While the COVID-19 pandemic has captured the attention of both the public and health officials, other health issues — including chronic conditions such as diabetes and emergencies such as heart attacks or strokes — haven’t stopped and must be treated. Doing so has forced some changes on providers and has led to changes in their patients, too.
“Our office has chosen not to bring in any patients with COVID-19 symptoms,” said April Bentley, a nurse practitioner with Airpark Primary Care, in Westminster. “We are using FaceTime and Skype apps and things like that to reach patients, which has been significantly different."
The practice is still seeing those patients with chronic conditions in the office when possible, according to Dr. Philip Ruzbarsky, but they made the conscious decision early on in the pandemic to try and manage people with COVID-19-like symptoms remotely or to refer them to the hospital in order to ensure the office staff could stay health and available to treat people with conditions not related to COVID-19, the disease caused by the novel coronavirus.
“People don’t understand that every triage call into a doctor in the best of times is a balance of risk and benefit,” he said. “We don’t bring in every person who is sick.”
And given the fact that asymptomatic COVID-19 patients can still spread the virus, even something as fundamental as taking a patient’s vitals versus accepting their own temperature readings from home requires considering the risk-to-benefit ratio.
“You go and take somebody’s temp in their ear, or over their forehead with the newer temperature monitors. Putting a reusable cuff on somebody’s arm and holding their wrist for a pulse,” Ruzbarsky said. “That’s all pretty intimate, when you think about it.”
So Ruzbarsky’s practice is bringing in fewer patients — though remaining busy, due to operating at less than full staff — but they are taking a lot more phone calls. And with more triage happening over the line, Ruzbarsky has moved from the back of the office to the front to man the phones himself most of the time.
“With the [Centers for Disease Control and Prevention] recommending, ‘Call your doctor;’ when that phrase gets said over and over again, there are a lot of people that call their doctor, let me tell you,” he said. “Normally I don’t like the term ‘Call your doctor,’ because it puts me in a situation where I am dealing with somebody over the phone, which is not my forte. But it’s forced to be my forte at this time.”
There’s three different types of phone calls Ruzbarsky tends to get right now.
“There’s the phone call from someone who is sick with an upper respiratory and is worried about COVID,” he said. “The next person is well, maybe older, maybe they are really motivated to isolate and not get caught in the first wave or two, so I am trying to manage their chronic conditions from afar.”
The third type of call is from patients whose health will be indirectly affected due to how COVID-19 has impacted the health care system, according to Ruzbarsky.
“I can’t get any CAT scans, I can’t get any ultrasounds, I can’t get a chest X-Ray,” he said. “When I say ‘can’t,' it’s very difficult to do that. Their staffing is down. They know as well as I do that an asymptomatic person could be shedding virus.”
And then there are people whose health might be affected because they delay even trying to get care for their symptoms not related to COVID-19.
At Carroll Hospital, COVID-19 has brought a drop in emergency department visits for non-coronavirus-related problems — a development that concerns Dr. Sandra Ruby, neurologist and director of the hospital’s stroke program.
“We don’t want patients hesitating to go the emergency department if they have acute stroke symptoms,” she said. “Our concern is patients may be delaying coming in when they really should.”
Dr. Mark Goldstein, director of clinical operations at Carroll Hospital, added, “I think it’s important to note that while COVID-19 does have some morbidity, there are other disease processes, which if left untreated, have higher morbidity than the coronavirus.”
Strokes and heart attacks are good examples.
“We are seeing people present later with heart attacks, and unfortunately, every second counts,” Goldstein said.
Goldstein worries that there might have been an over-correction in response to the “stay at home” and “flatten the curve” messaging — that some people might be too anxious to come in to the hospital due to their perceptions of emergency departments being flooded with COVID-19 patients.
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That’s not the case at Carroll Hospital, he said, where patients with the coronavirus or suspected to have it are kept separate from other patients the moment they enter the emergency department.
“The local emergency departments in our areas are not these uncontrolled chaotic environments where it’s daunting and they have to wait, exposed to other people,” Goldstein said. “The environment is actually very controlled at the moment.”
In fact, Goldstein said, that environment is an alternative for those patients, like Ruzbarsky’s, who cannot get their imaging done.
“I would err on the said of safety,” he said. “If you are, for example, having worsening pain and can’t an outpatient CAT scan, there is an option to come to the hospital.”
Ultimately, Goldstein and Ruby said, people should still get urgent treatment for conditions they would have gotten urgent treatment for before the pandemic.
But, Ruzbarksy notes, it’s possible to take serious symptoms seriously while still taking social distancing seriously as well.
“People just need to focus on flattening the curve,” he said. “We’ve done pretty well, to be honest with you.”