New Jersey hospitals are showing declines of up to 40% in the total number of patient admissions because non-COVID-19 cases are staying away in the likely mistaken belief that they will be infected by going to the hospital, health care leaders and doctors say.
Many people with urgent medical conditions like heart attacks, strokes or acute appendicitis are avoiding going to the hospital, even when instructed by their doctors, because they fear infection with the coronavirus or because they believe the hospitals are so overwhelmed by COVID-19 patients that they don’t have the capacity to treat people with other conditions.
Those patients risk getting more seriously ill and spending more time in the hospital, or even dying, as some have, doctors warned.
Every hospital in New Jersey now has the capacity to treat non-COVID-19 patients, who will benefit from rigorous infection-control protocols, leaving them less exposed to COVID infection than they would be by a trip to the grocery store, according to one emergency room doctor.
Other health care officials said hospitals have always been available for non-COVID-19 patients even though some have struggled to cope with the pandemic.
“Our message was never to avoid having patients that have truly medically necessary needs, and we want those individuals to make sure that they come through our doors because we’re really concerned that we’re going to see a second victim,” said Cathy Bennett, chief executive of the New Jersey Hospital Association (NJHA), which represents about 400 health care providers. “That will be those from non-COVID conditions that they put off seeking care for, and now they are reaching a crisis point.”
Bennett said anecdotal evidence suggests that overall hospital admissions during the pandemic are down 20-40% compared with pre-COVID levels, and compared with a year ago.
More urgent non-COVID cases
But she said that, with the latest decline in hospitalizations for COVID-19, there are signs in recent days that more urgent non-COVID cases are coming forward.
“Now that the number of hospitalizations has started to decline, we are starting to see some individuals in the last few days come to our hospitals seeking urgent care,” she said in an interview on Saturday.
As of 1 p.m. Saturday, the number of COVID-19 hospitalizations in the latest 24 hours was 378, the lowest one-day count since the previous weekend, Gov. Phil Murphy said at his daily briefing. That was outweighed by the 525 COVID patients who were discharged from hospitals. And the total number of COVID hospitalizations dropped by more than 1,000 over the past week to 5,713, Murphy said.
“We’ve peaked, we’ve started to come down and as we’ve done so, capacity has opened in the hospitals,” Bennett said. “But more than capacity is that we still have all the resources that are there and wanting to work and care for New Jerseyans but at the same time they are not coming through the door.”
Concern about non-COVID-19 patients led Bennett and state Department of Health Commissioner Judith Persichilli to make a public service announcement video that is due to air on YouTube and social media starting this week.
“Our hospitals are ready and waiting to care for you. Don’t delay, it just may save your life,” Persichilli says in the video.
Deadlier health conditions
Meanwhile, Hackensack Meridian Health warned non-COVID patients that some conditions like heart attacks are deadlier than COVID-19, from which most people recover at home without medical treatment; that faster treatment means better outcomes, and that patients are unlikely to be infected with COVID-19 in hospital emergency rooms because of strict disinfection protocols.
Dr. Jeremy Dayner, chair of the emergency department at CentraState Medical Center in Freehold, said the total number of patients coming into his emergency room has plunged by about half from the pre-COVID level of 150 a day since the pandemic took hold in mid-March.
Most of those who are coming in are COVID patients, so that means the many others are staying away, apparently because they fear infection, and by doing so they are putting their health at greater risk, Dayner said.
“We are seeing some, and they are coming in very late, some time after their symptoms started, because they are afraid to come in because of coronavirus,” he said. “And in a lot of cases, they have got to the point where we can’t help them. They have completed their heart attack and now for the rest of their life have a weakened heart. There’s nothing I can do once the damage is done.”
One man in his 70s died from emphysema recently after delaying a trip to the hospital, Dayner said. The patient’s family members were trying to convince him for days to seek hospital treatment but he wouldn’t go because he was worried about getting the coronavirus, and by the time they arrived at the emergency room, the patient was “effectively dead,” he said.
Strict hospital disinfection protocols
Dayner stressed the rigor of hospital disinfection protocols that significantly reduce the chances of non-COVID patients being infected with the virus.
Every staff member is masked and gowned, and those gowns get changed with every patient so that you are not being exposed to anyone, he said. Every patient is put in a mask as soon as they enter the building; the hospital has replaced curtained rooms with closed rooms, and no patients are left in hallways. There’s an individual room for each patient, and rooms are fully cleaned with bleach and ultraviolet light before the next patient is admitted.
“We’ve done so much to protect the patients coming in that you are much safer to come into the emergency department and be seen than you are to go grocery shopping,” he said. “It’s a very safe place to be; the odds of contracting COVID there are very low.”
And despite widespread media coverage about hospitals being overwhelmed by COVID-19 patients, hospitals do have the capacity to treat people with other illnesses, even in the northern areas of the state that have been hardest hit by the pandemic, said Dr. Ken Kronhaus, a family physician in Brick, and a member of the New Jersey Academy of Family Physicians.
“Hospitals will not turn away people who need to be in the hospital,” he said. “They will find somewhere to take care of them.”
‘Hospitals will not turn away’ emergencies
Kronhaus urged people with urgent conditions not to put off hospital visits even if they fear COVID-19. “They need to address their health issues appropriately, and if they require emergency room care, they should follow those directions if they’re given to them, certainly if they’re having chest pain or stroke symptoms. They need to go to the emergency room to get evaluated regardless of the risk of COVID,” he said.
Dr. Judith Lightfoot, chief of infectious disease at the Rowan School of Osteopathic Medicine in Stratford, said one of her patients, a 60-year-old woman, died after delaying a trip to the hospital for a chest x-ray, which Lightfoot ordered on April 16 because of the woman’s shortness of breath. “She died upon entering the emergency room. She did not get there soon enough,” the doctor said.
And she urged patients to make better use of telemedicine links with their primary providers, even if some doctors prefer in-person visits for diagnosis or treatment.
Even if non-COVID patients have overcome a fear of hospital infection, some have stayed away from hospitals because they want to obey social-distancing guidelines, and because they don’t want to add to hospital burdens, said NJHA’s Bennett.
But by doing so, such patients may be putting their own lives at risk, and, if they are eventually hospitalized, using capacity that might not have been needed if they had checked in sooner, she said.
“They were trying to be good, they were trying to manage their own symptoms, they were staying home, and they weren’t really appropriately identifying what was taking place,” she said. “That’s fine when your symptoms are mild but when your symptoms are severe, it could make your outcome worse.”