PLATTSBURGH — When it comes to strokes, time is neurons, a local doctor says.
Dr. Michael McMahon works in the University of Vermont Health Network, Champlain Valley Physicians Hospital Emergency Department.
Since the onset of the COVID-19 pandemic, he and his colleagues have noted fewer patients seeking care there for both less acute reasons, like minor injuries or illnesses, and more severe concerns, including strokes and heart attacks.
They see people who have delayed coming in with their symptoms, and are worried about some who may not come in at all out of fear of contracting COVID-19.
80 PERCENT CONCERNED
McMahon pointed to a poll conducted by Morning Consult on behalf of the American College of Emergency Physicians in which 80 percent of adults surveyed said they were concerned about contracting COVID-19 if they visit an ER.
Nearly a third said they had delayed or avoided seeking care due to such concerns.
"In that one-third group of people, there’s heart attacks, there’s strokes, serious abdominal emergencies like appendicitis," McMahon said.
"There are people there that are really putting themselves at risk waiting on things."
Additionally, almost 75 percent said they were concerned about stressing the health care system.
McMahon said he and his emergency department colleagues had initially worried about a significant increase in volume due to patients suffering from COVID-19, not a notable decrease in its typical numbers.
"We’ve all seen patients who have delayed their visit maybe by waiting a day or two, you know, and then coming in later, not just for strokes, but a lot of other conditions."
If people notice themselves or a loved one experiencing stroke symptoms, it is imperative for them to call 9-1-1 and get to an ER as quickly as possible, McMahon said.
Those symptoms include sudden trouble with balance, sudden loss of vision or blurred vision, weakness in the arms or face, or trouble with speech.
McMahon noted there are certain time-sensitive interventions available to people who suffer a stroke.
One, called thrombolytic therapy, comes in the form of a medication that is a potent blood thinner, the intent of which is to help dissolve the blood clot.
That is only available for people who come in within a few hours, McMahon said.
"So people that are waiting are really putting themselves at risk of having worse outcomes with their strokes, compared to risks that they might be worried about with contracting coronavirus."
Waiting could result in complications other than brain damage, and puts people at risk of disability or even death, McMahon said.
Through its affiliation with the University of Vermont Health Network, CVPH is able to coordinate with stroke interventionalists across the lake.
Patients can be transported by ambulance or helicopter flight to a comprehensive stroke center in Burlington.
"They have these specialists and they can actually perform what they call a clot retrieval," McMahon explained.
"So they can do a procedure to extract the clot or help dissolve it which is, for some folks, a real game-changer in helping restore blood flow to that part of the brain."
And, even before the COVID-19 outbreak, CVPH's ER was using telehealth to connect with neurologists who could evaluate stroke patients and help the ER doctors make decisions about treatment.
Telehealth can also be useful if patients are unsure of whether they should go to the ER and would like to reach out to their primary care physicians, McMahon said.
McMahon said he is concerned about reports that COVID-19 may be linked to stroke, sometimes leading to death, in young or middle-aged patients.
"While we’re used to stroke being a disease of our older population, the longer you work in this field, you do see that these kind of rules ... they’re not absolute."
Stroke can occur in children or people that do not have typical risk factors, including high blood pressure, diabetes or smoking, McMahon said.
"But now with this virus, of course, all of us that are taking care of patients have been pretty surprised and worried about what this virus has been capable of," he said.
"It does scare me that this virus is not just affecting the respiratory tract, that it is maybe causing or does seem to be linked to problems with the blood clotting in the body that could put a much younger population at risk of stroke."
McMahon said, thankfully, he has not seen such patients, noting that testing has not been widespread, so there could have been a case he was not aware of.
"Not only is coronavirus a concern taking care of a patient with the virus, but having a complication like stroke really makes a serious virus even more concerning."
As of Tuesday, the number of patients coming into the CVPH ER remained at a much lower level than normal, even amid discussions about reopening both the economy and hospital services, McMahon said.
He hopes that word of mouth about safe ER experiences — which include providing masks and checking patients' temperatures — will contribute to a return to typical volumes.
McMahon wanted to reassure people that the hospital, and in particular its ER, is taking many precautions to ensure staff and patient safety.
"Everyone in the ER is making sure that the emergency room is a safe place for any patient that feels that they have an emergent condition," he said.
"The quicker people can come in, the better they’re going to be."
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