Like many primary-care physicians across the country, Dr. Trevor Huber is using telehealth to triage patients for COVID-19 symptoms.
In one of these recent visits, a man in his mid-60s was complaining of chest pain, thinking it may be the virus. Huber wasn’t convinced, urging him to come into his practice in Little Elm, Texas, right away to make sure he wasn’t having a heart attack.
After hooking the patient up to an electrocardiogram, it was clear the patient was in cardiac arrest. Huber’s team called 911 right away.
This patient recovered, but others haven’t been so lucky. Three patients of the practice, called Modera Clinic, have died of heart attacks since the COVID-19 pandemic began. After discussions with the families, Huber learned the patients were complaining of symptoms for weeks, but they went unaddressed. “It’s basically when they are collapsing, having a terrible heart attack, and having to run a code in the field” when they finally call for help, Huber said.
Experiences like Huber’s are becoming more common for providers across the country as research shows patients are ignoring symptoms and putting off needed care during the COVID-19 pandemic, largely out of fear of contracting the virus in the healthcare setting. Providers are worried as the pandemic stretches on—and worsens this fall and winter season—about the long-term implications for patients who continue to delay seeing their doctors and getting emergent services. Conditions such as stroke, heart attack and diabetes can lead to lasting negative outcomes for patients that impact their quality of life if they go untreated and may even result in death.
“It’s a shame when people who are eligible for these treatments don’t come into the hospital to get them because they are scared of contracting COVID,” said Dr. Charles Matouk, associate professor of neurosurgery at Yale New Haven Health who has seen stroke presentations to the health system drop during the pandemic. “In comparison to not getting the treatment, the risk benefit analysis would cut to getting the treatment rather than staying at home.”
Untreated strokes can result in permanent paralysis and speech impairments that require long-term care services.
There are also costs to the healthcare system to worry about, said Julius Chen, assistant professor of health policy and management at Columbia University. If morbidity and disease severity worsen because of people delaying care, it’s likely healthcare spending will rise as well, he said. Chen is urging for research into the long-term implications of delaying care on healthcare spending, health outcomes and mortality. He said the research can be used by providers and policymakers to understand how to best invest more resources in the years to come. Studies so far are largely focused on evaluating delays in care across a variety of conditions.
“As we move forward, health policy researchers need to think about what happens when people delay routine or preventive services,” Chen said. “If we don’t plan on studying it now, it’s going to be too late by the time these effects manifest a few years down the line.”