he added, and are mainly done for patients arriving after severe incidents.
But the longer the coronavirus crisis continues, the more heart patients who defer treatment are likely to be harmed, Rubinstein warned. “If this continues more than a few weeks, I expect we’ll see a bad spike in increased sickness that could take a heavy toll,” he added, noting that any crisis that provokes tension and stress generally causes an upsurge in heart attacks.
The fact that people have stopped going to pharmacies to refill prescriptions also produces more heart attacks, he said. And like any infection, the coronavirus itself can increase the risk of heart attacks as well.
Dr. Zalman Itzhakov, director of Wolfson’s imaging institute, said that 30 to 50 percent of patients aren’t showing up for scheduled MRIs, CTs, mammograms and other tests. And in some cases, this is a real danger, as the tests are necessary to determine whether, for instance, a cancer patient needs surgery or should continue taking drugs.
He said the institute is taking stringent steps to prevent infection, including having patients wait their turns in their own cars. When a coronavirus patient needs a test, any vulnerable equipment is removed from the room, then put back and disinfected. “That’s a process that takes about two hours,” he said.
A longer-term problem is that many procedures deemed non-urgent have been postponed – and if they’re postponed for too long, patients’ medical conditions may well deteriorate.
“If you postpone elective operations for a few weeks, it’s no disaster,” said Prof. Haim Bitterman, scientific director of the Israel National Institute for Health Policy Research. “But if the situation continues for months, we’ll pay a price in the deterioration of all kinds of medical conditions.”
For instance, he said, kidney function can be affected if prostate operations are postponed too long, while untreated gallstones can cause infections.