COVID-19 Makes Other Emergencies More Perilous
The pressure that the current COVID-19 pandemic is putting on this country’s health care system is well-documented. Just about all areas of the country hit hard have a shortage of personal protective equipment (PPE), intensive care unit beds, and ventilators. In Tennessee, the Department of Health has advised doctors to use diapers and swim goggles if they cannot obtain PPE. In New York, patients are sharing ventilators because of shortages. However, this does not only affect our ability to treat COVID-19 cases. Heart attacks, strokes, births, car accidents: the other types of emergencies in our lives do not pause during this pandemic. They still occur, and with COVID-19 putting incredible pressure on our health care system, the outcomes of those emergencies are worse.
Part of the reason this is the case is because the surge of patients in emergency rooms not only exhausts ICU beds, masks, and other personal protective equipment, but also other necessary medical supplies. Hospitals are already reporting low supplies of asthma medications like albuterol, anti-malaria medications like hydroxychloroquine, and sedatives such as propofol and fentanyl. As a result, some people are already experiencing shortages for their asthma inhalers and lupus patients are finding it harder to obtain their treatments. Sedatives are necessary not just for COVID-19 patients but also for people coming in for cases like an emergency appendectomy or treating a gunshot wound — because yes even though much of the country is under a shelter in place order, shootings still take place.
There is another critical medical item that is in short supply: health care workers. At Massachusetts hospitals, over 600 employees have tested positive for COVID-19. States are planning to graduate medicate workers early and reach out to retired health care workers to fill the increasing demand. Illinois took the step to send mass emergency texts across the state looking for workers. The shortage of necessary workers not only leaves states scrambling to fill the gap, it also leaves a staff shortage in other medical areas. For example, assisted living homes are seeing a decrease in staff that can take care of the residents. As explained by one of the owners, for those that have dementia or other sorts of cognitive issues, this can easily “easily wreak havoc in that person’s world.” Other establishments are cutting staff despite the influx of COVID-19 patients in emergency rooms due to financial problems. While some of the hospitals have said they can and will bring back workers as the COVID-19 cases increase, this does little for the lack of staff for other emergency procedures.
We are already seeing how the strain of COVID-19 affects other emergencies in New York City. On April 2nd, paramedics and EMTs in New York City were instructed to pronounce heart attack victims who are unresponsive to life-saving measures dead on the scene instead of sending them to emergency hospitals. Naturally, this will lead to more fatalities from the leading cause of death in the state. Additionally, the average response time for emergency calls increased by about three minutes, thus making it longer to respond to calls where every minute — if not every second — counts.
But New York City is not the only place where COVID-19 has negatively impacted other emergencies. In Illinois, calls to the state child abuse hotline have declined 43% and 24% per week in the two weeks since governor J.B. Pritzker closed all K-12 schools in the state. The conclusion from people in the department is that the actual rate of child abuse and neglect has not actually decreased. In fact, the additional health and financial stress over this pandemic combined with physical isolation would increase the chances of child abuse. Rather, the conclusion is that the people who are obligated by state law to report child abuse and are most likely to see the signs of abuse — teachers and child care workers — cannot do so as schools and child care places are closed.
Another potential consequence of COVID-19 is perhaps one of the most surprising and concerning: doctors are finding that other types of emergency patients are reduced at their hospitals. Some have noticed that a lot of the cases they usually see for heart attacks and strokes are not at their normal levels. Others have noticed the same decrease for other emergency procedures and have mentioned it on Twitter:
And this anecdote is not limited to the United States; in Spain, a report noted a 40 percent reduction in heart attack emergency procedures from the period before the pandemic to the end of March. The most likely explanation is also the reason it is a concerning consequence: people may rather stay at home than go to the hospital and risk getting COVID-19. There is some evidence of this in Hong Kong, where doctors have noticed patients are entering the hospital late in their heart attack, when life-saving treatments are not as effective. If people are not in hospitals for cases out of fear of catching COVID-19, it stands to reason that this will lead to bad outcomes: either an increase in fatalities as people suffer at home instead of seeking treatment or an explosion of hospital admissions, overwhelming the system as beds diminish.
All of this serves to exacerbate existing medical problems in this country. The United States has the 55th lowest maternal mortality rates in the world, one of the worst among countries with similar wealth. The two states that have the worst rates are Georgia and Louisiana, two states that are also currently experiencing a high number of COVID-19 cases. The U.S. is also in the top 50 countries for percentage of people aged 20–79 with diabetes and has the 73rd lowest adult female mortality rate. Even before the pandemic, hospital staffing was disproportionately tilted towards administrative work as opposed to health care professionals.
This is one thing we must absolutely remember about this pandemic: while the disease itself is terrible and will claim many, many lives, it is not a singular event; it is a domino effect that cascades onto the rest of our health care system. Unfortunately, from shortages to unreported issues, this cascade makes other health areas worse off.
