As in other cities across the United States, Chattanooga's hospitals report a dramatic decline in the number of patients seeking care at those facilities - and it's not just "non-essential" procedures, which have stalled in an attempt to conserve resources and space in case of a COVID-19 patient surge.
Non-coronavirus-related emergencies such as stroke, heart attack and trauma have significantly decreased, leading providers to believe people who need emergency medical care are avoiding going to the hospital over fears of the coronavirus, according to hospital emergency department data.
The trend marks another significant financial blow to already struggling health systems, but more troubling is the impact it's having on the health of people who need emergency treatment.
"Overall, the number of patients we have been seeing is less, but they are sicker and require more attention," Dr. Ben Cottrell, medical director of the emergency department at Parkridge East Hospital, said by email. "We have seen patients with conditions such as uncontrolled diabetes, heart failure and oxygen-dependent COPD wait at home longer than they should have because they were afraid to come to the ER.
"Several cases we could have managed on the general floor - or maybe even discharged home - have ended up going to the ICU instead."
When compared to March and April last year, Parkridge's emergency departments have seen a 48% decline in visits in the same time frame this year, a 57% drop in neurological cases and 43% drop in cardiac cases. And these drops cannot be attributed to seasonal factors, Parkridge spokesman Michael Ferguson said by email.
"It stands to reason that COVID-19 has played a major role in keeping people who critically need emergency care away," Ferguson said.
Dr. Allen Atchley, a cardiologist at the Chattanooga Heart Institute and the chief of cardiology at CHI Memorial, said the hospital operated at about 40% to 50% of capacity over the last week of March and the first two weeks of April. While much of the decrease in volume is a result of deferring elective procedures, the hospital's rate of treating the most severe form of heart attack increased 40% to 50% between February and March.
"Patients basically have avoided hospitals and doctors to the extent that they just can't go any longer without seeking care, and they show up sicker. We have seen that on multiple instances," Atchley said.
While Atchley agrees that "we are doing absolutely what we need to do to minimize the impact of the virus," it's the future that worries him.
"Everything that's been done now has been done to mitigate COVID-19 spread, COVID-19 complications and to preserve hospital capacity and resources in the event of a surge," he said. "We are bracing for what may be other downstream consequences."
The primary theory is that people are avoiding going to the emergency room out of fear, but there are other reasons why volumes could be down and the severity of illness higher.
Atchley said a similar trend occurs over the winter holidays, when fewer patients go to the emergency room but the ones who show up are more sick. It's also possible that the threat of income or job loss is increasing stress and triggering heart attacks.
Erlanger Health System, home of the region's highest-level trauma center and only children's hospital, is seeing the same concerning trends related to stroke and chest pain. The hospital is also seeing some benefits of the stay-at-home order. Traumas, such as car accidents, work-related accidents and gunshot injuries, have all declined.
But as with adults, most children coming to the emergency department these days are sicker, signaling parents are waiting too long to bring their kids in, according to Don Mueller, CEO of Children's Hospital and Erlanger.
Since children experience such a low incidence of chronic disease compared to adults, much of the decline is attributed to kids being out of school and under more parental supervision.
"The children's emergency room is down 71% from a volumes perspective," Mueller said. "Part of this is, shutting down the schools has reduced the spread of illness, and kids aren't playing sports. Parks are closed. There are less group activities, so they're not getting hurt."
A silver lining of the shift has been the decrease in attempted pediatric suicides, which Mueller said he expected. He sees the same trend every summer.
"We don't see the same number of attempted suicides when school is not in session, and that's one correlated effect that's very well understood," he said, citing research from the American Academy of Pediatrics.
Hamilton County Emergency Medical Services has also seen a drop in its transports to hospitals.
"Our call volume is up slightly from what it was this time last year. However, over the past six weeks, our weekly run totals [patient encounters] have consistently diminished," said the agency's deputy director, John Miller, adding that it seems many of the less urgent calls have stopped.
Atchley understands why his patients may be hesitant to go to the hospital these days. Older adults and people with underlying cardiovascular conditions are more susceptible to serious COVID-19 infection. But if someone is feeling chest discomfort, breathlessness, unexplained swelling, heart racing or dizziness, they should not hesitate to seek care, he said.
"You still need to come to the emergency room and get it taken care of, because deferring that can make conditions worse and more difficult to treat effectively," he said, adding that hospitals have gone to extreme measures to ensure the safety of both their COVID-19 and non-coronavirus patients.
"If you feel poorly or if you're having new or worsening symptoms, you still need to call or see your physician and have those concerns assessed," Atchley said. "We should adhere to the important shelter in place and social distancing recommendations, but if you are sick, we are here and prepared to take care of you."
Contact Elizabeth Fite at efite@timesfreepress.com or 423-757-6673.