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Published on April 21, 2020

Don’t wait to seek care for a serious condition

ER Safety

Is your fear of COVID-19 preventing you from seeking treatment for another medical condition, like heart attack or stroke? Are you waiting too long to get care, and thereby running the risk of suffering serious and potentially fatal consequences, as a result?

“We’re definitely seeing delayed presentations,” said Emergency Medicine Physician Michael Rest, MD, medical director of the Yawkey Emergency Center at Falmouth Hospital. The Center, as well as the Cape Cod Hospital Emergency Center, have implemented proven protocols that make them safe to treat all conditions, he said.

“The ERs are fully prepared to safely treat anybody with emergent conditions, and we don’t want people to put off seeking treatment due to the fear of COVID-19.”

Emergency room volume is down 30-50 percent across the country, and the ERs at Falmouth Hospital (FH) and Cape Cod Hospital (CCH) in Hyannis are no exception, he said. This statistic has physicians concerned that those who would have sought treatment for life-threatening conditions, prior to the pandemic, are ignoring symptoms due to their fear of contracting the virus, he added.

“People have listened to the message to stay home and it has eliminated a lot of low-level complaints that probably don’t need to be treated in the ERs. But the message has swung a little too far and people who need to be coming in, aren’t,” Dr. Rest said.

One patient came to the Falmouth Hospital ER recently, six days after initial symptoms of appendicitis had started, according to Dr. Rest. By the time he arrived, his appendix had ruptured, and he had developed an abscess. A condition, if treated in the early stages, that would have resulted in an overnight stay in the hospital, had turned into a probable week-long stay, with a procedure to drain the abscess, and the need for antibiotics, he said.

“It certainly becomes more complicated,” he said.

Had the patient continued to delay treatment, he could have developed sepsis, a potentially deadly system-wide infection, he said.

Appendicitis symptoms include lower abdominal pain on the right side, loss of appetite, and frequently a fever, according to Dr. Rest. The pain generally gets worse as time goes on, unlike indigestion, which usually resolves over time.

Another patient called into the FH ER recently complaining of chest pains and shortness of breath and said she did not want to come in because of her fears of the coronavirus.

“We had to convince her that the actual risk of having a heart attack was worse than the theoretical risk of getting COVID-19,” he said.

A medical school classmate of Dr. Rest’s, who is now a cardiologist, told him he is seeing more people who have suffered cardiac arrest because they ignored heart attack symptoms five or six days earlier.

Many patients experiencing a life-threatening cardiac event known as a STEMI – the blockage of one of the major arteries to the heart - can be treated successfully with a catheterization procedure. But this must be done early in the event to have the best outcome, Dr. Rest said. People who wait too long to seek treatment risk permanent damage to the heart muscle, he added.

The number of patients being treated for STEMIs at nine of the nation’s high-volume catheterization labs dropped by 38 percent in March, according to a study done by the American College of Cardiology, as reported in the Washington Post on April 19, 2020.

Call 911 for These Symptoms

There are clear symptoms that should always be checked by a physician immediately because they can indicate you are having a heart attack or stroke, according to Dr. Rest. People experiencing these signs should call 911 and get to the hospital as soon as possible.

Heart attack symptoms include:

  • Chest pain
  • Shortness of breath
  • Lightheadedness
  • Left arm or shoulder pain
  • Jaw pain.

Stroke warning signs can be remembered by the acronym BE FAST:

  • B – Balance difficulty
  • E – Eyes or vision disturbance
  • F – Face droopiness
  • A – Arm (or leg) weakness
  • S – Speech difficulty
  • T – Time to call 911

“We also know that stroke and heart attack can happen at a higher rate in people with respiratory infections, including COVID-19,” Cleveland Clinic Neurologist Shazam Hussain, MD, said in a recent guest column in U.S. News and World Report on the drop in ER volume around the country. For every minute a stroke is untreated, an additional 1.9 million neurons or brain cells are lost, he added.

There are effective measures that can be taken to mitigate the effects of a stroke – “but there is a very short window of time to treat it,” Dr. Rest said. Physicians have three to four hours after initial stroke symptoms to start the clot-busting medication, tPA, and about 23 hours to perform a neuro-interventional procedure to remove a clot.

“Time is tissue. The earlier we can intervene, the more likely we are to save the brain,” he said. “If you come in a day or two later, there’s not a lot we can do to help you regain function.”

ERs are Safe and Ready to Treat You

The Emergency Rooms at FH and CCH have strict measures to ensure that all patients are safe and treated quickly, Dr. Rest said. All who come through the ER doors have been evaluated before they enter; either by the Emergency Medical System technicians in the ambulance or by a clinician at the door.

Those with suspected COVID-19 illness are taken to a room on one side of the 40-bed, 24,000-square-foot facility at FH and all other patients are taken to a room on the other side. The 54,000-square-foot, 72-bed ER at Cape Cod Hospital has also been divided in a similar way. Most rooms at both facilities are private.

Both ERs also have ‘negative pressure’ rooms in which they can perform procedures on infectious patients, such as intubations. These rooms are specifically designed to allow outside air in, and to prevent any air from leaving the rooms.

Patients who believe they may be experiencing COVID-19 symptoms, but appear to be managing well, are sent to the special tents that have been erected outside the FH and CCH ERs. They are evaluated and tested for the virus and are often sent home to recover.

Every patient who comes to one of the ERs is given a surgical mask to wear and every employee wears a mask, as well. This “significantly” lowers the chance of transmission of the virus, Dr. Rest said.

In addition, staff members are diligent about washing their hands frequently, and environmental services staff clean and disinfect ‘high-touch’ surfaces, like beds, chairs and equipment, after each patient, he said.

There is plenty of personal protective equipment for physicians and others who are in contact with patients. “Cape Cod Healthcare has done a really good job making sure we have this equipment,” Dr. Rest said.

Other Complaints? Call Your Doctor

If you are experiencing the warning signs of heart attack or stroke, are having trouble breathing, or have severe pain in the abdomen, call 911 immediately, Dr. Rest emphasized.

If you have an issue you are not sure qualifies for an emergency room trip, call your primary care provider to share your symptoms and concerns, he said. He or she can then refer you to the proper place for care.

To learn more about getting care during COVID-19, please review our frequently asked questions (FAQ) page.