Paramedics are making fewer trips to emergency room than they did at this time last year but seeing more patients who are dead on arrival or cannot be resuscitated. (Kevin N. Hume/S.F. Examiner)

Fear of COVID-19 may contribute to spike in deaths from other causes

Medical experts urge those with symptoms to seek treatment

The novel coronavirus had taken 33 lives in The City, as of Friday.

But the fear of exposure to the virus and the isolation of sheltering in place may be contributing to other deaths as well.

City data shows that fewer medical incidents have been reported to first responders overall since the shelter-in-place order took effect in March, but the number of those incidents where patients are found dead on arrival or cannot be resuscitated has spiked.

Health experts fear that concern surrounding visiting health care facilities amid the coronavirus pandemic is causing patients with sometimes life-threatening conditions to avoid seeking treatment.

“People are experiencing symptoms that they would normally come to the emergency department for, and they’re not coming,” said Dr. Maria Raven, chief of the Department of Emergency Medicine at University of California, San Francisco. “Either because they feel like they don’t want to take up space that a COVID patient might need, or they just don’t want to come because they’re worried about contracting COVID.”

Between March 17 and May 6, the San Francisco Fire Department has responded to 254 incidents where a patient was DOA or unable to be resuscitated — a 40 percent increase over the prior three years. The average number of such incidents for the same time period from 2016 to 2019 is 181, according to city data.

“There’s no question, people are waiting longer to come in,” said Dr. Christopher Colwell, chief of emergency medicine at Zuckerberg San Francisco General Hospital. “We’re seeing that not only in what we suspect from the ones where we arrive and they’re dead on arrival, but also what is coming into the emergency department.”

Over the past three years, an average of 1,795 medical incidents have been reported to the fire department per 100,000 people between March 17 and May 5, with a slight increase over time. But this year, during the pandemic, there has been a dropoff, with only 1,669 incidents per 100,000 people.

“People aren’t calling, or they are waiting too long to call, and they’re sick when EMS finally gets there,” said Raven. “Across the board in all emergency departments we are seeing lower volumes.”

covid shutdown medical examiner stats
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Colwell says he sees patients come in who may have had a heart attack, but put off a hospital visit for multiple days. By then, he says, “there’s a lot less we can do.”

On top of that, people may be finding themselves alone more often as they practice social distancing — leaving them helpless in the event of a life-threatening incident.

“People might have symptoms of a stroke, but no one is there to observe their symptoms,” said Raven. “And they can’t ambulate … or they cant speak, or maybe they fell, they can’t get up off the ground, and there’s no one really coming to check on them in the same way.”

“We see people come in all the time to the emergency department who wouldn’t have come in but for their family member that coaxed them to come in,” she said.

In addition, with testing still not widespread, it’s difficult to say how many excess deaths — deaths above what historical data indicate we should expect — were actually COVID-19 cases.

“How much of this is related to COVID that we’re just not picking up, and how much is not directly related to COVID but is indirectly related to COVID, is a really good question,” said Colwell.

Roughly 5,800 people die in San Francisco every year, 1,300 of whom are sent to the Medical Examiner’s Office. Of the 254 fatal incidents encountered by first responders during The City’s lockdown, about 80 percent were transported to the medical examiner. Medical examiner referrals often include people who die alone or under other questionable circumstances.

In California, there have been an estimated 807 more deaths than expected that were not due directly to COVID-19 between March 29 and April 25, according to the Centers for Disease Control. In New York City, the epicenter of the pandemic in the U.S., where hospitals have been overwhelmed by the virus, that number is 4,563.

In San Francisco, which has been less hard hit so far, hospitals are much better positioned to still be able to care for patients, COVID-19 or otherwise.

“We have not run out of ventilators, we have not run out of intensive care beds, we have not run into any of that in San Francisco to this point,” said Colwell.

But, as he points out, that could all change.

“I want to be careful because, as everybody is well aware, we don’t know what the next surge will look like,” he said. “San Francisco has done an outstanding job flattening this curve, but that also means that we’re in this for the longer haul.”

The important thing, Colwell says, is for people to understand that it is still safe to seek medical help.

“If you are experiencing acute medical issues you should seek help from your primary care physician, or if it’s a more serious issue — chest pain, you’re worried you’re having a stroke, those types of things — then you should absolutely come to the emergency department,” he said. “I can very confidently say that the health care environment is a safe one. It is far more dangerous to sit on medical issues than it is to seek help.”

cbrowning@sfexaminer.com

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