COVID-19 fears keep millions of Americans from seeking hospital care

Millions of Americans are jeopardizing their health by avoiding hospital care, even in medical emergencies, for fear of contracting COVID-19.

Emergency room visits across the United States have dropped sharply since the pandemic took hold, even though doctors say patients are far less likely to catch the virus lying in a hospital bed than shopping in a store.

April saw a 42% decline in emergency department use nationally. That amounts to 900,000 fewer visits per week compared with the same time period a year ago, according to a study published by the Centers for Disease Control and Prevention.

"That is just a stunning number that suggests a lot of people are not seeking care for things they should be seeking care for," said Dr. John Hick, a state adviser on COVID-19 and an emergency medicine doctor at Hennepin Healthcare, where emergency visits were 43% lower than normal in April.

At Methodist Hospital in St. Louis Park, emergency department volumes sank to 86 patients per day in April, just over half the normal level. At Regions Hospital in St. Paul, emergency trips dropped 35% to 167 per day in March and early April. Allina Health saw a collective drop of nearly 50% in visits to its 13 emergency departments in the metro.

Volumes are trending up, but they're still at least 20% below historic averages.

At least 4 in 5 people who get COVID-19 have mild to no symptoms, while as many as 5% may need critical care in the hospital. In about 85% of the 30,000 cases of COVID-19 confirmed by lab testing in Minnesota since March 5, those contracting the virus no longer need to remain in isolation.

Case counts currently are plateauing in Minnesota. But early in the pandemic, Gov. Tim Walz and other officials said the greatest risk from COVID-19 would come from overwhelming the health care system with droves of sick patients. Elective and nonemergency procedures were canceled to preserve limited supplies of masks, gowns and other protective gear.

Hospitals now say they have adequate supplies of protective equipment and contingency plans to handle another surge if it comes. In the meantime, many patients have become sicker by staying home while hospitals have suffered dramatic declines in revenue from lost business.

"Patients have been coming back, and we are seeing people are sicker than they normally would be. And it's because they are waiting," said Dr. Brent Walters, medical director of the emergency department at Methodist Hospital in St. Louis Park.

Taking precautions

Many Minnesota hospitals have implemented a wide range of enhanced infection-control measures to cope with the outbreak, including universal screening of patients, copious use of personal protective equipment and surface cleaning, and improvements in airflow and hallway traffic patterns. The result, doctors say, is a much lower risk of transmission in the hospital.

Health care workers have contracted the virus while on duty, but no source contacted for this story was aware of any patient getting the virus in the hospital. Neither was the Minnesota Department of Health.

"While COVID is a scary disease, and it is surprisingly transmissible compared to other respiratory viruses ... it is exceedingly uncommon to inadvertently transmit or acquire this infection while you are in the hospital," said Dr. Cameron Berg, medical director of the emergency department at North Memorial Health Hospital in Robbinsdale, where pandemic ED volumes dropped 40% below normal at one point.

Yet people are jeopardizing their health because they're not getting fast care for strokes, heart attacks, acute appendicitis, severe infections and other emergency needs. Doctors say people are either afraid of acquiring the virus in the hospital or believe that nurses and doctors don't have enough protective equipment.

"I have a lot of patients apologize for coming in," said Dr. Katherine Katzung, chairwoman of the emergency department at Abbott Northwestern Hospital in south Minneapolis. "During the protests I even had people apologizing for coming in. I was like, 'Well, you were sprayed with tear gas. That's a very reasonable reason for you to be in the emergency department.' "

Some pandemic precautions are immediately apparent at the front door. At many hospitals, temperatures are taken for every patient, and all must answer a series of questions about exposure and symptoms of COVID-19. Like many supermarkets, hospitals have markings on the floor for social distancing while standing in line.

Once inside the front door, patients are quickly "cohorted" into potential-COVID and non-COVID groups. Abbott Northwestern directs people to one side of the waiting room or the other, and Methodist has separate COVID and "NOVID" waiting rooms.

Nurses and doctors wear N95 respirators and eye protection while treating every patient. For COVID patients, heavier protective gear like face shields may be used, or powered respirator masks.

Many hospitals have started giving a rapid diagnostic COVID-19 test to every person admitted from the emergency department, and they use greater precautions until the test comes back negative.

At North Memorial, about 2% of tests given to people who initially screen as negative for COVID at the front door come back positive, Berg said.

Best practices

Many hospitals now have dedicated pods or wings of COVID rooms, both in emergency departments and in the general hospital. COVID rooms commonly have tablet computers mounted on poles that can be used to talk to clinicians and family members.

At Methodist, a dedicated, easy-to-clean stethoscope hangs outside each COVID patient room, and there's an ultraviolet cleaning robot parked in a hallway by the normal mop and laundry cart.

COVID rooms in the emergency department have closeable doors and negative-airflow systems that ensure air is ventilated out of the building, not into the hallway. At Abbott Northwestern, an alarm on an empty COVID patient room sounded after the door didn't close properly during a quick demo earlier this month. Many rooms have been retrofitted with box-size machines that sit on the floor and optimize air pressure.

And then there's all the colored tape. Many hospitals have affixed lines of red, yellow and green tape on the floor to mark different infection-risk zones. Patients are cohorted into zones on arrival, and clinicians and staff who cross the lines take precautionary steps, such as changing protective gear and sterilizing their hands.

Though the strips of floor tape may not look like health technology, the system — known as "traffic control bundling" — dramatically reduced infection rates among hospital workers in Taiwan during the 2003 outbreak of the SARS-CoV virus. For the current outbreak of SARS-CoV-2, hospitals are adapting the model.

"I don't want to suggest that health care facilities are sterile and there is zero opportunity to get a health care-acquired infection," said Kris Ehresmann, infectious disease director at the state Health Department. "But health care facilities are very in tune with COVID. ... Now, probably more than any other time, facilities are really in tune with infection-prevention."