What could possibly be worse than COVID-19?

We’ve all seen the COVID-19 numbers and exhaustively followed news stories about symptoms that may or may not be suggestive, testing which may or may not have high accuracy, treatments that may or may not work, etc. While it’s clear that we are learning new things about COVID-19 by the minute, the things we used to know about other serious diagnoses still hold true but aren’t getting enough attention.

Here’s an example. The largest physician-owned emergency medicine practice in the country sees about 6 million acute care patients per year at over 200 EDs in 20 states across the country. As such, there is a robust fount of data to analyze. As a result of COVID-19, you would think that the number of people going to the ER with respiratory or fever complaints are going up, which is correct: viral pneumonias are, indeed, up 261%. You would think that people with other symptoms are not going to the ER much overall out of fear of COVID-19, which is also correct: overall ER visits are down 43% as of this writing. You’d also correctly guess that fewer car accidents (and resulting injuries), sports-related injuries, ear pain, urinary tract infections, dental issues, minor rashes, etc. are prompting ER visits.

However, did you know that serious conditions are being seen at lower rates compared to before COVID-19? Diagnoses like heart arrhythmias (down 35.7%), sepsis (down 25.3%), congestive heart failure (down 48.1%), stroke (down 40.9%), appendicitis (down 22.8%), gall bladder disease (down 41.8%), and yes, even heart attacks (down 36.1%) are being seen at lower rates than pre-COVID-19. Is it possible that emergent conditions like heart attacks and strokes and congestive heart failure (which would normally prompt a prudent person to call 9-1-1) are just not occurring as often?

Highly doubtful, unfortunately. The fact is, people are not coming to the ER despite suffering these illnesses—they are just suffering them at home, by themselves. They are feeling symptoms like weakness, numbness, fainting episodes, abdominal pain, and even chest pain and not coming to the ER for them. What happens if you don’t seek care for these emergencies? Either you get lucky and nothing major happens, or, and far more likely, the conditions become untreatable, irreversible or result in death. A heart attack that goes untreated, for example, may develop into congestive heart failure, shock, or even sudden cardiac arrest. A delay of even a few minutes in calling 9-1-1 for your stroke symptoms could develop into a more powerful and debilitating stroke that is potentially untreatable.

Americans seem to be putting off true emergencies for fear of COVID-19. It is not difficult to understand why—public health experts and government officials have rightfully been pushing people to stay at home. News media tend to show images of overfull ERs, which is certainly true in many parts of New York City. However, nationally most ERs are seeing far fewer cases in general, almost half as many. The major unintended consequence of stay-at-home recommendations is that people are not seeking emergent care when they need to. Crowded grocery stores probably confer a higher risk of disseminating COVID-19 compared to ERs, where every health care worker around you is properly protected and your physical distancing is optimized.

Bottom line: if you think you have a medical emergency that could threaten life or limb—you should go to the ER to get it evaluated. After all, what’s the use in preventing COVID-19 only to suffer something even more serious, like a heart attack or stroke?

Amer Aldeen, MD,

Chief Medical Officer,
US Acute Care Solutions