Baptist HealthTalk

Avoiding Medical Care because of Coronavirus Fear is Bad Medicine

April 22, 2020 Baptist Health South Florida, Dr. Jonathan Fialkow, Dr. Marcus St. John Season 1 Episode 13
Baptist HealthTalk
Avoiding Medical Care because of Coronavirus Fear is Bad Medicine
Chapters
Baptist HealthTalk
Avoiding Medical Care because of Coronavirus Fear is Bad Medicine
Apr 22, 2020 Season 1 Episode 13
Baptist Health South Florida, Dr. Jonathan Fialkow, Dr. Marcus St. John

As the number of COVID-19 cases in the U.S. climbed in recent weeks, the number of visits to emergency rooms actually declined significantly – especially for heart attack and stroke patients. What’s going on here? And are we looking at a new kind of health crisis?

Host Dr. Jonathan Fialkow and his guest, Dr. Marcus St. John, Director of the Cardiac Cath Lab at Miami Cardiac & Vascular Institute, discuss this concerning trend and assure patients that seeking emergency care is still a safe thing to do, on this episode of Baptist HealthTalk.

 

If you are concerned you may have COVID-19, visit BaptistHealth-coronavirus.com to complete our online self-assessment that will help determine your risk level and provide next steps.

Show Notes Transcript

As the number of COVID-19 cases in the U.S. climbed in recent weeks, the number of visits to emergency rooms actually declined significantly – especially for heart attack and stroke patients. What’s going on here? And are we looking at a new kind of health crisis?

Host Dr. Jonathan Fialkow and his guest, Dr. Marcus St. John, Director of the Cardiac Cath Lab at Miami Cardiac & Vascular Institute, discuss this concerning trend and assure patients that seeking emergency care is still a safe thing to do, on this episode of Baptist HealthTalk.

 

If you are concerned you may have COVID-19, visit BaptistHealth-coronavirus.com to complete our online self-assessment that will help determine your risk level and provide next steps.

Speaker 1:

At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist Health Talk Podcast where our respected experts bring you timely, practical health and wellness information to improve your family's quality of life. How is Coronavirus connected to fewer emergency room visits and could this be contributing to a new kind of crisis? Hear why doctors are concerned on this episode of Baptist Health Talk.

Dr. Jonathan Fialkow:

Hello Baptist Health Talk Podcast listeners. This is your host, Dr. Jonathan Fialkow, and I'd like to welcome you to another special edition of our show focused on the Coronavirus. Since the start of the COVID-19 pandemic, doctors across the country have reported a significant drop in the number of patients they're treating for heart attacks, strokes, and various other acute illnesses. One reason, many people may be reluctant to go to the emergency room for fear of contracting the virus, and that's the topic of today's podcast. We'll look at this concerning trend with our special guest and a good colleague and friend of mine, Dr. Marcus St. John. Dr. St. John's an [interventional 00:01:08] cardiologist. He's the medical director of the Cardiac Catheterization Lab at Miami Cardiovascular Institute and the medical director of Interventional Cardiology for Miami Cardiac and Vascular Institute Cardiology. Thank you for joining us, Marcus.

Dr. Marcus St. John:

Thank you for having me here.

Dr. Jonathan Fialkow:

So Marcus, this is kind of something that I recall you and I talking about just in side conversations a couple of weeks ago, and then earlier this month in the New York Times was a great article by Harlan Krumholz of Yale titled Where Have the Heart Attacks Gone? And in that article, he talks about an informal Twitter poll of interventional cardiologists where most of the respondents noted 40 to 60% reductions in heart attacks, acute heart attacks which we would think we would not be able to necessarily control with the COVID-19 pandemic. So what have been your particular experiences regarding the acute heart attacks that we are called to be responsible for at Baptist Hospital?

Dr. Marcus St. John:

John, I think we have seen similar trends here at Baptist that had been seen elsewhere around the country, specifically for heart attacks that require treatment immediately by being taken to the cath lab. That volume has decreased by about 50%. So the heart attack doctors are getting called much less. Then there's a second version or second flavor of heart attacks in which you have a little more time to decide what to do, and that volume has also decreased by about 50%. we've felt it in terms of the numbers of cases that we are doing in the cath lab where that volume has decreased. As you said, there is not any credible reason why the COVID virus should decrease the risk for heart attack. In fact, quite the opposite. So it has led us to believe that maybe patients are unsafely avoiding care.

Dr. Jonathan Fialkow:

Which is obviously problematic. Are we seeing people ... We know that we teach people and we educate people and we really promote the message that if you think you're having a heart attack, call 911, get checked out quickly. The quicker we get to someone having a heart attack, the more we can prevent death and maybe disabling illnesses. Are you seeing people that are presenting with heart attacks a little bit later than maybe otherwise? Have you notice that trend at all or the ones that are presenting are at least the ones that are calling pretty quickly?

Dr. Marcus St. John:

The latter. The ones who are presenting seem to be just presenting as they would have normally. We haven't yet seen an influx in cases of what we would call delayed presentations, and we may yet see those patients who finally sort of cry uncle and say, "Well I have to call now because this has been going on for two weeks." So we may see those patients. What we have seen from some reports out of New York, and you and I have talked about this before, is that the EMS services have documented an increase in the numbers of calls they're getting to patient's homes for people who have died suddenly and presumptively, at least a large proportion of those are probably what we call sudden cardiac death where someone had a heart attack, ignored the symptoms, and then simply died at home. What our fear is that the missing heart attacks are in fact simply dying at home.

Dr. Jonathan Fialkow:

And that goes against everything we've accomplished over the last decades of, again, getting people to recognize the symptoms, get treated quickly, staying home, fearful, dying or maybe we'll start seeing people with damage from heart attacks and the consequences of that as well. So that is a concern. Many different reasons out there, but what would you feel, especially in speaking to the people who are coming in and what you're reading around, speaking around the country, why is this the case? Why do you think we're not seeing this preponderance of heart attacks as we did prior to COVID-19?

Dr. Marcus St. John:

I think, John, the reality is people are afraid. Even physicians are fearful. There's anxiety that I've spoken about with with colleagues, but patients, people at home are being given these very strong messages from all levels of government to stay home and avoid crowded situations. I think people are translating that into being very afraid of calling an ambulance and very afraid of coming to a hospital. I think our message throughout this podcast and beyond is if you are having heart symptoms that could be a heart attack, you still have to call for help because ignoring it could be deadly.

Dr. Jonathan Fialkow:

Well how can we reassure the population with that message which is of paramount importance? How can we reassure them that the hospital is safe for you to get care that's not COVID-19? Can you speak to a little bit about how the COVID-19 cases may be separated or what precautions are being taken for someone who might be having a heart attack or a non-COVID-19 emergency?

Dr. Marcus St. John:

Absolutely. So Baptist Hospital, as with every other health system around the country, is going to great lengths to separate patients by risk for COVID or by a diagnosis of it. So many hospitals have tents or structures outside of the emergency department where people are screened initially. Those who are at low risk for COVID can then come into the emergency department and get their usual care. Those who are likely to have COVID can be screened appropriately and sent home where appropriate or admitted to specific units sequestered from the general population. So I think the message to patients is that it is safe to come to the hospital. We're not going to mix you in with people who might put you at infectious risk, and we have taken great lengths to create structures where if you come with a non-COVID-related issue, we will take care of that issue and diminish your risk of getting COVID by coming to the hospital. So we hear you and it's safe to come when you need to come.

Dr. Jonathan Fialkow:

And you said we've had a 50% decrease in acute heart attacks, patients being brought to the cath lab. Of those that came in, we've not seen any hospital-induced COVID-19 infections, I think. Is that fair to say?

Dr. Marcus St. John:

That's an excellent observation and it's an accurate one and hopefully one that will give people comfort. So certainly that we are aware, we haven't, by taking patients for procedures or treating their heart disease, unwittingly infected anyone with COVID.

Dr. Jonathan Fialkow:

So the heart attacks are of paramount importance because of that urgency of getting taken care of, but again as we've noted, there's other kinds of emergency type of medical conditions that have also decreased in presentations. Can you speak to a few of those?

Dr. Marcus St. John:

Yeah, so I think the first one that I was remiss in not mentioning is stroke. So stroke and heart attack have a lot of the same risk factors. A lot of the same things cause strokes that cause heart attacks. Our stroke colleagues who treat the strokes with emergency procedures have seen a similar decrease in their presentations. So I think we are also suffering from people being afraid to come for treatment of neurologic conditions. And then outside of the cardiovascular symptoms like gallbladder disease or other types of things, hernia problems or things that might otherwise cause people to come to the hospital because of pain, because of other symptoms, they are also seeing a decrease. I don't have those exact numbers, but I know from communication with our colleagues in the hospital, they're seeing a decrease in other usual causes of admissions with the only reasonable explanation being likely fear of coming to the hospital itself.

Dr. Jonathan Fialkow:

Right. You would think that people are home and they're anxious. You would think that people are eating poorly or maybe they're eating better, but the stress of the COVID-19 would increase these acute illnesses and we can't say they're not. We're just not seeing them in the hospital. I think as you're saying, our colleagues are noticing that whether it be infections or strokes or gallbladder and appendicitis and various other fairly common conditions. So we have to assume people are afraid to come in. As you mentioned, the concern is the people that survive may be dealing with more significant disabling situations that could have been prevented elsewhere. So I appreciate that.

Dr. Jonathan Fialkow:

So I guess kind of the recommendation and the messaging we continue to give is for people to not delay. Don't delay if you're feeling something significant. Still call 911. Let the paramedics assess you. They'll take the proper precautions. Go to the hospital if necessary. The proper precautions will be made for safety and don't delay. Marcus, I think is it worth saying that the medical practices are still available as well? I know we're certainly available for our patients and we're taking those, the heart failure patients, the high risk patients, and making sure that they still have the medical care. Can you speak a little bit about what's being done in the medical practice and maybe touch on telemedicine a little bit?

Dr. Marcus St. John:

Absolutely, Jonathan. You've been a leader in this. We are open for business. I think if listeners take away only one thing from this podcast, it is the medical profession is open for business. We are here to serve you. We've adapted to the times. We can serve you safely. So if you have an appointment that was scheduled already, don't assume that it's canceled or don't assume that you shouldn't come. Call, call your practice, call your doctor and see what arrangements they have made. Certainly if you are having symptoms, call your doctor and he or she will make arrangements to have you evaluated. Now, how that evaluation happens has changed and that's what you are mentioning, this evolution, this rapid evolution of telemedicine which is going to be here to stay in some form or another whereby we can see you on a phone or a computer link and certainly hear you. We can assess you and then make some recommendations.

Dr. Marcus St. John:

For some patients following that assessment, it may still be prudent to have you come to the office for a more detailed exam. For others, the over-the-phone assessment is sufficient to make a diagnosis and begin treatment. So no patient should simply stay at home and not access care because every medical practice in this country has made some adaptation and is able to help patients by telephone or some other medium that doesn't always involve being in the office itself. For those who we think need to come to a practice, rest assured that the waiting rooms are now empty. I've gone through our waiting room, John, once or twice in the last week and there has never been anyone in there. The chairs are separated. We have taken all appropriate measures to reduce your risk. All of our staff wear masks in the office and all of our patients will be asked to wear a mask upon presentation. So you can access medical care, you should access it, and we will do it in a safe and effective manner.

Dr. Jonathan Fialkow:

I appreciate that. Those adaptations are replicated throughout the medical practices in the Baptist Health System and the significant work being done as we come out of this to make sure that we continue these safe practices in terms of patients getting seen by their medical providers or having other medical care given. So I like what you said. We're open for business. That's not a business model. It's an availability for those that need it and I think that's of paramount importance. So again, Marcus, this is wonderful. I mean we're very fortunate that you and other leaders in Baptist Health and in Miami Cardiac and Vascular Institute, I know you and others are staying attuned to national trends and our society and medical organization guidelines. There's nothing out there that we're not exposed to and I really thank you for all that energy, time, and expertise that you've put to that. Any final comments that you'd like to make before we wrap up? I know you hit all the high points.

Dr. Marcus St. John:

Yeah, I think we have, John. I thank you for this opportunity and I hope that people get the message that we're here to help. We have adapted to this current crisis. So if you need help, call us and we'll make it work. Don't stay and suffer in silence because that's when you'll get into trouble.

Dr. Jonathan Fialkow:

.Again, well said and I hope our listeners feel reassured that we are here to help and they're not alone. So folks, don't delay. Call your doctor's office if you're not feeling well, if you notice anything unusual. They're still around to help you. If you're really suffering, concerned with major symptoms, call 911. The proper protection will be there. The proper assessments will be made. If you're brought to the hospital, be reassured. You will not get COVID-19 from being in the hospital, but that's where you'll need to get your urgent care. Hopefully these trends will reverse so the right people can get taken care of in the right place. Once again, thank you for listening during this Coronavirus pandemic to our podcast. As before, any thoughts, any topics, any ideas, send an email to [email protected] Thank you again to our guest, Dr. Marcus St. John, and stay safe and stay home, everybody.

Speaker 1:

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