New U.S. health crisis looms as patients without COVID-19 delay care

[July 13, 2020]  By Sharon Bernstein

(Reuters) - A Texas man who waited until his brain tumor was softball-sized; a baby who suffered an ear infection for six days; a heart patient who died: The resurgence of COVID-19 is creating another health crisis as hospitals fill and patients are fearful or unable to get non-emergency care.

With U.S. coronavirus infections reaching new heights, doctors and hospitals say they are also seeing sharp declines in patients seeking routine medical care and screenings - and a rise in those who have delayed care for so long they are far sicker than they otherwise would be.

"I had one lady who had delayed for five days coming in with abdominal pain that was getting worse and worse," said Dr. Diana Fite, who practices emergency medicine in Houston. "When she finally came in, she had a ruptured appendix."

After the pandemic was declared a national emergency in March, many states banned non-essential medical procedures, and the number of patients seeking care for other ailments took a nosedive. Hospitals and medical practices were hit hard financially.

Emergency department use dropped by 42% during the first 10 weeks of the pandemic despite a rise in patients presenting with symptoms of the coronavirus, data from the U.S. Centers for Disease Control and Prevention show. In the same period, patients seeking care for heart attacks dropped by 23% and stroke care by 20%.

As the initial outbreak leveled off in the weeks that followed, healthcare experts planned to handle primary care differently should infections rise again, making sure minor procedures like cancer screenings were still allowed and assuring patients that hospitals and clinics were safe.

But the recent surge in cases has swamped hospitals in many states, including Texas, Arizona, Florida and parts of California.

CANCER MORTALITY RATES

Texas has again banned many non-emergency procedures, though cancer surgeries are still allowed, and a hospital in California's San Joaquin Valley for several days admitted only COVID-19 patients.

Patients without COVID-19 - either out of fear, confusion or because of difficulty in obtaining the care they need - are again staying home.

The result is a healthcare crisis in the making, said Austin oncologist Dr. Debra Patt, who said she expects mortality rates from cancer to skyrocket in the years after the pandemic because patients have delayed their care.

"They're scared to go in the hospital unless they absolutely have to," said Patt. "And even when the patients are willing, it's hard to get things done."

Patt in recent days treated a man who waited to come in for headaches and dizziness until he had lost 35 pounds and had a softball-sized tumor in his head.

Fite, who is president of the Texas Medical Association, cared for a baby whose parents waited six days before bringing him in with a severe ear infection.

A protective screen is seen at the entrance to a negative pressure ICU hospital room, where COVID-19 patients are treated, at St John's Regional Medical Center in Oxnard, California, U.S., July 9, 2020. Picture taken July 9, 2020. REUTERS/Sandra Stojanovic

Patt said screening mammograms are down by 90% in Austin, where she specializes in breast cancer and serves as executive vice president of Texas Oncology. That means some tumors will be missed, and women who develop aggressive cancers might not know about it until the disease is more advanced and more likely to be deadly.

"It's an impact we will see on cancer survival for years to come," she said.

Dr. David Fleeger, a colorectal surgeon in Austin and a past president of the Texas Medical Association, said he has had numerous patients cancel colonoscopies in recent days.

"The delays in colonoscopies that are occurring right now ultimately will lead to more cancers and more deaths," he said.

'IN A HOLDING PATTERN'

Patt's patient Helen Knost had to put off surgery for breast cancer in early spring because it was considered non-emergency in Texas and barred at the time, and she was treated instead with the medication Tamoxifen.

"It's very strange to know you have cancer and you're just hanging out with it, just in a holding pattern," said Knost, who did ultimately undergo successful surgery.

In California, doctors at the 150-bed Adventist Lodi Memorial Hospital in the San Joaquin Valley breadbasket were determined that a second surge in coronavirus cases would not bring a repeat of the pandemic's early days, when emergency room visits dropped in half. Emergency medical technicians also reported a 45% rise in the number of heart patients who died before they could be brought to the hospital.

Hospital CEO Daniel Wolcott led a campaign to inform the community that the medical center was open and safe, even speaking to people about it in the grocery store.

But with new COVID-19 cases swamping the hospital, sickening nearly 30 staff members and forcing it to divert non-coronavirus cases to other facilities for several days, Wolcott fears that again patients with heart conditions and other illnesses will stay away.

"We won't know for years how many people lost their lives or lost good years of their lives for fear of coronavirus," he said.

(Reporting by Sharon Bernstein in Sacramento, California; editing by Bill Tarrant and Cynthia Osterman)

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