MultiCare neurologist Dr. Madeleine Geraghty knows firsthand about consequences from stroke victims who delayed calling 911. A recent elderly patient who feared getting COVID-19 waited a day, and now she has permanent damage.
Geraghty said doctors are concerned here, nationally and globally that 911 calls have declined rapidly since February among people with stroke or heart attack warning signs. Health professionals say they commonly hear too late that victims were more afraid of contracting COVID-19.
That’s heartbreaking, Geraghty said, because minutes count to prevent permanent disabilities or death. Emergency response units and ERs follow strict COVID-19 protocol and sanitary measures, so they are safe, said Geraghty, an American Stroke Association volunteer medical expert.
“It isn’t just in Spokane or just in Washington state, but we see a nationwide trend of people not coming to ERs,” Geraghty said. “Initially, people were afraid of overwhelming the health care system when our focus was very intentionally on flattening the curve.
“There are also concerns and fear that going to the hospital would give them COVID. I’ve had this experience myself the last time I was on call. A delightful elderly woman had a warning of a stroke, a TIA the day before she came in, and didn’t call because she was so frightened of COVID.”
A TIA is a transient ischemic attack that causes a temporary period when a blood clot goes up to the brain and blocks blood flow for a few minutes with symptoms similar to those of a stroke, but it doesn’t cause permanent damage.
“It wasn’t until the next day when she actually had a stroke and had sought emergency help because she knew she had no choice. Her symptoms became permanent. She was deathly afraid of staying in the hospital. We talked about why she didn’t call the day before with her stroke warning.”
The American Heart Association’s state office and MultiCare spokesman Kevin Maloney say statistics show lower-than-normal rates for overall emergency calls. City and Spokane Valley fire departments have reported a 12% decrease in daily 911 calls for March and April compared with that period a year ago based on statistics shared with the AHA.
Maloney said Deaconess Hospital’s ER saw a 13% decrease in 911 calls for medical transport in March compared with February and a 33% decrease in April compared with February. He said the trend is similar at other local hospitals.
Physicians are discussing the concerning pattern across the globe, Geraghty said.
“I attended an international webinar led by a neurologist in Italy earlier this week, and they are seeing the same phenomenon – a decrease in patients coming into emergency centers for strokes and heart attacks, so it’s not onlylocal to Spokane and the nation.
“It’s a behavior we have to change.” The reason is simple: “Time is brain,” she said.
A TIA is a warning that something is lurking to cause a stroke before it happens. Hospital acute care must move quickly to remove a blood clot, followed by strong supportive care, Geraghty said.
With delays, “the risk of a worse outcome increases,” and that’s concerning now when people are afraid to come in and stay home instead.
Maloney said people with any fears of emergency treatment should realize that hospitals follow sanitizing and safety protocols. Facilities here are isolating any patients with COVID-19 on a separate floor, and there are few of them, he added.
Hospital workers are wearing masks, and all visitors with any respiratory symptoms must put on a mask immediately. Waiting areas have social distancing.
Another concern is a new trend of strokes thought to be COVID-19-related in younger patients, Geraghty said.
“Although it does not seem to be frequent yet, we are starting to see some COVID-causing stroke in healthy young people in their 30s and 40s,” she said. “That would be nationally, and that is a big concern to neurologists now. Stroke has never been a disease of the elderly alone.”
Geraghty agreed that hospitals here have isolated COVID-19 wards along with high standards for keeping all patients safe. She feels confident with the sanitary measures at emergency facilities.
“I Lysol my shoes after I go to the grocery store,” she said. “I don’t Lysol my shoes after I go into the ER.”
Also, she said ambulances are regularly sanitized, while paramedic and EMS staff constantly use gloves and masks. “Using the ambulance service is highly encouraged,” she said.
Permanent disabilities from strokes can depend on what part of the brain is afflicted, she said, but impacts can include speech and vision impairments or the ability to walk because of paralysis on one side. Other impacts can be subtle.
“The key is the signs come on suddenly, so my rule is if something changes and if a person was normal a few minutes ago and now someone is not, we have ambulances for a reason. No one in the medical community will be upset if there is a false alarm.”
Having a TIA or early warning signs are “a golden opportunity” to find where the problems are so a stroke might not happen in the first place, she said.
Some patients with stroke symptoms might get treatment with a clot-busting medicine called tPA, for tissue plasminogen activator. The shot must be given within a short window of time.
Others might qualify for treatment with a catheter and removing the clot, Geraghty said. “After a certain amount of time, none of the treatments will be effective.”
“My message is for people to come in as soon as humanly possible,” she said. “Knowing that people are afraid to come in is breaking my heart. That patient I saw broke my heart. We lost a day in treating her.”
The AHA urges learning common stroke signs under FAST and to call 911.
Face Drooping. Does one side of the face droop, or is it numb? Ask the person to smile. Is the person’s smile uneven or lopsided?
Arm Weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
Speech. Is speech slurred? Is the person unable to speak or difficult to understand? Ask the person to repeat a simple sentence.
Time to call 911 if the person shows any of these symptoms, or even if the symptoms go away, for transport to the hospital immediately.
Warning signs for a heart attack can include:
Arm, back, neck, jaw or stomach pain
Shortness of breath
Breaking out in a cold sweat
Nausea or feeling lightheaded.
During the current stay-home orders, it’s also important to check on those who live alone, Geraghty said. Speaking to a friend, neighbor or a loved one on the phone or during a video call can give clues about early warning signs.
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