Medical emergency? Don't fear COVID-19; get help, Naperville doctor says
In three months of caring for patients with COVID-19, none of the 40 doctors in the emergency department at Edward Hospital in Naperville have contracted the virus.
That's important to mention, said Dr. Tom Scaletta, medical director of the emergency services department at Edward, because it illustrates that there is not a high risk of picking up the virus from visiting an emergency room for urgent medical needs.
Hospitals across the region and the country, including Edward, have been reporting lower patient volumes during the pandemic. Doctors say as many as a third of the typical number of patients are staying away - at significant risk to their health - because of what Scaletta described as "a misperception that they're going to be at high risk for acquiring COVID."
When a patient comes to the Edward emergency department with suspected COVID-19 symptoms, such as shortness of breath, coughing or fever, Scaletta said, that patient is placed in a private room. Rooms for suspected and confirmed COVID-19 patients are in a separate area, away from patients visiting the hospital for other reasons.
Most patients go straight from a podium at the door where they are greeted and triaged into a private room to await a nurse and a doctor.
"You're not going to be in the waiting room sitting next to somebody who is coughing, which would be very scary," Scaletta said.
Everyone at the hospital is required to wear a mask.
Still, during his shift May 24, Scaletta saw two patients who waited days to seek help, one who likely had suffered a heart attack two days before, who came in only because he fainted, and another whose sudden shortness of breath began two days earlier, a result of a blood clot that could have killed him.
"Usually, you don't ignore that. Waiting two days is very, very dangerous," Scaletta said. "That guy took a chance with his life."
With patients like these in mind, Scaletta posted a question on a private Facebook page for doctors across the country, asking what examples they'd seen of patients suffering consequences that could have been prevented because they waited too long out of fear of the coronavirus.
He got hundreds of examples within hours. On the list were deaths, amputations, gangrene, kidney failure, aggressive cancers, strokes, ulcers, cardiac arrest, internal bleeding, multiple organ failure, full-body infections, clogged arteries, ectopic pregnancies. Some doctors even said their own relatives waited too long to seek care.
"I've filled out more death certificates in the last two months than in the last five years combined," one doctor wrote. "Some may have been COVID, but I think the majority are from delay of care, with family frequently telling me the delay was due to fear of COVID exposure in the (emergency department)."
Scaletta's message in light of these treatment delays is not to take health risks of any kind. Follow the distancing and sanitizing guidelines to help limit the spread of COVID-19, but do not fear it. For true medical emergencies, visit an emergency room or call 911.
Examples of hospital avoidance gone wrong
Dr. Tom Scaletta, medical director of the emergency services department at Edward Hospital, posted this question on a Facebook group for emergency doctors nationwide: "Please share some examples of cases where increased morbidity or mortality as a result of someone delaying an emergent problem due to fear of acquiring COVID." He got hundreds of responses within hours. Here is an edited version of six of the answers, decoded by Scaletta into lay people's terms.
• Young adult with significant pre-existing conditions had three weeks of diarrhea. The patient avoids the ER due to COVID fears. Later, she comes in with severe anemia, kidney failure, low blood pressure and an extremely low potassium level, which caused her heart to stop in the ER, where she died.
• Man in his late 60s with severe kidney failure. He had avoided coming in for over a week due to fears of COVID. He was profoundly short of breath and had acid in his blood. He died within hours of arrival. Doctors had to break the news over the phone to his family that it was just too late to help him. When asked why they didn't come in three weeks ago, they said, "Because I was afraid of catching corona from the hospital."
• Gall bladder infection moving up into the ducts and liver causing a severe blood infection and shock. Died hours later. Paramedics were called the day before and after they examined the patient, it was decided not to come to ER due to COVID risk.
• Patient came in with abdominal pain and was found to have a bowel blockage due to constipation. This did not resolve in the emergency department but patient refused to be admitted. Because of long delay in coming in, the bowel became very dilated and consequently burst. This caused overwhelming infection and shock, which resulted in the patient dying.
• 30-year-old woman with persistent cough for five weeks. Avoided in-person evaluation, so no one assessed her vital signs. Finally, she came in and had an extremely high heart rate of 140, which is double the normal rate. Her chest x-ray showed a large tumor in the back of her chest, which was an aggressive cancer that would have been diagnosed and treated sooner had she come to the emergency department.
• Woman in her 20s came in with coma and immediately had a cardiac arrest. Supposedly had been "sick" for a couple days, according to paramedics, but no more detail was shared. She had a pregnancy in the fallopian tube that ruptured. She was revived and made it through surgery, but ended up with multiple organ failure.