Dr. Richard Zane can list the cases he never wanted to see: a woman who had chest pain for four days, but only got to the hospital after her heart stopped. A man with a treatable blockage in his gallbladder that led to infection throughout his body. Several people who delayed coming in when they had numbness and blurred vision — clear signs of a stroke.

“Not a single day that we don’t see someone like that,” said Zane, who is the chair of emergency medicine at the University of Colorado’s School of Medicine and chief innovation officer at UCHealth.

Denver-area hospitals report emergency room visits were down 30% to 50% in April — amid the coronavirus pandemic — compared to the same month last year, according to local health care providers.

Some of that decline could be due to fewer accidents from work and outdoor recreation as Coloradans were ordered to stay home, but that doesn’t explain why hospitals are seeing fewer heart attacks and strokes, said Dr. Devin Bateman, an emergency room physician and chief medical officer at Parker Adventist and Castle Rock Adventist hospitals.

Jeff Hulley, an emergency medical services supervisor at South Metro Fire Rescue, said he hasn’t kept track of numbers, but there has been a shift as paramedics respond to fewer accidents and fire alarms at businesses. They initially staffed up, expecting a surge of COVID-19 calls, but those haven’t come at the level they anticipated, he said.

Some patients have called after their symptoms escalated, but Hulley said he can’t be sure if fear of the virus was what stopped them. He said people should feel comfortable calling for help, because emergency medical units have enough protective equipment and sufficient decontamination procedures to keep themselves and the public safe.

“Right now all our firefighters wear thick masks, even on a motor vehicle accident,” Hulley said.

Helen H. Richardson, The Denver Post
Donning personal protective equipment, South Metro Fire Rescue firefighter John Cronin, second from right, performs chest compressions on a patient as firefighters, from left to right, Roxy Ligrani, Chris Herrington, Eric Szabo and Jeff Hulley move a patient on a gurney to an ambulance to transport them to the hospital on May 5, 2020.

“Hospitals have done a really good job”

Hospitals don’t survey patients about why they might have delayed care, but Bateman, Zane and others suspect that fear of catching the new coronavirus and a misconception that hospitals are bursting at the seams have discouraged people from seeking care.

Chelsea Párraga, a Denver resident, said she delayed seeking medical care though she had worsening stomach pain and persistent vomiting. She said she held off because she had heard from family and friends that hospitals don’t want patients to come to the emergency room right away because of the coronavirus pandemic, and she was worried about catching the virus if she didn’t already have it.

“This was such a scary thing and I don’t think that I needed to be as scared as I was,” she said.

On April 20, Párraga finally messaged her doctor, who told her to go the emergency room. At Presbyterian St. Luke’s hospital, she was diagnosed with a ruptured appendix, and had to undergo surgery.

Dr. Ryan Griffith, a general surgeon at Presbyterian St. Luke’s, said he’s seen at least two appendicitis cases and two perforated gallbladders since the pandemic began, which is unusual. It’s not clear if COVID-19 has anything to do with the abdominal infections themselves, but fear of getting or spreading the new virus has led to people delaying care, he said.

“I want people to think about if they have abdominal pain and do want to go to the emergency department,” he said. “Hospitals have done a really good job quarantining patients with (COVID-19) infections.”

UCHealth University of Colorado Hospital at ...
RJ Sangosti, The Denver Post
Aurora’s UCHealth University of Colorado Hospital at Anschutz Medical Campus, pictured on March 31, 2020, is one of several Denver-area hospitals handling COVID-19 cases.

“A silent wave”

In the early days of the pandemic, hospitals and public officials tried to get out the message that people shouldn’t seek emergency room care unless absolutely necessary, to avoid a crush of patients with mild respiratory symptoms. Now, some worry that the nuance — that some health problems really do demand immediate attention — got lost as people avoided health facilities in general.

Nationwide, emergency rooms are seeing similar drops in volume to those reported in Denver, according to NPR.

Dr. Stephen Wolf, director of service for emergency medicine at Denver Health, said it doesn’t make sense to see fewer heart attacks and strokes, particularly since the new virus can target the heart — and people are still dealing with the same conditions they had before.

“My colleagues and I have been startled about where are the heart attacks? Where are the strokes?” he said.

Wolf, Bateman and Zane emphasized that their hospitals have taken precautions to prevent the spread of COVID-19, including using masks, increased hand-washing and separating patients with respiratory symptoms from others.

“The underlying condition is far more likely to be dangerous than leaving their home,” Bateman said.

SCL Health, which owns five hospitals in Colorado, including Saint Joseph Hospital in Denver, also said patients shouldn’t fear to seek care, because everyone who comes in is screened and directed to the right area.

“While we encourage patients to use virtual care options if appropriate, those who need to seek emergency care should not delay and go to the nearest emergency department,” the health system said in a statement.

UCHealth has seen more requests from paramedics to pronounce a patient dead, and more people showing up to urgent care clinics with conditions that need hospital-level care, Zane said.

“We’re seeing what used to be unheard-of complications of common diseases,” he said. “We feel like this is a silent wave of COVID.”

Emergency room team members prepare for ...
AAron Ontiveroz, The Denver Post
Emergency room team members prepare for the arrival of a patient at the Medical Center of Aurora on Wednesday, April 22, 2020.

“They’re scared”

Ambulances have reported more cardiac arrest calls in Denver, Wolf said. Typically, cardiac arrest happens when the heart has been under stress from worsening heart failure, which would cause symptoms — though patients might not always recognize what they’re feeling.

“The significant public health message was, ‘Come in only if you absolutely must.’ A lot of these cardiac and neurological symptoms are subtle,” he said.

If signs of worsening heart failure are caught early, a person often can go home after tweaking their medications, Wolf said. If fluid has begun to build up in the chest, however, they might need a breathing tube to get enough oxygen, he said.

“It’s sad,” he said. “They’re staying home in part because they’re scared.”

In some cases, patients who have COVID-19 also have come in when they’re already severely ill, Bateman said. He isn’t certain why, but guessed people may not know when their symptoms have gotten bad enough to warrant emergency care.

“There are some patients who decline more quickly than they realize,” he said.

Denver Post staff writer Jessica Seaman contributed to this report.

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