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E.R. Visits Drop Sharply During Pandemic E.R. Visits Drop Sharply During Pandemic
(3 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.
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.
Updated June 5, 2020 Updated June 12, 2020
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.
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.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.
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.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.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
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.
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.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.
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 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.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.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.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“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.