IN THE MIDST OF THIS PANDEMIC, THERE'S GROWING CONCERN THAT
PEOPLE WHO MIGHT BE SUFFERING FROM OTHER ILLNESSES THAT
REQUIRE EMERGENCY CARE ARE TOO AFRAID TO SEEK TREATMENT, WHICH
OF COURSE JEOPARDIZES THEIR HEALTH EVEN MORE.
CAROLEE MCGRATH SPOKE WITH DR. NEILS RATHLEV, THE CHAIR OF
THE EMERGENCY DEPARTMENT AT BAY STATE HEALTH, TO LEARN MORE.
>> WELL, THE TRENDS HAVE BEEN VERY DRAMATIC.
SINCE THE BEGINNING OF MARCH WHEN COVID FIRST REARED ITS
HEAD, WE HAVE THE VOLUMES IN THE E.D. HAVE DECREASED BY ABOUT 50%
OVERALL. THIS HAS BEEN PARTICULARLY
NOTABLE IN OUR PEDIATRIC EMERGENCY DEPARTMENT.
AT THE HEIGHT OF FLU SEASON WE WERE SEEING SOMETHING LIKE 150,
160 CHILDREN A DAY. AND IN THE LAST COUPLE WEEKS
IT'S BEEN CLOSER TO 20. THERE HAS BEEN A DRAMATIC DROP.
AND I THINK THAT CLEARLY WHAT THIS SAYS IS THAT PEOPLE ARE
AFRAID OF COMING TO THE HOSPITAL AND COMING TO THE EMERGENCY
DEPARTMENT AND ARE STAYING AWAY. >> WHEN YOU'RE TALKING ABOUT THE
PEDIATRIC VISITS ESPECIALLY WITH THE FLU, I'M ASSUMING THAT
PEOPLE ARE AFRAID AND ARE TRYING TO OPT FOR TELE MEDICINE.
BUT HOW DANGEROUS COULD THAT BE FOR LITTLE ONES WHO ARE
SUFFERING? >> WE ENCOURAGE FAMILIES AND
PATIENTS TO CALL THEIR PRIMARY CARE PHYSICIAN FIRST, IN ALL
CASES, UNLESS THEY HAVE AN ABSOLUTE EMERGENCY IN WHICH CASE
OBVIOUSLY THEY SHOULD CALL 911. THAT WOULD BE FOR THINGS LIKE
ACUTE SHORTNESS OF BREATH, CHEST PAIN, THOSE ARE COMPLAINTS WHERE
YOU REALLY SHOULD BE CALLING 911 AND COMING TO THE HOSPITAL.
AS FOR LITTLE KIDS, CLEARLY WE CALL IT RESPIRATORY SEASON WHEN
KIDS GET PROBLEMS WITH NOT JUST THE FLU BUT OTHER RESPIRATORY
VIRUSES. THAT HAS ABATED SOME, SO FLU
SEASON IS ESSENTIALLY OVER, AND WAS OVER A COUPLE WEEKS AGO.
BUT OF COURSE NOW WE'RE CONTENDING WITH COVID-19.
FOR THE KIDS IN PARTICULAR WHAT WE'RE CONCERNED ABOUT ARE
CHILDREN WITH CHRONIC ILLNESSES, LET'S SAY FOR EXAMPLE DIABETES,
WHO ACTUALLY ARE GETTING SICK BECAUSE THEIR BLOOD SUGARS ARE
GOING TOO HIGH AT HOME, AND WE'VE HAD SEVERAL INSTANCES
WHERE CHILDREN HAVE COME IN WITH VERY, VERY HIGH BLOOD SUGARS AND
HAVE BEEN REALLY IN VERY, VERY SERIOUS CONDITION.
SO THE MESSAGE HERE IS REALLY, IF YOU CRITICALLY ILL, LET'S SAY
IF YOU HAVE CHEST PAIN, YOU'RE SHORT OF BREATH, THE ARM DOESN'T
WORK, YOU CAN'T SPEAK CORRECTLY, SYMPTOMS SUGGESTIVE OF A STROKE,
WE NEED YOU TO COME TO THE HOSPITAL.
IF YOUR DIABETES OR HIGH BLOOD PRESSURE IS OUT OF CONTROL, YOU
REALLY DO NEED TO HAVE IT TAKEN CARE OF RIGHT AWAY.
>> CAN YOU EXPLAIN HOW THINGS ARE SET UP SO THAT IF SOMEBODY
DOES CALL 911 AND THEY'RE BROUGHT INTO THE EMERGENCY
DEPARTMENT, HOW THEY ARE TRIAGED FROM THERE?
>> SURE. SO WHAT WE DO IS CLEARLY
SEPARATE OUTPATIENTS THAT HAVE SYMPTOMS SUGGESTIVE OF COVID-19
FROM OTHER PEOPLE. SO THE MINUTE YOU WALK IN THE
DOOR OR THE MINUTE YOU MEET THE PREHOSPITAL PERSONNEL, THE
PARAMEDICS OR EMT'S, THEY WILL ASK YOU QUESTIONS IMMEDIATELY,
SCREENING QUESTIONS, TO SEE IF COVID-19 IS A POSSIBILITY.
AND THEY WOULD BE FEVER, SHORTNESS OF BREATH, EXTREME
FATIGUE, MUSCLE ACHES, NAUSEA, VOMITING, DIARRHEA CAN ALSO BE
SYMPTOMS OF COVID, LOSS OF TASTE, LOSS OF SMELL.
THESE ARE ALL THINGS THAT CAN SUGGEST THAT A PATIENT HAS
COVID. SO WE SCREEN IMMEDIATELY ANYBODY
WHO HAS THESE SYMPTOMS, WE PUT A MASK ON AND WHAT WILL HAPPEN IS
WE WILL ASSESS, TREAT THESE PATIENTS IN A SEPARATE AREA FROM
OTHERS. IF YOU NEED TO BE ADMITTED WE
TEST EVERYBODY. >> I THINK PEOPLE PROBABLY, AS
YOU MENTIONED, ARE NERVOUS AND FEARFUL, AND THINK MAYBE I
SHOULD JUST TOUGH IT OUT, MAYBE THEY MIGHT BE HAVING CHEST
PAINS, BUT MAYBE THEY THINK, WELL, IT COULD BE INDIGESTION.
HOW DANGEROUS IS THAT FOR SOMEBODY WHO COULD BE
EXPERIENCING A HEART ATTACK OR STROKE?
>> COULD IT BE EXTREMELY DANGEROUS BECAUSE THESE ARE TIME
SENSITIVE CONDITIONS. SO FOR STROKES, NEGOTIATION,
MORE THAN 24 HOURS OUT -- FOR EXAMPLE, MORE THAN 24 HOURS
OUT, THERE ARE NO INTERVENTIONS WE CAN UNDER TAKE.
AND THE SAME THING WITH A DIFFERENT TIME FRAME IS TRUE OF
SERIOUS HEART ATTACKS. WHAT HAPPENS IS THAT SEVERE
STROKES AND HEART ATTACKS, WE ARE STILL SEEING.
WHAT WE'RE NOT SEEING ARE THE PATIENTS THAT HAVE, SHALL WE
CALL THEM MILDER HEART ATTACKS OR CHEST PAIN FOR OTHER REASONS,
HIGH BLOOD PRESSURE THAT'S OUT OF CONTROL.
STROKES, WE CALL THEM TRANSIENT ISCHEMIC ATTACKS, THESE ARE
MINOR STROKES WHERE THE SYMPTOMS COME ON SUDDENLY AND THEN GO
AWAY WITHIN A SHORT PERIOD OF TIME, MAYBE AN HOUR OR TWO AND
THEN GO AWAY. THOSE ARE STILL HARBINGERS OF
WORSE THINGS TO COME IF NOT TAKEN CARE OF QUICKLY.
AND THERE'S A MUCH HIGHER INCIDENCE, ONCE YOU'VE HAD A
MINOR STROKE OR MINOR CHEST PAIN EPISODE, YOUR CHANCE OF HAVING A
POOR OUTCOME WHEN YOU HAVE A LARGER EVENT IS MUCH MORE
SERIOUS. >> SOME PEOPLE OBVIOUSLY AREN'T
QUITE SURE WHAT HAS HAPPENED AS FAR AS THOSE SYMPTOMS GO.
WHAT ARE THE TREATMENTS THAT CAN BE USED IMMEDIATELY IN THE
EMERGENCY DEPARTMENT FOR A STROKE VICTIM?
>> FOR A STROKE VICTIM, WE USE CLOT BUSTING DRUGS.
IF PATIENTS COME IN WITHIN A CERTAIN PERIOD OF TIME,
TYPICALLY FOUR AND A HALF HOUR, WE CAN GIVE THEM CLOT BUSTING
DRUGS, THIS IS FROM ONSET OF SYMPTOMS.
WE CAN ADMINISTER THIS TO THEM. IN THE EMERGENCY DEPARTMENT WE
USUALLY DO THAT IN CONJUNCTION WITH A STROKE NEUROLOGIST THAT
SEES PATIENTS. THERE ARE PATIENTS WHO CAN GO
AND GET A CATHETERIZATION AND RECEIVE CLOT BUSTING DRUGS INFRA
VENOUSLY. SO THERE ARE SPECIFIC
INTERVENTIONS WE CAN UNDER TAKE, BUT IT DEPENDS ON WHEN THE
PATIENT PRESENTS FROM THE ON SET OF SYMPTOMS.
SO THIS IS SOMETHING THAT WE JUMP ON IMMEDIATELY, AND THE
SAME THING IS TRUE OF HEART ATTACKS WITH EKG'S SUGGEST THAT
THIS IS SOMEONE NEEDS TO GO TO THE CATHETERIZATION LAB RIGHT
AWAY. >> AND THIS IS NOT UNIQUE TO THE
STATE. WHAT ARE YOU HEARING FROM COLLEAGUES ACROSS THE
COUNTRY? >> THERE WAS AN ARTICLE IN THE
"NEW YORK TIMES" THAT SAID EXACTLY THE SAME THING, EVERYONE
IS SEEING THIS ACROSS THE NATION.
THE MESSAGE FROM US WHO WORK IN THE HOSPITAL IS THAT IF YOU ARE
NOT SURE, WE TAKE GREAT PAINS TO KEEP YOU SAFE, AND HAVE BEEN
VERY EFFECTIVE IN DOING THAT, BY THE WAY.
WE HAVE NOT HAD PATIENTS THAT HAVE BECOME ILL WHILE THEY'VE
BEEN IN THE HOSPITAL HERE. SO BECAUSE OF THE PRECAUTIONS
THAT WE'RE TAKING. SO IF YOU ARE CONCERNED, I WOULD
NOT TOUGH IT OUT, AND LET US TAKE A LOOK, AND IF IT TURNS OUT
THAT THIS IS JUST HEARTBURN, THEN THAT'S GREAT.
AND WE WILL LET YOU GO ON YOUR WAY.
ON THE OTHER HAND IF IT'S SOMETHING ELSE, THEN THERE ARE
WAYS WE CAN TAKE CARE OF YOU. BUT MY CONCERN IS THAT NOW THAT
WE ARE STARTING, MAYBE NOT IN MASSACHUSETTS, BUT IN OTHER
PLACES, STARTING TO RELAX A LITTLE BIT AROUND QUARANTINING
AND SOCIAL DISTANCING, THAT WE'RE NOT GOING TO START TO SEE
MORE OF THESE PATIENTS THAT SHOULD HAVE COME DO US A WEEK
AGO OR A COUPLE DAYS AGO, AND NOW THEY'RE COMING AND WE CAN'T
REALLY DO MUCH, BECAUSE IT'S TOO LATE.
>> I THINK A LOT OF PEOPLE THOUGH WHEN YOU TALK ABOUT THIS
FEEL LIKE, YOU KNOW, WHEN THEY LOOK AT THE NEWS OR THEY LOOK
ACROSS THE COUNTRY, THAT THE ONLY THING THAT HOSPITALS CAN
HANDLE RIGHT NOW ARE COVID-19 PATIENTS, SO THEY MIGHT FEEL
GUILTY ABOUT COMING IN IF IT IS JUST HEARTBURN.
>> YES, AND YOU HAVE TO LOOK AFTER YOURSELF FIRST, AND I
THINK THAT NO ONE WANTS YOU TO HAVE A HEART ATTACK AND SIT AT
HOME WHILE THIS IS HAPPENING OR A STROKE WHERE IN RETROSPECT WE
COULD HAVE CHANGED THE OUTCOME FOR THE BETTER.
BUT IT IS NOW TOO LATE TO REALLY DO SOMETHING.
SO WE SEPARATE ON THE INPATIENT WARDS WE SEPARATE THE COVID-19
PATIENTS FROM EVERYONE ELSE. AND THE WAY THAT WE DO THAT IS
WE TEST EVERYONE WHO IS BEING ADMITTED IN THE EMERGENCY
DEPARTMENT. SO BEFORE THE PATIENT LEAVES, WE
KNOW IF YOUR TEST IS POSITIVE, AT LEAST FOR AN INPATIENT WARD.
WE KNOW IF YOU'RE POSITIVE OR NEGATIVE.
>> SO BOTTOM LINE IS HOSPITALS ARE OPEN FOR BUSINESS, THE SAME
BUSINESS YOU HAD, EXCEPT FOR ELECTIVE SURGERIES.
AND THAT'S CONFUSING TO A LOT OF PEOPLE.
>> YES, AND IRALSO WANT TO REEMPHASIZE THAT WE ARE NOW
SEVEN WEEKS INTO THIS AND WE REALLY HAVE WORKED OUT OUR
PROCESSES FOR TESTING, FOR PROTECTIVE GEAR, AND SEPARATING
PATIENTS FROM EACH OTHER IN THE HOSPITAL WHEN THAT IS NECESSARY.
SO OUR PROCESSES NOW ARE REALLY MUCH BETTER THAN ADMITTEDLY THEY
WERE ON DAY ONE. WHEN THIS HAPPENED WE TOOK GREAT
PAINS TO WORK OUT OUR PROCESSES AND PARADIGMS SO THAT WE'RE ABLE
TO KEEP PATIENTS SAFE. AT THIS POINT I CAN DEFINITELY
SAY THAT WE'RE ABLE TO DO THAT.