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Palomar doctor urges those with serious conditions: Don’t wait to seek care

Photo of retrofitted negative pressure rooms. This was taken a couple of months ago in the ICU (intensive care unit) wing. You can see the ducting coming out of each room and being exhausted outside. Filters and fans outside suck the air from the room, through the filters and to the outside air.

When you have a sudden serious medical condition, don’t put off getting medical attention because you are afraid of catching the Coronavirus  or because you don’t want to fill up the hospital. 

Amidst the COVID-19 pandemic there is much anecdotal and statistical evidence to suggest that many people are delaying seeking care for conditions like heart attack and stroke because they fear becoming infected with the virus when they go to the hospital emergency room.

Dr. Allan Hansen, who is medical director of the emergency department for both Escondido and Poway campuses of Palomar Health, wants the public to know it is safe to come to the hospital for treatment. 

During the Coronavirus pandemic public health officials have hammered home the theme that people who have symptoms of the coronavirus, but are not feeling serious effects, such as difficulty breathing or high temperature, shouldn’t flood the hospitals.

The bad take away from those public service announcements would be people who need medical attention for a possible stroke or heart attack but stay home because they feel they aren’t sick enough. “The processes are there to make sure patients are sent to the appropriate place,” Dr. Hansen told The Times-Advocate.  “People shouldn’t delay care because of that concern.”

The hospital is a safe place to be if you have a condition other than COVID-19, said Dr. Hansen. “We are seeing people delaying care. People have been concerned because of the current pandemic and perceived safety issues. Anecdotally we know that people come in later than they might. We really are pushing that if you are having an emergency we have systems in place and a process. People can be seen while we are also caring for the COVID patients. Definitely people are delaying emergency care. We do see that in the admission rates to the hospital. Our rate is about 16-17 percent from the emergency department.” They have seen about a 40% drop in admissions from the baseline before the pandemic. That is probably because of the lockdown and shelter in place, he said.

Nurse in an ante room attached to the built-in negative pressure room dressed in personal protective equipment (PPE.) This is how they dress when they treat COVID patients. The built-in negative pressure rooms look like any ordinary room but have a second room attached (ante room) to keep air from cross contaminating. Medical personal enter through the anteroom to the patient room.

“People who are coming in are more sick,” said Hansen. “People are delaying care and when we admit them they have a higher degree of illness.”

Asked if there has been a measurable higher degree of deaths attributable to this cause, Dr. Hansen answered. “It’s difficult to measure that. No way to know how many people have died.”

How important is early intervention? “With a stroke we have the ability to give medication that might reverse stroke injury, but it needs to be given in first to six hours of symptoms, to give us the opportunity,” he said. After that there can be irreparable damage to brain tissue.  

The same is true of a heart attack. “The longer treatment is delayed the more heart tissue can be damaged,” said Dr. Hansen, who has seen people wait too long and put their life in jeopardy because they are afraid of contracting COVID in the hospital. Early intervention is critical, especially for heart attacks and strokes. 

During the lockdown Palomar has taken precautions to ensure COVID patients are segregated from non-COVID patients and built up its supply of PPEs (personal protective equipment) so they can continue doing elective surgeries while the pandemic numbers spike. “We are much better prepared, nationally and locally, than we were in March to handle COVID patients,” he said.

They employ multiple safety processes in the emergency department and the hospital itself. All patients and physician staff are masked. Everybody’s temperature is taken when they enter. The emergency room employs what Dr. Hansen calls “a robust process.” “We use a screening tool, which consists of a variety of questions. Do they have a fever? A cough? A screener at the door asks a set of standard questions, following  CDC (Centers for Disease Control) guidelines.

People entering are temperature screened. Those with COVID symptoms are sent to a separate waiting area and then treated in what is called “Pod D.”

The hospital’s emergency department has four pods, each with about 15 beds. There’s A, B and C, but Pod D is completely separate. “Given the pandemic, the hospital converted eight of the rooms into negative pressure rooms,” he said. 

Although you might read about hospitals in south county reaching capacity as the virus spikes, that is not true of North County. “We’re definitely seeing an increase,” he said. “Our volume had been down forty percent in April and May. Now we are down fifteen percent. We have the capacity to see an increased number of patients. That’s not an issue at all.”

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