“Whether it’s benevolence or fear of exposure, we need to address that,” he said.
Kazi is most worried about people who are experiencing acute symptoms that could snowball into a severe condition if left untreated.
“Individuals who are having very extreme heart attacks are going to get help, but at the fringes you have people who have acute symptoms who are staying home,” said Kazi. “I am worried that these patients could suffer severe consequences weeks or months down the road that could have been avoided if we had intervened.”
Most hospitals have instituted telehealth programs that allow patients to seek a medical evaluation remotely. In a situation that is not potentially life-threatening, these lines should always be used over showing up at a hospital, but people should still follow typical protocol for all medical emergencies during the pandemic, not just those related to the virus, Kazi said.
“I do not recommend that if patients are having warning signs of a heart attack or stroke that they should try and use telehealth to reach their doctor,” Kazi said. “These warning signs should result in a 911 call, and because EMS may be busy, calling 911 in a timely manner is even more important right now.”
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Delaying care could also put more strain on the health care system in the long run.
“If people defer calling 911 for life-threatening emergencies or put off life-saving procedures because they’re afraid of getting exposed to the coronavirus in emergency rooms or hospitals, we can expect to see an increase in deaths among these people that is not reflected in COVID-19 death toll numbers,” said Kazi.
Emergencies in New York City
In New York City, the national center of the pandemic, 911 calls are at all-time highs, fleets of first responders are coming down with COVID-19 and wait times for ambulances have exceeded six hours in recent weeks.
But according to Oren Barzilay, president of the FDNY EMS Local 2507, which represents 4,500 first responders in New York City, call priorities, which determine where help is sent first, have not changed because of COVID-19. Low-priority calls are the ones experiencing these significant delays, not high-priority emergencies.
In fact, holding off on calling 911 until heart attack symptoms worsen could make it impossible for New Yorkers to get to a hospital at all. The Regional Emergency Medical Advisory Committee of New York City announced on Tuesday, March 31, that if an adult is in cardiac arrest and emergency responders are unable to restart their heart at the scene after 20 minutes, that person will not be taken to the city’s overburdened hospitals for further revival attempts, as is normally the case. This means seeking help when symptoms start is even more crucial.
“If anybody is experiencing a true emergency, we will always be there for you. We will never turn anyone away,” Barzilay said.
That goes for doctors working in New York City hospitals as well, though they are carefully weighing treatment options to keep emergency patients from staying in the hospital when possible, said Dr. Daniel Herron, the chief of general surgery at Mount Sinai Health System.
One example is appendicitis: “If a patient presents with abdominal pain which is strongly suggestive of appendicitis, which can be treated with surgery or with antibiotics, we would lean very heavily toward the treatment option that minimizes the use of hospital resources, which would be the antibiotic option,” Herron said. But “in cases where there is only a surgical option, then surgery is still available.”