While fumbling through the dark landscape of tragedy, my colleagues and I have often mourned the stories of patients who sought out medical care despite their fears about contracting Covid, only to become casualties of an overburdened system. Early in the pandemic, a colleague told me about an elderly patient with heart disease who died in the emergency room while waiting nearly a day to be admitted to a hospital filled with Covid patients. During the 2020 winter surge in Los Angeles, another patient developed a terrible headache at home, and by the time paramedics arrived an hour later, blood had flooded her brain. She never regained consciousness.
Around the same time, a woman with cirrhosis began to drink more heavily and couldn’t get a timely appointment with her usual physician, who’d been deployed to treat Covid patients in the hospital. Shortly after she went to an urgent care center, she died from liver failure.
The families of these people suffered the singular ache of wondering whether they had pushed their loved ones hard enough to go to the hospital or advocated sufficiently for them to get the care they needed. Their doctors often wondered the same.
I’ve thought about whether listening to patient stories earlier in the pandemic might have improved health care systems’ responses to their needs during these tumultuous years. In April 2020, leaders at Adventist Health Lodi Memorial, a community hospital in central California, noticed that visits to the emergency room dropped by around 50 percent shortly after California issued its first stay-at-home order. Paramedics reported a record number of cardiac arrests outside the hospital, and patients with strokes 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 physicians in Lodi about their health care experiences during the early months of the pandemic and reported, “the overarching theme from these interviews was fear.” To feel safe, patients said they needed to understand the hospital’s efforts to minimize transmission of the virus as well as clear guidance about when to go to the emergency room and reassurance that they would receive care.
The hospital responded swiftly. Patients with respiratory symptoms that could signal Covid were evaluated in one part of the emergency room, a safe distance away 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 began to return to the emergency room, and lives were potentially saved.
The health care system should emulate Lodi Memorial’s approach and pursue the stories of those who died shadow deaths in order to prevent such deaths from happening amid the next crisis or surge. Researchers and policymakers must investigate and learn from the experiences of people like my patient and the patients in Lodi to understand how to minimize obstacles to getting care even amid the tumult of a pandemic — particularly emergency care for people suffering heart attacks and strokes.