We were prepared for a rise in COVID-19 patients, but we didn’t expect the sharp decline we saw in everyday cases. Our emergency department visits fell by half in early April, a time when we would normally see growth as flu season overlaps with an increase in trauma as the weather improves. Inpatient stays fell by nearly two-thirds during the same time period.
Did the population of a state that ranks in the bottom of most health indicators suddenly get better? Did their lung disease, heart disease and vascular disease improve?
In the emergency room, we heard the real reason: “I thought I could wait this out,” patients told us.
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In hospitals across the U.S. and Europe, people fearing contracting COVID-19 have been choosing not to seek the emergency treatment they need. One survey conducted in April found that nearly a third of U.S. adults had delayed medical care or avoided seeking care because they were concerned about getting COVID-19.
A study in Spain found a 40% drop in the number of patients undergoing emergency cardiac catherization for a dangerous type of heart attack known as STEMI between the late February and mid-March. A similar study in the U.S. found a 38% drop in heart catherization for STEMI cases from January to March. Children’s vaccinations also dropped off significantly, according to the Centers for Disease Control and Prevention, raising new concerns after last year’s measles outbreak.
This has certainly been our experience as physicians and faculty at the West Virginia University School of Medicine. The patients we saw in the emergency room in April were a lot sicker, and the proportion of emergency room patients who needed hospitalization increased.
The costs of delaying emergency care
Delaying treatment for acute and chronic conditions comes at a cost, both human and financial.
A patient with appendicitis who gets treatment early will usually undergo laparoscopic surgery, using small incisions and a camera, and can go home two days later. If the same patient waits too long, however, and a pocket of infection known as an abscess forms, that means more complex surgery. We will have to insert a tube for several days to drain the abscess, and the patient will be hospitalized longer, in addition to going on antibiotics. In the worst case, the appendix could burst and lead to diffuse peritonitis and sepsis, a medical emergency with severe abdominal pain and low blood pressure.
Similarly, if a diabetic with a foot infection that is early in the stages of cellulitis, a painful localized skin infection, waits a week to two longer than usual, there’s a greater chance the infection has reached the bone, becoming an osteomyelitis that could require amputation.
The ultimate cost for delaying treatment can be loss of life. Data from the CDC shows the U.S. had 66,000 more deaths than expected from January through the end of April, with only about half of those linked to COVID-19.
In some cases, clinics are trying to balance the risks. For example, many clinics have delayed preventative care such as cancer screenings because of the risk of COVID-19. One U.S. study found an abrupt drop in preventative cancer screenings of between 86% and 94% through April. Treatments for cancer patients are continuing, with hospitals taking extra precautions to protect patients while their immune systems are compromised.
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The hospital experience is changing
COVID-19 is not going away anytime soon, nor will heart attacks, strokes or appendicitis.
If you feel you need to see your doctor, go. If you feel you need to go to the emergency department, call 911. It’s better than the pain and costs that can come with delay.
Your experiences during hospital visits going forward will definitely be different for a while. People arriving for hospital care that doesn’t require staying overnight should expect some kind of screening process to make sure that they are not ill with COVID-19. The health care system will encourage social distancing at check-ins, as well as in the waiting rooms, and everyone will be wearing face masks.
As a patient, you might not be allowed to have visitors, but you will receive the health care that you need.
While these certainly unprecedented times have upended our care processes, they also offer patients and health care systems new opportunities.
When we talk to our patients, many of them appreciate the opportunity for virtual visits, especially those at highest risk for complications from COVID-19 infection. The ability to establish virtual urgent care as well as offer many clinical services through virtual visits is here to stay.
The past few weeks have seen very significant changes at all points of patient entry into a hospital or clinic. However, clinical medicine’s fundamental principle of primum non nocere, “first do no harm,” prevails, and we remain committed to making sure that patients that need care get it on time and do not have to delay their visits or ignore their symptoms.
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Arif R. Sarwari, Physician, associate professor of infectious diseases, chair of Department of Medicine, West Virginia University and Christopher Goode, Emergency medicine physician, chair of Emergency Medicine, West Virginia University
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Will America-First News Outlets Make it to 2023?
Things are looking grim for conservative and populist news sites.
There’s something happening behind the scenes at several popular conservative news outlets. 2021 was bad, but 2022 is proving to be disastrous for news sites that aren’t “playing ball” with the corporate media narrative. It’s being said that advertisers are cracking down, forcing some of the biggest ad networks like Google and Yahoo to pull their inventory from conservative outlets. This has had two major effects. First, it has cooled most conservative outlets from discussing “taboo” topics like Pandemic Panic Theater, voter fraud, or The Great Reset. Second, it has isolated those ad networks that aren’t playing ball.
Certain topics are anathema for most ad networks. Speaking out against vaccines or vaccine mandates is a certain path to being demonetized. Highlighting voter fraud in the 2020 and future elections is another instant advertising death penalty. Throw in truthful stories about climate change hysteria, Critical Race Theory, and the border crisis and it’s easy to understand how difficult it is for America-First news outlets to spread the facts, share conservative opinions, and still pay the bills.
Without naming names, I have been told of several news outlets who have been forced to either consolidate with larger organizations or who have backed down on covering certain topics out of fear of being “canceled” by the ad networks. I get it. This is a business for many of us and it’s not very profitable. Those of us who do this for a living are often barely squeaking by, so loss of additional revenue can often mean being forced to make cuts. That means not being able to cover the topics properly. Its a Catch-22: Tell the truth and lose the money necessary to keep telling the truth, or avoid the truth and make enough money to survive. Those who have chosen survival simply aren’t able to spread the truth properly.
We will never avoid the truth. The Lord will provide if it is His will. Our job is simply to share the facts, spread the Gospel, and educate as many Americans as possible while exposing the forces of evil.
To those who have the means, we ask that you please donate. We have options available now, but there is no telling when those options will cancel us. We have our GivingFuel page. There have been many who have been canceled by PayPal, but for now it’s still an option. Your generosity is what keeps these sites running and allows us to get the truth to the masses. We’ve had great success in growing but we know we can do more with your assistance.
Thank you, and God Bless!
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