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E.R. Visits Drop Sharply During Pandemic E.R. Visits Drop Sharply During Pandemic
(14 days later)
Emergency room visits in the United States have dropped sharply during the pandemic, underscoring concerns that people with serious medical conditions, like heart attacks, are avoiding hospitals, according to a new analysis released on Wednesday by the Centers for Disease Control and Prevention.Emergency room visits in the United States have dropped sharply during the pandemic, underscoring concerns that people with serious medical conditions, like heart attacks, are avoiding hospitals, according to a new analysis released on Wednesday by the Centers for Disease Control and Prevention.
As the coronavirus spread across the United States this spring, visits to emergency rooms decreased by 42 percent over four weeks in April, compared with the same period in 2019. The declines were greatest among children 14 and younger and women, and in the Northeast.As the coronavirus spread across the United States this spring, visits to emergency rooms decreased by 42 percent over four weeks in April, compared with the same period in 2019. The declines were greatest among children 14 and younger and women, and in the Northeast.
While there have been a recent rebound in visits, the C.D.C. noted, the volume of visits remains significantly lower. Visits to the emergency room were down 26 percent in the last week of May, compared with figures from a year earlier.While there have been a recent rebound in visits, the C.D.C. noted, the volume of visits remains significantly lower. Visits to the emergency room were down 26 percent in the last week of May, compared with figures from a year earlier.
While hospitals in hot spots like New York City were often overwhelmed by the numbers of seriously ill coronavirus patients, and admissions for infectious diseases and pneumonia climbed, there were drastic declines in the volume of patients who typically come to the emergency room for care.While hospitals in hot spots like New York City were often overwhelmed by the numbers of seriously ill coronavirus patients, and admissions for infectious diseases and pneumonia climbed, there were drastic declines in the volume of patients who typically come to the emergency room for care.
“It was eerily quiet,” said Dr. Thomas Balcezak, the chief clinical officer for Yale New Haven Health, who recalled walking through his hospital system’s emergency departments at the peak of the epidemic and being struck by the lack of patients.“It was eerily quiet,” said Dr. Thomas Balcezak, the chief clinical officer for Yale New Haven Health, who recalled walking through his hospital system’s emergency departments at the peak of the epidemic and being struck by the lack of patients.
In a possible sign that patients were coming in later and sicker, he pointed to the C.D.C.’s finding that visits for conditions like ventricular fibrillation had increased, suggesting that patients might have had heart attacks and initially stayed home before coming in with a worsening condition. “That’s worrisome,” he said.In a possible sign that patients were coming in later and sicker, he pointed to the C.D.C.’s finding that visits for conditions like ventricular fibrillation had increased, suggesting that patients might have had heart attacks and initially stayed home before coming in with a worsening condition. “That’s worrisome,” he said.
The agency’s report highlights the monthslong decline in general care as the virus took hold and overwhelmed some hospitals. Across the nation, hospitals stopped performing elective procedures, whether a routine mammogram or a knee replacement, even if they were not experiencing a surge in virus patients. While they have slowly begun resuming care, many patients, concerned about potential infection, continue to avoid hospitals.The agency’s report highlights the monthslong decline in general care as the virus took hold and overwhelmed some hospitals. Across the nation, hospitals stopped performing elective procedures, whether a routine mammogram or a knee replacement, even if they were not experiencing a surge in virus patients. While they have slowly begun resuming care, many patients, concerned about potential infection, continue to avoid hospitals.
“Where are all the heart attacks and strokes?” asked Chas Roades, the co-founder and chief executive of Gist Healthcare, which advises health systems. He said that many patients were returning for rescheduled surgeries, but that hospital executives were reporting that people, worried about possible infection, continued to avoid their emergency rooms and urgent care clinics.“Where are all the heart attacks and strokes?” asked Chas Roades, the co-founder and chief executive of Gist Healthcare, which advises health systems. He said that many patients were returning for rescheduled surgeries, but that hospital executives were reporting that people, worried about possible infection, continued to avoid their emergency rooms and urgent care clinics.
“This is a national concern that patients are worried that the hospitals, health care systems, physician offices could be more dangerous than grocery stores, hardware stores and other essential businesses,” said Dr. Balcezak, although he emphasized there was no evidence that the risks were any higher in hospitals.“This is a national concern that patients are worried that the hospitals, health care systems, physician offices could be more dangerous than grocery stores, hardware stores and other essential businesses,” said Dr. Balcezak, although he emphasized there was no evidence that the risks were any higher in hospitals.
In some cases, patients may be opting for virtual visits or some other alternative, said Dr. Stephen Klasko, the chief executive of Jefferson Health, who has seen the declines in visits across all of the system’s hospitals. But in other cases, patients are forgoing needed care, he said. “The real key here is virtual triage,” Dr. Klasko said, where someone who feels dizzy or has chest pain can find out if a trip to the emergency room is warranted.In some cases, patients may be opting for virtual visits or some other alternative, said Dr. Stephen Klasko, the chief executive of Jefferson Health, who has seen the declines in visits across all of the system’s hospitals. But in other cases, patients are forgoing needed care, he said. “The real key here is virtual triage,” Dr. Klasko said, where someone who feels dizzy or has chest pain can find out if a trip to the emergency room is warranted.
Hospitals are taking numerous steps to ensure patients remain safe from infection, said Dr. William Jaquis, an emergency room doctor who is the president of the American College of Emergency Physicians. Emergency rooms are not only less crowded, he said, but they have taken a number of steps to screen patients for potential infection and to make sure both patients and providers wear masks. Patients who may be infected are treated in separate areas.Hospitals are taking numerous steps to ensure patients remain safe from infection, said Dr. William Jaquis, an emergency room doctor who is the president of the American College of Emergency Physicians. Emergency rooms are not only less crowded, he said, but they have taken a number of steps to screen patients for potential infection and to make sure both patients and providers wear masks. Patients who may be infected are treated in separate areas.
Congress has responded to the hospitals’ loss of patients and resulting revenue by providing as much as $175 billion in funds to hospitals and other providers, but much of the money has gone to the largest, most profitable institutions, compared with medical centers in rural communities or those that serve low-income patients.Congress has responded to the hospitals’ loss of patients and resulting revenue by providing as much as $175 billion in funds to hospitals and other providers, but much of the money has gone to the largest, most profitable institutions, compared with medical centers in rural communities or those that serve low-income patients.
Updated July 7, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
While emergency room visits for minor ailments like stomach pains, earaches and sprained ankles have been far fewer this year, agency officials pointed to a more disconcerting drop in the number of people who arrived with chest pain, including those experiencing heart attacks. There were also declines in children requiring emergency help for conditions like asthma.While emergency room visits for minor ailments like stomach pains, earaches and sprained ankles have been far fewer this year, agency officials pointed to a more disconcerting drop in the number of people who arrived with chest pain, including those experiencing heart attacks. There were also declines in children requiring emergency help for conditions like asthma.
“Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed,” the C.D.C. officials said. They added that people should be encouraged to reduce their potential exposure to infection by using telemedicine and other methods of triage to determine whether they need to go to the hospital.“Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed,” the C.D.C. officials said. They added that people should be encouraged to reduce their potential exposure to infection by using telemedicine and other methods of triage to determine whether they need to go to the hospital.
But the officials also said the drop in emergency room visits could affect people’s ability to get care when they have no other alternative sources. People who use the emergency room “as a safety net because they lack access to primary care and telemedicine,” they said, might be disproportionately affected if they avoid seeking care because of concerns about the infection risk.”But the officials also said the drop in emergency room visits could affect people’s ability to get care when they have no other alternative sources. People who use the emergency room “as a safety net because they lack access to primary care and telemedicine,” they said, might be disproportionately affected if they avoid seeking care because of concerns about the infection risk.”
“It’s made that access to care even harder,” said Dr. Balcezak of Yale. “We’re not seeing them in the emergency department.”“It’s made that access to care even harder,” said Dr. Balcezak of Yale. “We’re not seeing them in the emergency department.”
The analysis of visits from the National Syndromic Surveillance Program, which collects real-time electronic health data, representing nearly three-quarters of all emergency room visits in the United States, was published in an early release of the Morbidity and Mortality Weekly Report by the C.D.C.The analysis of visits from the National Syndromic Surveillance Program, which collects real-time electronic health data, representing nearly three-quarters of all emergency room visits in the United States, was published in an early release of the Morbidity and Mortality Weekly Report by the C.D.C.