Local doctors report coronavirus fears are driving down ER visits

Cardiac patients at Hoag Hospital’s Newport Beach and Irvine locations have dropped by half in the past three months, and Dr. Subbarao Myla wants to take that as a silver lining. Maybe the stay-at-home orders that have all but shut down most of society for the past several weeks have created less traffic, less time in stressful workplaces and more attention to healthful habits — things that could reduce heart attack triggers.

But the veteran cardiologist worries that the specter of the COVID-19 coronavirus is keeping people out of emergency rooms even if they’re having a heart attack.

His colleague Dr. Michael Brant-Zawadzki, a neuroradiologist, has seen the same reluctance in stroke patients, sometimes leading to irreversible damage.

“‘I was afraid of catching the virus so I didn’t come,’” he said they say.

He replies, “‘Well, now it’s too late to treat your stroke. I’m sorry.’”

Orange County health officer Dr. Nichole Quick reminded people this week to call 911 or go to an ER in case of a medical emergency, despite any unease about leaving home — especially for a hospital — during the coronavirus pandemic.

The need for medical attention is typically lower for the coronavirus than for a heart attack, bowel obstruction or stroke, Quick said. According to the World Health Organization, more than 80% of coronavirus patients don’t require intervention.

Meanwhile, about 800,000 Americans die of cardiovascular disease each year, and 1.5 million heart attacks and strokes occur annually in the United States, according to the Centers for Disease Control and Prevention.

“While we certainly understand the fear and anxiety our neighbors are experiencing related to COVID-19, I caution residents not to let those feelings overwhelm their better judgment in an emergency,” Quick said in a statement. “Our healthcare system is here to help you.”

Brant-Zawadzki said Hoag is relatively quiet amid what he calls “the fear virus,” along with a nationwide suspension of elective surgeries and the lack of an overwhelming coronavirus surge locally.

The volume of stroke patients at Hoag has dropped by about 40% since January. Patients with heart attack symptoms have dropped by about 50%. Overall, the two campuses have seen double-digit declines in ambulance runs over the past month.

“Our emergency room is mostly empty other than the occasional broken leg,” Brant-Zawadzki said.

He acknowledged that the amount of COVID-19 cases is staggering — as of Friday, more than 660,000 nationwide; nearly 29,000 statewide; 1,500 in Orange County — because the disease is so communicable.

“We’re very concerned that patients are irrationally scared of coming to a very clean, very orderly, very prepared set of emergency rooms where the risk of dying from COVID is less than 1% in the people who are infected, whereas the risk of a ruptured appendix or a heart attack or stroke is much, much greater,” said Brant-Zawadzki, who also is a senior physician executive at Hoag.

Symptoms that require immediate care include difficulty breathing, crushing chest pain, intense localized abdominal pain, sudden numbness, weakness and inability to see or speak, uncontrollable bleeding, fever with convulsions, severe headache or head injury and vomiting blood, Quick and Brant-Zawadzki said.

Myla, medical director of cardiac and endovascular labs and cardiovascular research at Hoag’s heart and vascular institute, said urgent-care clinics or consultations using telemedicine can be options. But he doesn’t want people to spend time scouting doctors outside the hospital while experiencing chest pressure and heaviness and tightness in the neck, arms and jaw. “Time is muscle” during a heart attack, he said.

“The risk that they’re balancing in their mind [is] a risk of a heart attack or ... a risk of catching COVID,” Myla said.

They might convince themselves they have heartburn, he said. It could actually be heart muscle dying.

Dr. Martin Fee, Hoag’s chief clinical officer and an infectious-disease specialist, said in a video message with Newport Beach city leaders this past week that patients are canceling appointments to avoid possible coronavirus exposure.

He has his staff follow up with offers of telemedicine. But some things just have to be seen in person.

“You shouldn’t ... have your chest pain at home,” he said.

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