As we stumbled through the dark landscape of the tragedy, my colleagues and I have often mourned the stories of patients who sought medical care despite their fear of contracting Covid, only to fall victim to an overloaded system. Early in the pandemic, a colleague told me about an elderly patient with heart disease who died in the emergency room while waiting almost a day to be admitted to a hospital full of Covid patients. During the winter storm of 2020 in Los Angeles, another patient at home developed a terrible headache, and by the time the paramedics arrived an hour later, the blood had flooded her brain. She never regained consciousness.
Around the same time, a woman with cirrhosis started drinking more heavily and was unable to get a timely appointment with her usual doctor, who had been deployed to treat Covid patients in the hospital. Shortly after going to an emergency room, she died of liver failure.
The families of these people suffered the unique pain of whether they pushed their loved ones hard enough to go to the hospital or advocated enough for them to get the care they needed. Their doctors often wondered the same thing.
I’ve pondered whether listening to patients’ stories earlier in the pandemic would have improved healthcare systems’ responses to their needs during these tumultuous years. In April 2020, leaders of Adventist Health Lodi Memorial, a community hospital in central California, noticed that emergency room visits dropped about 50 percent shortly after California issued its first stay-at-home order. Paramedics reported a record number of out-of-hospital cardiac arrests, and stroke patients almost uniformly waited to seek help until the severity of their symptoms worsened.
A team of researchers, mainly from the University of California, San Francisco, interviewed patients and doctors in Lodi about their healthcare experiences during the early months of the pandemic and reported, “The overarching theme of these interviews was fear.” To feel safe, patients said they needed to understand the hospital’s efforts to minimize the transmission of the virus, as well as clear guidelines about when to go to the emergency room and reassurance that they would receive care.
The hospital responded quickly. Patients with respiratory symptoms that could indicate Covid were evaluated in an emergency room area, a safe distance from others. Patients received emails about the measures taken to keep the hospital clean, the prevalence of Covid cases in the community and what symptoms should prompt an immediate visit to the emergency room. People soon started returning to the emergency room and potentially lives were saved.
The health care system should take Lodi Memorial’s approach and follow the stories of those who died in the shadows to prevent such deaths from happening during the next crisis or wave. Researchers and policymakers need to research and learn from the experiences of people like my patient and the patients in Lodi to understand how barriers to getting care can be minimized, even during the tumult of a pandemic – especially emergency care for those who suffer to heart attacks and strokes.
