Hospitals around the state and the nation have seen a decrease in emergency department patients, and health care professionals at St. Luke's and Essentia Health who are seeing the same say that's not because people aren't experiencing the usual medical emergencies.
Immediately after Minnesota Gov. Tim Walz issued the stay-at-home order in March, the emergency department saw a drop in volume of around 50%, St. Luke's emergency physician Dr. Jonathan Shultz said.
"I fear there's a perception that the hospital is not a safe place and that if you come to the hospital you're going to get coronavirus," Shultz said. "I almost feel like the hospital has maybe never been a safer place in terms of getting an infection because we're so careful about it now."
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For example, between patients, rooms are being cleaned and sanitized with the help of ultraviolet lights, which sterilize by killing viruses and bacteria.
In the past week, Shultz said the volume of ED patients has started increasing but not back to where it used to be.
Of concern is that now both Essentia and St. Luke's are seeing a higher-than-expected percentage of patients coming in quite ill — not with COVID-19 symptoms — and in need of more intensive care, likely because they waited too long to seek the care they needed.
Shultz said St. Luke's has seen a number of patients with decompensated chronic medical conditions such as poorly controlled diabetes, asthma and heart failure.
"Patients with chronic medical conditions need very close care," Shultz said. "They should be in touch with their providers through tele-health visits or going into the clinic to see their providers if they need to so that they stay on top of their condition before they decompensate and wind up with a medical emergency."
Dr. Andrea Boehland, an emergency department physician at Essentia Health, said they've seen several cases of ruptured appendicitis, which is what happens when people experiencing appendicitis do not go in for care right away.
There also have been cases of people waiting several days after a heart attack before going in, at which point they're quite ill.
"Another example is that we've seen people with dangerous heart rhythms that are worried to come in and come in quite ill," Boehland said. "If they would have come in in the first place, they would have been less ill."
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Anecdotally, Boehland said she's noticed that the volume of patients in the emergency department is down by about half. She stressed the work being done in the emergency department to keep it as safe as possible, including an alternative flow for patients with COVID-19 symptoms.
"Those people who we are concerned might have COVID aren't even interacting at all with people who we think don't have COVID," Boehland said.
In many areas of the emergency department, airflow is being contained to specific rooms to keep respiratory droplets from entering hallways and other rooms.
"It really is as safe as we can make it," Boehland said.
The same can be said for the birthing center, said Essentia OB-GYN physician Dr. Andrea Wahman, who also has a master's degree in infectious disease epidemiology.
"I think it's just really important that people know that it is still safest to deliver in the hospital for mothers and for the babies," Wahman said. "We have done so much work to get everything ready for our delivering patients."
Everyone who comes in for a delivery is tested, with results known in 45 minutes. So far, no one has tested positive, Wahman said, but if they did, they would be placed in a room set up to prevent the virus from getting out into the hallways.
Health care workers in Duluth are aware of local instances in which expecting parents fearful of contracting the virus at a hospital switched to at-home births that have ended in tragedies.
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The chief medical officer of St. Luke's, Dr. Nicholas Van Deelen, said well-child check-ups including immunizations should also not be delayed, as that could put the child at-risk of developing another set of illnesses.
It's something the hospital is seeing as clinic appointments at St. Luke's are down 50% as well. Van Deelen, an emergency physician by training, said the hospital expected a slight decline in visits but not the degree to which it has occurred.
"If we look back at our numbers and our experience prior to the stay-at-home order, the level of drop-off in cases just doesn't make any sense," Van Deelen said.
The drop in volume at both hospitals has made the financial situation more difficult. St. Luke's, for example, is seeing $4 million in weekly losses due to incurring costs while volumes in all areas are down about 50%, said St. Luke's President and CEO Kevin Nokels.
As a result, the hospital has had to reduce staff according to value, which Nokels said is a difficult strategy to enact while anticipating a surge in high-need COVID-19 patients.
"I would say that we're a very safe place to be," Nokels said. "People should not fear getting the coronavirus coming to St. Luke's."
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