A couple of weeks ago, Dr. John Harold, a cardiologist at Cedars-Sinai Medical Center, had a patient who'd taken a fall. The patient had a headache and felt weak in the left side of his body.
But it took a while for Harold to hear about it.
"He opted not to call the ER, even call me, because of concerns about getting exposed to COVID-19," Harold told me. "Eventually, his symptoms progressed into basically a full-blown stroke and he ended up at the hospital."
Harold, who's board president of the Los Angeles affiliate of the American Heart Association, said his patient waited two days to get treated. And his patient wasn't an anomaly. He told me doctors across the country have seen patients avoiding or delaying care because of concerns about contracting the virus.
"People are in this fear mode," he said.
"But the challenge is -- heart attacks and strokes and cardiac arrests -- they don't stop for COVID-19."
'WHERE ARE ALL THESE PATIENTS?'
According to the California American College of Emergency Physicians, ER volumes have been down 40% to 70%. Doctors say part of that is due to people staying at home, and avoiding trauma or injuries so they don't wind up in the ER. But emergency rooms are also seeing fewer heart attack and stroke patients.
"I mean, we've all been scratching our heads -- where are all these patients?" Dr. Larry Stock, an ER doctor at Antelope Valley Hospital, told me. "The answer is, they're at home, and we're starting to see the tip of the iceberg of this phenomenon."
At Loma Linda University Medical Center, the 52-bed ICU for coronary patients is usually full of people coming in by way of the emergency department. But recently, the unit has been only about a third to a half full, said Dr. Anthony Hilliard, a cardiovascular disease specialist at Loma Linda University's International Heart Institute.
"It's counterintuitive to some extent, because these are conditions that aren't on a schedule," he said. "These are things that present out of the blue or acutely and require urgent or emergent care."
A report published in Journal of the American College of Cardiology showed a 38% drop in March of STEMI patients -- or heart attack patients who had complete arterial blockage. At Cedars-Sinai, the ER has seen 18% fewer stroke patients and 10% fewer STEMI patients from March to April 15 compared to the same period last year, according to a spokesperson for the hospital.
When patients do show up, doctors say they're often sicker. Dr. Andrea Austin, an ER doctor in downtown Los Angeles, told me she's seen fewer non-COVID patients overall during the pandemic, but she's seen more serious cases because of patients' unwillingness to go to the ER right away.
"We've seen that before COVID, sometimes, people have delays in care, but I've never seen the number of delays that I have in the last month or so," she said.
Austin said in some cases, patients have run out of medicine for their chronic conditions, like diabetes. In other cases, she's had stroke patients come into the hospital days after having symptoms like nausea, dizziness and vomiting.
"I think that's really one of the tragedies of COVID-19 is that people are scared," she said. "They're staying at home and trying to diagnose themselves, or really playing down their symptoms, where if they came in, we as trained emergency physicians would quickly realize that this was potentially a stroke."
Austin said she's been using telemedicine to help triage patients to the emergency department.
'THE BEST CARE IS CARE'
Jacqueline Alikhaani understands why people have been afraid to go to the hospital. She has a rare form of heart disease and diabetes, and she had a stroke several years ago. She's 59 years old, and her husband is 70.
"I've been feeling a lot of anxiety," she told me last week. "They're saying that people who have heart disease and diabetes, those kind of chronic conditions, are at a higher risk."
Recently, she said she's been having some chest pains, and has been unsure if it's related to her anxiety. Before the pandemic, she said, she'd go down the street to her local ER.
"That's just not something I feel very comfortable with right now," she said. "It's a tough call, tough decisions."
She said she's been in close contact with her doctor and monitoring her symptoms, like her blood pressure, and says her doctor has made sure to tell her that she shouldn't hesitate to go to the ER.
And that's the message doctors have been trying to tell their patients despite COVID-19.
Harold, with Cedars-Sinai and the American Heart Association, said hospitals have taken precautions to keep people safe from the virus, and delaying care in major events like a heart attack or stroke can only make things worse.
"I tell people the best care is care, and not just to sit at home and wait for things to get better spontaneously," he said.