Coronavirus hits Michigan hospitals, but where are all the other patients?

Physicians say that emergency departments are safe for people to visit for injuries or other illnesses during the coronavirus pandemic. Convincing Michiganders may be a tall order, though. (Shutterstock)

As Michigan’s hospitals continue to swell with COVID-19 patients, many emergency and urgent care physicians said they’re increasingly troubled by a new trend: Patients with non-coronavirus ailments — heart attacks, strep throat, strokes, chest pains — have all but disappeared. 

Dr. Sam Mossallam, an emergency room doctor at Henry Ford Hospital in Detroit and Henry Ford Medical Center in Dearborn, said the ER in Detroit would normally treat about 120 patients on a Tuesday afternoon. This Tuesday, he said, there were 32.

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Physicians say they are worried about the people whose medical needs won’t vanish by staying at home. For emergency rooms, where are all the drug- and alcohol-related emergencies? The heart attacks and strokes? For urgent care clinics, where are the children with flu and strep throat? The elderly people with urinary tract infections?

“What happened to those people?” Mossallam said. “Where did they all go? I hope and pray they’re finding care elsewhere, but we’re not hearing about it.”

Several physicians said the drop is due in part to patients complying with social distancing orders. People with sprained ankles or bad migraines may be thinking twice about whether they truly require a hospital visit, and the statewide stay-at-home orders also mean fewer drivers on the road getting into accidents, or fewer illnesses picked up at buffets and birthday parties.

But others are skipping in-person care because they’re afraid of contracting the virus from other patients who may have COVID-19, or the medical staff that treat them. 

After assessing a child with a high fever through telemedicine, Dr. Farrah Iftikhar, medical director at Urgent Care Management, with four locations in southern Michigan, asked the family to bring their child to her clinic or a hospital for an in-person evaluation. 

The family refused, Iftikhar said, wary of exposure. When she tried to call and follow up with them, they didn’t respond.

“People are scared to come in,” Iftikhar said. “They don’t want to get an infection.”

In less pandemic times, the most common reasons why Americans needed an ambulance for emergency care were abdominal and chest pain and injuries from falling, according to a 2017 national survey. U.S. News & World Report, noted that 27 percent of urgent care visits in 2016 were due to respiratory illnesses like bronchitis and colds.

A few years back, Beaumont Health listed the top 10 reasons why people visit the emergency room. The top three: headaches, foreign objects in the body and skin infections.  

One particular ailment some emergency physicians expected to see more of during Michigan’s  broad stay-at-home order is heart disease. Staying indoors and limiting physical activity can themselves be “stressful” for the heart, said Dr. Chadi Alraies, a cardiologist at DMC Heart Hospital. 

That should lead to a spike in patients with acute heart problems, he said. Instead, the number of cases he has seen has dwindled from 15 to 20 a week to one or two.

“Either they unfortunately didn’t make it, or they’re sitting at home watching TV … having a heart attack,” Alraies said.

Even when patients do come in, more of them are waiting too long before seeking care, several physicians said. Dr. R. Dale Jackson, medical director of emergency management at Sparrow Health System in Lansing, said a colleague told him about a patient who avoided the hospital for days after breaking a leg, afraid that a visit would mean contracting COVID-19. 

“I had to drain a couple of abcesses this week. They should have been here much earlier, then it wouldn’t have gotten this bad,” Iftikhar said. “People just wait to see if they get better on their own, which they won’t.”

Physicians interviewed by Bridge said they understand why people might be reluctant to visit a hospital during the spread of the coronavirus. But they said for patients with illnesses or injuries unrelated to the virus, there is little to fear. In hospitals, people with COVID-19 are roped off from the rest of the patients, while many urgent cares are screening people for temperatures and any coronavirus-like symptoms before allowing them to enter.

“You, as a patient, are not a burden,” Alraies said. “You are doing yourself a disfavor if you come very late.”

For many urgent care clinics, the dwindling patient turnout has led to layoffs. Nearly all of Iftikhar’s part-time staff were let go after her clinic saw a 50 percent drop in patients from February to March. 

O’Coyle said about 30 percent of his employees were laid off. He also had to reduce the clinic’s hours of operation from 12 a day to eight.

Some in-person visits have been replaced by telemedicine, which allows physicians to evaluate their patients over video calls. Iftikhar’s clinic had to reduce its walk-in hours, but it’s still available 12 hours a day over Telemedicine.

It’s not a perfect substitute for in-person care, however, bypassing physical examinations that cardiologists like Alraies need to listen to the heart and the chest. And although telemedicine allows for more people to see a health care professional from the comfort of their own homes, it can also create barriers for people with unreliable internet access or people who aren’t accustomed to using the technology.

People who are sick or injured enough to require care should still come in, physicians urged, and anyone who is uncertain about the severity of their need can consult physicians through a phone call or other form of telemedicine first. 

“Any patient who feels like they’re having a medical emergency … they should not be afraid to come to the emergency department,” Jackson said. “We still are fully capable of treating all of that … and protecting patients from contracting COVID.”

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Comments

Anonymous
Wed, 04/08/2020 - 7:00pm

Yes, people are too afraid to use hospitals unless absolutely necessary. Hospitals are the front line.

LOL
Wed, 04/08/2020 - 8:43pm

WOW, BRIDGE!
Way to spin "The hospitals are empty and this coronavirus hysteria is unfounded" into a "SICK PEOPLE AREN'T COMING TO THE HOSPITAL" crisis!

Bravo, bravo! I salute you for your amazing spinning capabilities. You belong in a spin class.

Adrian Elliott
Sat, 04/11/2020 - 1:20am

No spin. The dragging out of this epidemic will kill more people than the virus itself, if it is drug out much longer.

Chris W
Thu, 04/09/2020 - 8:53am

The article fails to name another reason why people stay away. I was scheduled for a heart procedure at Michigan Medecine in AA and they called me that they had to take me off the list due to the Corona situation (beds and resources needed for that).

MEDIA HYSTERIA
Thu, 04/09/2020 - 9:07am

So you're saying the hospitals that are supposedly overloaded with corona patients are safe to go to? So is it safe to be around patients with corona? Why then is the government taking our rights away in the name of "social distancing" and safety? Why are we destroying our economy? Why don't we go back to work with maybe a mask and some gloves on and if someone is sick don't come to work?...like normal?

Arjay
Thu, 04/09/2020 - 9:23am

Hospital here had to lay off about 15% of staff including nurses, and predicting a $16 million loss this year from lack of elective surgeries. Telemedicine helping some to keep patients out of doctors offices and ER’s. Preschedule a lab test, meet a lab tech at the door, get your test, teleconference with the doc, go to pharmacy to pick up pills. Very efficient, may be the wave of the future.

Martha
Thu, 04/09/2020 - 9:30am

My 18 year old daughter was sent home from her teller job at the bank on Monday because she had a very sore, swollen throat. I called the walk in center and let them know we were on our way and 2 minutes away. They asked the usual questions: date of birth, symptoms, has she been here before (she had, many times). The receptionist told me that they would pull her chart and we were to wait in our car and someone would come and get her. only her. after 3 hours and 4 phone calls, some in full haz-mat looking gear, came and got her. Honestly, I wasn't sure I'd ever see her again. Once inside, she waited an additional 30 minutes, was swabbed for strep by a nurse. After waiting for the results, finally saw the doctor who dismissed her questions and sent her home telling her it was a common cold without any instructions or follow-up care or things to watch for. She is still very sick, is running a +2.0 degree fever and waiting for her family doctor to return her call requesting an appointment. Had the walk-in staff actually talked to her and read her chart they would have known that she has a heart condition, asthma and was currently working as an "essential" employee. I completely understand the necessity for the use of caution and PPE but, if you're going to treat everyone as if they are contagious, then TEST everyone as if they are contagious. And, while I'm on my soap-box, I must add that you cannot contain anything in a strainer. Everything should have been shut down for a minimum of 3 weeks from the start in mid-March, or earlier, making provisions for delivery-only services by a limited number of people with protective equipment. Do we really need every corner convenience store open so patrons can visit it 2-3 times a day for cigarettes and vodka? Yes, that's a real statistic from my 25-year old daughter working part-time to try to make ends meet. My 21- year old son also works as an "essential" employee. How is the stay-at-home order protecting us when they risk bringing it home to each other and to me every day? This pandemic is going to last much longer and return frequently because of the timid and ineffective steps our government took to "protect" us.

Had it
Thu, 04/09/2020 - 10:15am

You are overreacting. Had infected people at work and nearly everyone I work with got it. Some of us lost our sense of smell for a couple days and nothing else. One had a fever and cough for a couple days. The rest just had sniffles and a headache or random symptoms like that. This chinese flu isn't even that bad. And guess what? Out of all of us, the only person they even wanted to test was the person with the fever and the cough. They just told the rest of us to stay home. This is a giant conspiracy. Or maybe it's just the largest case of bureaucratic incompetence ever. Not sure.

Matt
Thu, 04/09/2020 - 10:38am

Is there any evidence at all that all the "essential " employees who've contuned working regular jobs (grocery, hardware, big box etc - not in hosipals) have exhibited any higher rate of infection than the public in general? Think about it. CVD19 is a serious issue and there is a ton of BS flying around about it - both can be true.

FearGod
Thu, 04/09/2020 - 9:31am

Am I reading this right? This clinic is laying off medical workers? I thought medical workers were being overwhelmed by the virus? How can this be?

What???
Thu, 04/09/2020 - 9:42am

Wow! First the news media, Government, and medical community, scare the shit out of the public. They tell you to stay home or die. "Only" absolutely necessary trips outside the home. "Now" they are worried because people are actually doing just that? WTH!!!

Allie
Thu, 04/09/2020 - 12:02pm

I think the point was: If you have serious medical issues that need treatment, don’t be afraid of getting treatment. I have a friend having TIAs (little strokes) and out of control blood pressure who is not receiving adequate treatment out of fear of the hospital. COVID-19 is scary, but so is sudden death. I sent her this article in hopes of encouraging her to go get treatment.

Myla
Thu, 04/09/2020 - 11:32am

One of the ongoing problems we have had with our health care system is the overuse of ERs for non-emergency visits. Although it's alarming that people with true emergencies may be staying away, it may be good that some of the typical, non-emergent visits aren't happening.

Don
Thu, 04/09/2020 - 9:49pm

Are you kidding. Nothing but articles and videos of supposedly overworked ER nurses and doctors. Many of them crying on YouTube. Now complaining where are the rest of the non Covid patients. Sorry, cant have it both ways. Which is it? Hey Beaumont, HF, and Trinity, here's an idea, because you all have multiple hospitals and clinics, pool your resouces during this pandemic and segregate Covid and non covid hospitals and clinics. Then jointly advertise the new structure. I'd love to have my rotator cuff fixed but niw deemed non essential. I can assure you that the Orthopedic surgeon is NOT working ER on Covid patients. He's sitti g home social distancing. And while Im at it, be nice if my Beaumont network primary doctor would call to say hi how you doing? I know hes not working Covid ER either. Nope, sitting home and doing his teledoc visits. Tough life. Bottom line, you've scared away the cash cow. Those of us with insurance and non Covid health issues. That shoulder surgery can wait another year.

Jim
Fri, 04/10/2020 - 5:25pm

No they are just plan scared to go into a ER Unit they don't want the virus that's the whole truth.