Sumter hospital leaders worried people need care but are avoiding health facilities


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It's a narrative health care professionals are hearing more than they'd rather recently.

People are avoiding the emergency room and their doctors because they're scared and "have been told to stay home." It's causing preventative health emergencies in people who don't have COVID-19, and hospital and urgent care leaders in Sumter want to help clear the air.

At the onset of the pandemic caused by COVID-19's spread globally, nationally and locally, we were being told to stay home. Avoid the ER if you're sick with symptoms connected to COVID-19. At first, it was only get tested if you're sick becuase there weren't enough tests to go around.

To help prevent hospitals and emergency departments from being overwhelmed with patients, elective procedures were postponed, and doctors' offices closed to regular checkups.

"We see a ton of patients every year, and if we would have just stayed open, we would, I think, have seen a bigger spread," said Clay Lowder, a doctor specializing in family medicine and a partner at Colonial Healthcare.

Colonial was one of the first and biggest places to offer testing in Sumter for the highly contagious respiratory coronavirus, along with Prisma Health Tuomey Hospital. Lowder said he thinks keeping people home as much as possible helped.

"We encouraged everyone to stay away at our own peril. Our business was hurt by it. Now, we want people to come back," he said. "We have seen some really bad cases of things where people have waited too long to get treated."

Now, with universal testing and an increased number of mobile testing sites offering specimen collection to anyone, regardless of symptoms, the message Lowder and other health care professionals want out there is that people need to get the services necessary to protect their health.

He said two or three people suffering heart attacks during the past month have come in after having reservations about doing so. A man came in on Thursday, he said, for a stress test and found 80% blockage in a critical artery that, left unchecked, can be suddenly and likely fatal.

He said he is seeing increased cases of untreated diabetes and high blood pressure. Colonoscopies and mammograms are down, and mental health needs are up.

The "same chatter" is being heard nationwide, said Scot Dilts, an emergency medicine trained doctor and the medical director of Tuomey's Emergency Department. He said he has heard a lot of stories of sick people delaying a trip to the doctor for chest pain and stroke evaluations because they're afraid to come in.

"People should not be afraid to come to the Emergency Department. Certainly not for chest pain, numbness in your arms, tingling in your fingers, difficulty with speech, those symptoms of heart attack and stroke," Dilts said. "Those are time-sensitive evaluations, and they should not be put off."

The sooner you treat someone suffering a heart attack, the more heart muscle you save, he said. The better both for short-term life-saving efforts and long-term recovery.

"Time is muscle," Dilts said.

Stroke patients need even more prompt professional intervention. Generally, care rendered within three hours gives the patient and the medical staff their best hope for treatment.

Dilts said patient volume at Tuomey's ER is down. They're seeing less minor complaints, and the admission rate is up, so that means there's a higher percentage of sicker patients.

"Which is what we want the Emergency Department to be used for, but we also want to make sure that sick patients are coming in," he said.

Waiting to get care, he said, could mean what would have been an outpatient procedure and easier treatment now means the patient has medical needs that require hospital admittance.

Dilts said people may be scared they'll contract COVID-19 at the hospital.

"My non-medical friends always tell me, 'You work in such a dangerous place.' Really, I think we work in the safest place in the city," he said.

Every person inside the hospital has a mask, and there are no nonessential people inside, he said. Visitors are only allowed in rare circumstances that necessitate one companion, and the hospital staff knows the status of everyone inside.

"If I get sick, it'll be in the grocery store or in the gas station or the big department store or something like that," Dilts said.

Gene Dickerson, Tuomey's physician executive, which he describes as vice president-level, said patients are still being encouraged to postpone routine checkups but to see your doctor if you need care to keep it preventative and not reactive.

Dickerson oversees patient safety, quality, medical staff services and risk management, and he said offices are relying on telehealth for nonemergency visits. Much of the routine meetings between doctors and patients in family medicine, cardiology, orthopedics and other such fields can be done virtually.

Those who are visiting offices and the hospital are all screened for symptoms and fever, Dickerson said, and everyone is given a mask. He said rooms are cleaned after each patient.

Tuomey has a separate COVID-19 unit, and even within that unit everyone is separated. The unit can handle up to 24 patients in individual rooms and a site manager ensuring staff don't miss anything in putting on and taking off their PPE.

There is a separate COVID-19 operating room. Usually, there are 10 ORs. They're running five or six right now. Before COVID-19, the department would take about 30 cases a day. Right now, there are around 20.

"That's by design," Dickerson said.

If the point of keeping people away at first was to not overwhelm hospital capacity and staff, it seems to have worked at Tuomey.

Dickerson said they had up to 17 inpatients at the same time in mid-March, a few in the ICU and the rest on the COVID-19 floor. The ICU has 17 beds with the ability to expand to 21, and the COVID-19 unit has the ability to expand from its current 24. Tuomey also has the other hospitals in Prisma Health's network to tap into if needed.

There was a resurgence in hospital visits a couple weeks ago, Dickerson said, but as of Friday at 6 a.m., the inpatient count was down to eight.

Dickerson and Dilts both voiced confidence that safety procedures are being followed successfully and that people should not be afraid to see the doctor or go to the hospital if they are in need. Not doing so could be worse.

They both also said people need to return to getting care because they don't see the situation ending soon.

Until a vaccine is developed and widely administered, these safety measures are expected to remain. They both said they think that may be for at least another year.

Back at Colonial, Lowder said he's starting to see people come back. Their safety precautions remain, too. Waiting rooms are separated, and testing is done outside.

The man whose artery was 80% blocked was happy it was discovered before it proved to be fatal, Lowder said.

"He said, 'If I could hug you, I would,'" he said. "It matters that people get care."