During the early months of the pandemic, people avoided visiting hospital emergency departments because they were afraid of contracting the coronavirus or overstressing the healthcare system. Those fears have not fully abated.
“I think it’s a combination of things. I think folks are still a little nervous about coming in due to COVID,” said Dr. Tom Balcezak, the chief clinical officer at Yale New Haven Hospital in Connecticut. “Some healthcare is discretionary, and I think some people are exercising [that discretion] right now.”
An American College of Emergency Physicians survey from late April found that 29% had delayed getting care over concerns of contracting the coronavirus in a medical facility. Additionally, nearly 3 out of 4 respondents worried about overstressing the healthcare system if they visited an emergency room.
Even in areas where COVID-19 seems to be under control, emergency room volumes have not returned to normal.
At Massachusetts General Hospital in Boston, emergency department volume has been at 80-85% of pre-COVID-19 levels over the past few weeks, according to a spokesperson. Adult emergency department volume was at about 90% of normal, and pediatric volume was at about 60-65%.
In June, Massachusetts averaged 397 new coronavirus cases daily. That has dropped to about 245 in July. New daily cases averaged about 150 in Connecticut in June. This month that has fallen to 73. Yet patients are still not visiting the emergency department in the same numbers they were a year ago.
Patient volume at the Yale New Haven Hospital emergency department was at about 90% of where it was a year ago, according to Balcezak.
By late April, patient volume at emergency departments across the country had dropped 42% when compared to 2019. That had eased some by late May when it was down 26%, according to the Centers for Disease Control and Prevention.
The American Hospital Association estimated that hospitals nationwide lost over $200 billion between March and June of this year due to the virus-related decline in services and procedures. However, that estimate may be low, as it assumed a cancellation of 67% of emergency department services.
Balcezak said that emergency department volume at Yale New Haven dropped about 75% in March and stayed that way until June.
For Yale New Haven, the financial impact is severe.
“The resulting losses are staggering,” said Balcezak. “We’ll lose money this year for the first time in 40 years.”
He estimated that the decline in emergency department patients combined with a stoppage in elective surgery and other inpatient services would result in a $50 million loss to Yale New Haven this year.
It’s not clear how emergency department volume is faring in parts of the United States where the virus is surging. But Dr. Ross Goldberg, vice chairman of the Department of Surgery for Valleywise Health in Phoenix, suspects that it is not good.
“I wouldn’t be surprised if ER volume in Arizona was down,” he said. “As a surgeon, I can tell you that some patients still don’t want to come in for surgery. They don’t want to be exposed to COVID patients.”
Balcezak emphasized another concern about patients avoiding emergency rooms.
“As a physician, it does worry me that there might be patients out there that are still not seeking needed medical care,” he said.
The CDC found that emergency department visits for heart attacks fell 23% in the 10 weeks following the declaration of a national emergency on March 13. Visits for stroke fell 20% and for uncontrolled high blood sugar declined 10%.
“Our physicians are telling us that they are seeing patients presenting in later stages of their illnesses … because patients didn’t seek care back in April and in May,” said Balcezak.
