Symptoms are not always clear cut
Thank you for an important report enjoining patients to seek care for critical medical conditions during COVID-19 (“Hospitals see people delaying treatment,” Metro, May 19). The assessment that declines in hospitalizations for emergent conditions are due to fearful patients avoiding care may be incomplete. As a health services researcher, I am mindful that patients often contact primary care providers about symptoms of conditions that could require emergency treatment. Symptoms of these conditions are not always clear cut, and it is the medical provider who directs the patient to the emergency room or recommends testing that could lead to hospitalization. Provider responses to guidelines around essential care management during the COVID-19 crisis can affect the care of non-COVID patients. The chain of connections that brings patients to the hospital for critical care may also contribute to declines in hospitalizations for stroke, heart attack, and other emergent conditions.
The writer is an adjunct assistant professor in the Department of Public Health and Community Medicine at the Tufts University School of Medicine.
Healthier patients don’t go to the emergency room
Finding fewer strokes and heart attacks at their door, hospitals that rely on these events for their revenue conclude that patients aren’t seeking medical attention (“Hospitals see people delaying treatment," Metro, May 19). Yet there’s an equally if not more plausible explanation: The incidence of these events has fallen during lockdown.
There are good reasons to think this is the case. The air is cleaner, so patients are less exposed to environmental factors that trigger respiratory and perhaps cardiovascular events. Social distancing not only prevents transmission of coronavirus; it also prevents transmission of other infectious agents. Patients are more compliant with their medications and diet to avoid vulnerability to COVID. Finally, fewer medical interventions means fewer iatrogenic complications. In our PACE (Program of All-inclusive Care for the Elderly) program, we’ve seen a significant reduction in non-COVID hospital utilization since the pandemic arrived. We are also in daily telephone contact with our patients and their households. If they were having strokes and heart attacks, we’d know about it. Rather than citing anecdotes and wringing our hands about quiet emergency departments and half-empty hospitals, maybe we should be considering important lessons for a post-COVID world.
Dr. Adam Burrows
PACE Medical Director
Upham's Corner Health Center