Palm Sunday was a beautiful day in New York’s Hudson Valley, a little more than two hours north of New York City where the country’s largest coronavirus pandemic was then raging. Amy Barr, observing the state’s stay-at-home order with her husband, two sons, and a daughter-in-law, joined in a family game of pickle ball in the afternoon. “I ran backwards to hit the Wiffle ball and I slipped, fell and broke my fall with my left wrist,” she told me. She was in enough pain to know an X-ray was in order, but did she dare go to the emergency room, where she could be exposed to the novel coronavirus?
Barr’s husband called the hospital to ask what precautions they were taking in the ER to protect patients.
Upon arrival, she would be directed to a separate entrance, and the hospital staff assured the Barrs that heightened sanitizing protocols were in place. Before entering, she encountered a security booth in the parking lot staffed with a nurse, who, Amy Barr says, “asked questions about where I’ve been, how I felt, if I had a fever – and then she instructed my husband that he could not go inside.”
The hospital’s no-visitors policy protects everyone from needless exposure and follows the Centers for Disease Control and Prevention guidelines for health-care facilities, which specifically call for: screening for fever, cough and difficulty breathing before entering a facility; ensuring proper use of personal protective equipment by personnel who come in close contact with “confirmed or possible patients with COVID-19”; and considering strategies to prevent patients who can be cared for at home from coming into a facility.
Barr didn’t have much choice about whether to go to the hospital – she ended up with a broken wrist that needed a metal plate, multiple pins and a cast. But for many others, the answer is less clear. And it’s apparent from friends, acquaintances and others around the country that there’s real fear in many places about interacting in person with the health-care system.
Poet Kathryn Levy says she’s “trying to avoid doctors at all costs.” Many others, such as George Bishopric, who lives in South Florida, are putting off routine appointments because “a doctor’s office seems like high-risk environment,” he said. Brooke Shelby Biggs, who works as a media literacy educator and at Trader Joe’s in San Francisco, postponed a hysterectomy “until the worst is past, not out of fear but so as not to tax the health-care system.” She’s lucky she had any choice – many hospitals canceled all elective surgeries in March (although some are starting to slowly restart those procedures).
Caity McArthur, a North Carolinian who had a baby boy last month, said it has been “a very scary time to be giving birth.” She had a Caesarean-section delivery at her hospital, fearful all the while for her asthmatic husband facing greater risk from COVID-19.
Hospitals across the country have seen a sharp decline in patients coming in with heart attack, stroke, cardiac arrest – even appendicitis – out of fears about COVID-19. Recently, the American Heart Association, the American College of Emergency Physicians and several other medical groups issued a joint statement urging those experiencing symptoms of such threatening conditions to call 911 and go straightaway to the hospital.
So how do we balance the risk of contracting COVID-19 at a health facility against the risk of not seeking care? Several moms told me they hover over stir-crazy kids’ risky behaviors to reduce the chance of needing an ER, but children (and even adults) break bones and can get sick. How do we stay safe when it’s necessary to get care?
“Hospitals and clinics are reducing the on-site transmission risk by limiting or restricting visitors, postponing elective procedures, screening staff for illness before they start their shifts and accelerating the use of telehealth,” Amy Williams, a physician and executive dean for practice at Mayo Clinic, said in an email.
The CDC issued COVID-19 care guidelines, which specify ideal infection control procedures, but Williams acknowledges “resource constraints are making it nearly impossible to meet guidelines.” It doesn’t mean hospitals aren’t providing good care, she says. It means, “they are providing the best care they can in extremely difficult circumstances.”
That puts some of the burden back on us, the patients, to stay safe and be proactive. Arthur Caplan, director of the division of medical ethics at the NYU Grossman School of Medicine, suggests following the new normal precautions.
“Make sure you’re not all sitting in a waiting room together,” he says. “If the waiting room looks crowded, I might yell, ‘Are we going to do social distancing, or what’s happening here? Can’t we spread the seats in the hall?'”
I’m not sure I would shout, but I would definitely speak to the receptionist or office manager – pronto. We all need to take responsibility for safeguarding one another from exposure.
Caplan also recommends a mask, even if it is not required, just to be safer. (When I went to check out my hospital for this column, all but one person in the largely empty lobby was masked.) Before meeting your health-care provider, Caplan recommends washing your hands or using hand sanitizer (bring it with you, just in case). When you get home, wash your hands, your clothes and that mask (or throw it away), and take a shower, he cautions.
I wondered whether it was safer to seek treatment at a small local facility, where COVID-19 might be less prevalent than at a large urban hospital. Mayo Clinic’s Williams says “the risk of exposure in a hospital or clinic is related to the level of infection in the community where it is located. … (F)amilies must make the best decisions for themselves (in consultation with their doctors).”
After Amy Barr learned that her broken wrist required surgery, and had returned home, one of her sons wanted her to get a second opinion at a university medical center. Barr told him she felt comfortable with the orthopedic surgeon at the local hospital, who had done hundreds of similar surgeries.
“I also didn’t want to expose myself to the virus in another hospital, or go to New York (City),” she added.
Deciding whether to go to an ER or doctor can be tough decisions, especially since we can’t turn to Yelp or Healthgrades to see which hospitals, clinics and doctors are tightly following CDC guidelines for COVID-19. If I needed surgery right now, I’d have to balance the number of coronavirus patients in a particular hospital with the expertise of the surgeon there. And what if I did get sick with COVID-19? It’s a tough question.
“Hospitals that have the resources and highly trained and experienced clinical care teams will be able to care for these very sick patients more successfully than hospitals that do not,” Williams says. So a small local clinic for a broken arm and a large urban hospital for the virus? It’s a conundrum and often not that black and white.
Regardless, Williams said, their campuses expect “to operate in a COVID environment for the next year or longer … where infections will be within our hospitals and the communities we serve.”
For visits that don’t require face-to-face contact, there’s a great alternative: telemedicine, aka video visits. The Mayo Clinic, for instance, has gone from 40 scheduled video appointments a day in early March to more than 2,000 daily by late April, Williams says.
NYU’s Caplan says, “If you can do it by telemedicine, then do it by telemedicine.” It’s not only safer, but “it’s not taking anybody’s resources away,” he says.
As for Amy Barr, who didn’t have a choice, she said she felt safe at the hospital and is home sporting a cast.
“They were wearing masks and I was wearing a mask, but they had to touch me,” she says. “And I thought, ‘How scary for them that they have to touch a stranger.’ It really struck me as such an act of selflessness and bravery that every single day they’re touching people.”