Health & Fitness

Lying in the prone (face down) position, in which your chest is down and your back is up, could be a simple way to improve outcomes in cases of severe respiratory distress. This topic has received renewed attention during the COVID-19 pandemic, as invasive mechanical ventilation is conventionally delivered with the patient in the supine (face up) position, which refers to lying on your back.

“Mechanical ventilation is the main supportive treatment for critically ill patients” infected with novel coronavirus 2019 (COVID-19), according to a February 2020 study published in The Lancet Respiratory Medicine.¹ However, reports suggest that many COVID-19 patients put on ventilators don’t make it.

In a JAMA study that included 5,700 patients hospitalized with COVID-19 in the New York City area between March 1, 2020, and April 4, 2020, mortality rates for those who received mechanical ventilation ranged from 76.4% to 97.2%, depending on age.² There are many reasons why those on ventilators have a high risk of mortality, including being more severely ill to begin with.

However, given the poor outcomes, some physicians are now trying to keep patients off ventilators as much as possible by using alternative measures, including having patients lie on their stomachs (prone) to allow for better lung aeration.³

It’s also possible that prone ventilation, which is ventilation delivered with the patient lying in the prone position, may help patients who aren’t responding to conventional ventilation in the supine position,⁴ as well as reduce mortality in those with acute respiratory distress syndrome (ARDS).⁵

Prone Positioning Lowers Death Rate in Those With ARDS

ARDS is a lung condition that causes low blood oxygen and fluid buildup in the lungs. As fluid builds up in the lungs and surfactant, which helps the lungs fully expand, breaks down, the lungs are unable to properly fill with air.⁶ A person with ARDS will have shortness of breath, which can progress to low blood oxygen, rapid breathing and rattling sounds in the lungs when breathing.

ARDS is a common complication among seriously ill COVID-19 patients, with one study suggesting that 100% of COVID-19 patients who died in one study were suffering from ARDS.⁷

In 2013, a study published in The New England Journal of Medicine found that early application of prone positioning may improve outcomes in people with severe ARDS.⁸ During the study, 466 patients with severe ARDS were randomly assigned to receive prone-positioning sessions of at least 16 hours or to stay in the supine position.

After 28 days, 32.8% in the supine group had died, compared to 16% in the prone group. After 90 days, the supine group had a mortality rate of 41%, compared to 23.6% in the prone group, with researchers concluding, “In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality.”⁹

Not only have previous studies found that oxygenation is significantly better among patients in the prone position compared to the supine position, but prone positioning may also prevent ventilator-induced lung injury.¹⁰

Why Prone Positioning Benefits ARDS Patients

In the video above, Jonathan Downham, an advanced critical care practitioner in the U.K., explains why prone positioning can be so beneficial for those with ARDS. Using a simple example of a sponge filled with fluid, he shows how the direction of drainage changes depending on the sponge’s position.

In ARDS, the lung’s air sacs, or alveoli, become damaged. Fluid leaks through the air sacs’ damaged walls and collects.¹¹ Fluid in the lung will increase its weight, which then squeezes out the gas from the dependent regions. If the sponge represents a fluid-filled lung, in the supine position the dependent regions are at the back of the lung.

While the fluid in an ARDS patient’s lung is more evenly distributed than the sponge model suggests, it helps to show how the increased lung mass squeezes out the gas of the gravity-dependent lung regions, and why the lung densities shift when moving from the supine to the prone position.

According to Downham, this shift can occur in a matter of minutes after changing a person’s position. Differences in shape of the lungs and chest wall also come into play. Lungs are normally conical, with the dependent side being the base and the non-dependent side being the apex. When supine, your lung is in this configuration.

The chest wall, however, has a cylindrical shape, and because of this difference the lung must expand its upper regions more than the lower regions, which leads to a greater expansion of the nondependent alveoli and a lesser expansion of the dependent alveoli.

Imagining that the lung is like a slinky, Downham then shows how, when a patient is in the prone position, the weight becomes much more evenly distributed, allowing for better ventilation.

Taken together, when in the supine position, gravitational forces, increased pressure from the wet lung and shape-matching issues all combine to act in the same direction to have a detrimental effect on the dependent alveoli. The prone patient, however, suffers less from these effects. Other benefits also occur with prone positioning, including:

• Removing some of the weight of the heart from the dependent lung¹²
• Rapid, significant and persistent improvement in oxygenation in the ARDS patient with heart failure
• Removing some of the weight of the abdominal contents from the better ventilated posterior aspect of the lung¹³

Prone positioning can also help with stress and strain on the lung, with stress referring to the tension in the fibrous skeleton when distending force is applied and strain being the volume increase caused by the applied force relative to the resting volume of the lungs. It also reduces lung inflammation in ARDS patients¹⁴ and may reduce the severity and the extent of lung injury caused by mechanical ventilation.¹⁵

Support for Early Use of Prone Positioning

Increasing research suggests that prone positioning should be used “systematically” in the early management of severe ARDS, and not reserved as a “rescue maneuver or a last-ditch effort.”¹⁶ As noted by a pathophysiology-based review published in the World Journal of Critical Care Medicine:

“Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle.”¹⁷

The researchers suggested that prone positioning seemed to be beneficial in most cases of ARDS and recommended that “early use of prolonged prone positioning in conjunction with lung-protective strategies decreases mortality significantly.”¹⁸ For best results, other researchers have suggested that prone ventilation sessions should last 12 to 18 hours per session and should be begun early, within 36 hours of diagnosis.¹⁹

A small study of patients with severe COVID-19-related ARDS who required mechanical ventilation in Wuhan, China also revealed that lying in the prone position for 24-hour periods was better for the lungs.^20,21 Unfortunately, despite the many potential benefits, prone positioning remains an underused technique. One study suggested that only 13.7% of patients with ARDS, and 32.9% of patients with severe ARDS, were placed in the prone position.²²

Awake Proning Is Also Beneficial

Much of the research into prone positioning for respiratory distress has focused on its use during mechanical ventilation. However, at least one study has been planned to determine whether the use of prone positioning in awake self-ventilating patients with COVID-19-induced ARDS could improve gas exchange and reduce the need for invasive mechanical ventilation.²³

Previous research also suggests that awake, spontaneously breathing patients who are not intubated can also benefit from prone positioning, which leads to improved oxygenation.²⁴ Another study of care involving critically ill COVID-19 patients in China’s Jiangsu Province recommended the use of awake prone positioning, which, the researchers noted, “showed significant effects in improving oxygenation and pulmonary heterogeneity.”²⁵

It’s also been suggested that the physiological changes that occur with prone positioning may be even more favorable in spontaneously breathing patients than in those who are intubated.

A 2003 study found, in fact, that the prone position led to a rapid increase in partial pressure of oxygen, or PaO2, which is a measure of how well oxygen moves from the lungs to the blood, among patients with respiratory failure.²⁶ All of the patients in the study were able to avoid mechanical ventilation.

In the case of COVID-19, some experts suggest that all patients who are awake and able to adjust their own position should use the prone position for two- to four-hour sessions, two to four times a day. Massachusetts General Hospital also released a prone positioning protocol for nonintubated COVID-19 patients, which states:²⁷

“… [P]atients admitted with hypoxemia should be encouraged to adopt the prone position where practical and prone positioning may be used as a rescue therapy in patients with escalating oxygen needs.”

How to Use Prone Positioning at Home

Some hospitals have also released instructions for self-proning, which can be used at home for people with cough or trouble breathing. If you’re struggling to breathe, you should seek emergency medical care. However, in cases of cough or mild shortness of breath being treated at home, guidelines from Elmhurst Hospital recommend not spending a lot of time lying flat on your back.^28,29

Instead, it suggests “laying [sic] on your stomach and in different positions will help your body to get air into all areas of your lung.” The guidelines recommend changing your position every 30 minutes to two hours, including:

• Lying on your belly
• Lying on your right side
• Sitting up
• Lying on your left side

This is a simple way to potentially help ease breathing difficulties at home and, if you or a loved one is hospitalized, can be used there too. If your health care providers don’t suggest it, ask whether prone positioning could help.

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Those living in nursing homes or other long-term care facilities are the people most susceptible to infectious diseases. So, it is no surprise that nursing home residents make up a huge part of the U.S.'s COVID-19 deaths. At the end of April 2020, COVID-19 deaths in nursing home reached nearly 12,000.¹ According to The Washington Post, almost 1 out of 10 U.S. nursing homes has COVID-19 cases.²

There are clear reasons for the high number of COVID-19 deaths in nursing homes and other long-term care settings like assisted-living facilities, group homes and rehabilitation and psychiatric centers. The residents often have poor overall health and weakened immune systems and they live in close quarters. Moreover, such facilities have frequent visitors and shared staff, both of which can introduce pathogens.

Still, the lack of transparency of COVID-19 cases and deaths among nursing home residents and staff is shocking. Many states release no or only partial information about nursing home outbreaks.³ Some suggest the data embargo is an attempt to hide substandard infection control and medical oversight. Patients' families, patient advocates, staff and, increasingly, lawmakers are demanding change.⁴

Nursing Homes Are Loosely Regulated

There are 15,600 nursing homes in the U.S, housing 1.3 million people.⁵ Nearly 70% of the facilities are operated by for-profit companies with 57% run by chains.⁶ Genesis Healthcare, whose Milford, Delaware, location reported 12 resident deaths and 61 presumed COVID-19 cases in April 2020,⁷ runs 426 nursing homes.⁸

Life Care Centers Of America Inc., whose Kirkland, Washington, facility experienced 37 deaths when the U.S. COVID-19 outbreak first began,⁹ operates 214 nursing homes.¹⁰

Nursing homes are lightly regulated by the federal government with most oversight falling to the states,¹¹ including disclosure of COVID-19 cases and deaths.¹² Family and staff members have been kept in the dark about COVID-19 infections, and risks and outbreaks have been deliberately downplayed.¹³

When USA Today probed why there was not greater federal oversight of nursing homes, especially during the COVID-19 crisis, the answers they received were not satisfying.¹⁴

"A spokeswoman for the Centers for Medicare and Medicaid Services said nursing homes are required to follow their local and state reporting requirements, but she did not respond to questions about why the agency is not tracking the number nationally.

CDC spokesman Scott Pauley said the agency used “informal outreach” to state health departments late last month to estimate that 400 nursing homes had positive cases."

In April 2020, federal lawmakers pressed the federal government to release COVID-19 cases in nursing homes. In a letter to the director and administrator of the CDC, Sen. Ron Wyden, D-Ore., ranking member of the Senate Finance Committee, and Sen. Bob Casey, D-Pa., ranking member of the Senate Special Committee on Aging, wrote:¹⁵

"As we work to track and mitigate the spread of this virus … we are alarmed by reports that the Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) are maintaining a list of facilities that have had one or more cases of COVID-19, and yet, have declined to make this information public.

As our nation faces a crisis unlike we have ever experienced, we write to urge you to release this list of facilities immediately and request information on what you are doing to keep nursing home residents, their families and health professionals informed."

Rep. Jan Schakowsky, D-Ill., and 77 House Democrats wrote Health and Human Services (HHS) Secretary Alex Azar and CMS Administrator Seema Verma asking them to collect and publicly report COVID-19 cases and deaths in nursing homes.¹⁶

Nursing Home Problems Existed Even Before COVID-19

Problems at U.S. nursing homes preceded the COVID-19 outbreak. According to City Journal, almost 51,000 of the 61,099 total deaths from the 2017-2018 flu season occurred in those of nursing home age.¹⁷ Moreover, the facilities often flunk their inspections, writes the newspaper:¹⁸

"Seventy-five percent of U.S. nursing homes have been cited for failing to properly monitor and control infections in the past three years, according to a USA TODAY analysis of federal inspection data …

Those citations have been as mild as a paperwork problem and as serious as failing to inform state officials that unmonitored workers had spread disease to patients in an outbreak."

Up to 40% of U.S. nursing homes are cited for deficient infection-control procedures, City Journal reported, including the Kirkland, Washington, Life Care Centers of America facility where COVID-19 was first recognized in the U.S.¹⁹

Nursing homes are supposed to have an infection-control staffer, but 60% lacked specialized training, according to a 2018 survey, reports the journal.²⁰ According to The Washington Post:²¹

"Nearly 45 percent of the nursing homes with known coronavirus cases nationwide were repeatedly cited in recent years for violating federal rules meant to protect residents from the spread of infections …

In Oregon … [a] facility failed to screen staffers before they entered the building or ensure that caregivers washed their hands or wear personal protective equipment, inspectors found.

In New Mexico, the state attorney general is investigating a nursing home with at least 13 deaths, saying managers did not require staff members to wear gloves or enforce social distancing."

CMS inspections conducted post-COVID-19 discovered that over a third of facilities were not observing proper hand-washing and one-fourth were not using protective gear correctly.²² In an opinion piece in The Wall Street Journal, Dr. Michael Segal expresses shock that scrubs are now commonly worn on the street, defeating the whole purpose of them being sterile:²³

"When I was being trained as a doctor in the 1980s, we were forbidden to leave the hospital in scrubs. You changed clothes in the hospital to avoid bringing in infections out on scrubs or bringing dirt in. At some point that changed and health care workers started removing scrubs at home and washing them there."

Patients and Families Not Told of Outbreaks

Nursing homes and long-term care facilities that do not report their COVID-19 cases publicly also likely do not inform residents and their families. According to KUSA TV in Colorado, a woman who went through rehabilitation at the Orchard Park Health Care Center in Greenwood Village after a fall and her son were not told of a COVID-19 outbreak she was exposed to.²⁴

After discharge, she was admitted to a hospital where she tested positive for COVID-19 and died a week later. According to KUSA TV, her son, Jim Wilson:²⁵

"… said he was never told about the outbreak, even after his mother died. 'I think we should have been told when she was in there. She should have been tested when she was in there, said Wilson. 'They should inform all future, current and past residents of what’s going on.'"

Jan Ransom, a reporter for The New York Times, was also not told that a nursing home in the Bronx where her father lived had cases of COVID-19, which he had caught. Ransom writes in Pro Publica:²⁶

"What I did not know was that he already had the virus. Shortly after being admitted to the hospital, he tested positive for COVID-19. Hours later, I called the nursing home to alert the staff. A nursing home staffer told me that my father was not the first resident to test positive. He was the fourth. I was stunned …

After realizing my dad’s nursing home had left me in the dark, I started to make some calls. I thought about my father’s roommate and the families of other residents at the facility who were unaware of the storm brewing inside. I was certain I should have been alerted that the virus had been detected in the home they shared. I was wrong.

When I called the state Department of Health to complain on my family’s behalf, I was informed that nursing homes in New York — the epicenter of the crisis in the United States — were not obligated to tell families when the virus is detected in other residents."

According to National Public Radio, nursing home residents who are poor or of color are also more likely to be exposed to COVID-19.²⁷

"Seven of the 11 nursing homes with the highest number of deaths report that 46 percent or more of their residents are ‘non-white.’ Most of these 'non-white' residents are black and latinx. At one facility, the Franklin Center for Rehabilitation and Nursing in Queens, which reported 45 deaths, 80 percent of the residents are minority, including 47 percent who are Asian."²⁸

Nursing Home Workers Endure COVID-19 Abuses

A nursing home or long-term care facility that does not report COVID-19 outbreaks to authorities or families is unlikely to let staff know the virus risks, either. This puts both residents and staff at risk. Just as heart-breaking as the COVID-19 patients are the deaths of heroic health care workers.²⁹ According to USA Today:³⁰

"Francine Rico, who has worked at Villa at Windsor Park [Illinois] for nearly 23 years, said she found out that a resident she had worked with had tested positive for COVID-19 from a co-worker who happened to take the call from the hospital where the resident was tested. She said her facility’s administrators were not upfront.

'I'm mad because we are frontline workers but we have been lied to,' she said. 'They put our lives on the line. They have put our residents' lives on the line.'"

Another employee, Tainika Somerville, working at Bridgeview Health Care Center in Illinois, was also kept in the dark. According to USA Today:³¹

"… she, too, worked directly with a resident who tested positive for COVID-19 and later died. She said no one at the Bridgeview Health Care Center in Illinois told her she’d been in contact with someone who had it. Instead, she learned about it through news articles and social media."

Nursing home workers, among the lowest paid of all health care workers, have expressed their plans to strike over the lack of protection against COVID-19.³²

Nursing Home Risks Starting To Be Acknowledged

There are signs that the great risks nursing home residents and employees face from COVID-19 are being acknowledged. In Pennsylvania, nursing home administrators outside of Pittsburgh announced they would no longer just test for symptoms, but presume all residents to be positive.³³

A study in the New England Journal of Medicine confirms that testing only symptomatic residents for COVID-19 is dangerously inadequate and that asymptomatic residents must be included.³⁴

"The data presented here suggest that sole reliance on symptom-based strategies may not be effective to prevent introduction of SARS-CoV-2 and further transmission in skilled nursing facilities.

Impaired immune responses associated with aging and the high prevalence of underlying conditions, such as cognitive impairment and chronic cough, make it difficult to recognize early signs and symptoms of respiratory viral infections in this population."

With increasing reports of underreported nursing home COVID-19 cases and deaths, CMS issued new guidelines. According to City Journal:³⁵

"In the wake of coronavirus’s emergence, the Centers for Disease Control advised nursing homes to initiate strict controls, including restricting outside visitors, examining all residents for early signs of respiratory distress, and isolating where possible those who test positive for Covid-19.

The CMS followed up with more instructions, including beginning symptom screenings such as temperature checks for all residents. And the federal government instructed states to make nursing homes a priority for receiving medical supplies."

A few days later, on April 19, 2020, the CMS mandated that nursing homes inform residents, their families and the federal government about cases of COVID-19, which the agency will collect.³⁶ CMS also admitted that nursing homes have become "an accelerator" for the virus.³⁷

But the growing awareness does not assure the transparency and containment of COVID-19 infections. According to NBC News, the nursing home industry is fighting back and seeking to get states to provide immunity from lawsuits to the owners and employees of U.S. nursing homes.³⁸

"So far at least six states have provided explicit immunity from coronavirus lawsuits for nursing homes, and six more have granted some form of immunity to health care providers, which legal experts say could likely be interpreted to include nursing homes …

Of the states that have addressed nursing home liability as a response to the outbreak, two — Massachusetts and New York — have passed laws that explicitly immunize the facilities. Governors in Connecticut, Georgia, Michigan and New Jersey have issued executive orders that immunize facilities."

While nursing home risks have rarely been clearer, the reaction of too many nursing homes is to circle the wagons rather than improve their conditions. If immunity is granted to nursing homes, it is safe to say the risks from COVID-19 will only get worse.

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It's not always possible to get outdoors for your daily walk (hello winter weather - we see you looming), and not everyone has the space for a treadmill. But you can get your walk in without even having to leave your lounge room. 

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Ditch the cardio and gym equipment. All you need is a good pair of walking shoes to get fit and lose weight. 

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A new study found that organic nitrates do not have clinically relevant effects on bone mineral density or bone turnover in postmenopausal women, and the medications caused significant side effects.

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Neuroscientists find that the protein Synaptotagmin 7 limits the supply of neurotransmitter-containing vesicles for release at synapses.

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Health screenings can catch conditions early, helping patients avoid a condition's worst consequences or even preventing it from developing altogether. Think of mammograms to catch breast cancer early or high blood pressure screening before a person has a stroke. Screening helps pre-symptomatic patients take actions to reduce their risk of a catastrophic outcome.

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A study is reporting a blood-DNA-methylation measure that is sensitive to variation in the pace of biological aging among individuals born the same year. The tool - DunedinPoAm -- offers a unique measurement for intervention trials and natural experiment studies investigating how the rate of aging may be changed by behavioral or drug therapy, or by changes to the environment.

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Girls and young women shouldn't spend a lot of time editing selfies for social media because it negatively influences their thoughts about their looks, according to a new publication.

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How fit are you, really? Fitness is not always best measured by parameters like your weight, your ability to run a 5K, or whether you can do 10 push-ups. Instead, one test of fitness is how well you can stand from a seated position.

Try this: Rise from the floor without using your hands

Before you start: Keep in mind that this test is not for everyone. For instance, someone with a sore knee, arthritis, poor balance, or another kind of limitation would have difficulty doing the test with little or no assistance.

Instructions: Sit on the floor with your legs crossed or straight out. Now stand up again. (This may not an easy movement for many people, so for safety do this with someone next to you.)

How did you do? Did you need to use your hands or knees? Could you not get up at all?

Now, do the test again, only this time grade your effort. Beginning with a score of 10, subtract one point if you do any of the following for support when you both sit and stand:

• use your hand
• use your knee
• use your forearm
• use one hand on the knee or thigh
• use the side of your leg
• lose your balance at any time.

For example, if you sat with no problem, but had to use either a hand or a knee to get up, take off one point. If you had to use both your hands and knees, deduct four points (two points each).

If you can sit and stand with no assistance, you scored a perfect 10. If you could not get up at all, your score is zero. Ideally, you want a score of eight or higher. (For the record, the first time I tried, I got a seven.)

What the no-hands test tells us about fitness

“The sit-and-rise movement — sometimes also referred to as the no-hands test — can reveal much about your current strength, flexibility, and overall wellness,” says Eric L’Italien, a physical therapist with Harvard-affiliated Spaulding Rehabilitation Center.

Performing the sit-and-rise test requires leg and core strength, balance and coordination, and flexibility. But if you struggle, that does not necessarily mean you are out of shape.

“Think of it as a way to highlight areas of your physical health you should address,” says L’Italien. Even if you currently do reasonably well on the test, practicing it regularly can find weak spots before they become worse.

Three exercise that can improve your performance

If you need to improve your performance, here are three exercises L’Italien recommends that can help improve your score — and ultimately your fitness. He recommends adding them to your regular workout routine. If you are just starting out, perform them twice a week and build from there.

Lunges. The simple lunge helps with both leg strength and balance.

• Stand with your feet shoulder-width apart.
• While keeping your abdomen tight and your back in an upright position, step forward with one leg until your knee is aligned over the front of your foot. The trailing knee should drop toward the floor.
• Hold for a few seconds and return both legs to the starting position. Repeat with the opposite leg.
• Do five to 10 repetitions with each leg to make a set. Do two to three sets.

Modification: Stand next to a wall for hand support if needed. For an extra challenge, hold small hand weights during the movements.

Hamstring stretch. Tight hamstrings are a significant contributor to poor flexibility among older adults.

• Lie on your back and place a strap, belt, or towel around one foot.
• Holding the strap, gently pull the leg back until you feel a stretch in the back of the leg.
• Hold the stretch for 30 seconds and then release. Switch to the other leg and repeat.

Plank. This can help strengthen a weak core.

• Lie face down with your forearms resting on the floor.
• Raise up your body, so it forms a straight line from your head and neck to your feet.
• Tighten your abs and try to hold this position for 10 seconds.
• Rest and then repeat. Do two to three planks in total. Work up to holding each plank for 30 seconds or longer.

Modification: To make the exercise easier, do it while leaning against a counter or table at a 45-degree angle. You can also hold the plank from a full push-up position.

The post All rise now — just how fit are you? appeared first on Harvard Health Blog.

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In the era of COVID-19, the hospital must be a place of mystery to those on the outside. I imagine some think it’s bustling with activity, with caregivers scurrying around at a frenetic pace. Of course, we’ve seen video on the news from hard-hit New York City or Lombardy, Italy, when they were at their initial peak of the COVID-19 epidemic. But the reality is that, in most hospitals around the country, it is actually somewhat calmer than usual.

This calm makes sense given the mandate for social distancing, working from home, and canceling nonessential activities. What doesn’t make sense is this: in the emergency departments where I work, daily patient visits have significantly decreased. These days, we are now treating about half the number of patients that we usually do. Although we are busy with COVID-19 patients, the absence of patients with the typical reasons for emergency department (ED) visits, like chest pain, abdominal pain, and headache are way down. This has left us scratching our heads, thinking “where are they?”

People report avoiding emergency departments over fear of COVID-19

A recent article in the Journal of the American College of Cardiology describes a nearly 40% reduction in use of cardiac catheterization labs to treat acute severe heart attacks, which is shocking. This phenomenon occurred in Italy as well, where admissions for heart attacks decreased markedly. Although staying at home is likely to reduce visits for trauma — like falls or car accidents — it shouldn’t affect the rate of heart attacks, right?

A new poll from the American College of Emergency Physicians and Morning Consult may explain where the patients are: at home. About four out of every five adults in the survey said they are concerned about contracting COVID-19 from another patient or visitor if they need to go to the ED, and over half thought they might get turned away for care. About three-quarters of the people in the survey were concerned about overstressing the healthcare system by coming to the ED.

Although we appreciate the sensitivity about burdening the system, it is important for people not to delay medical care when it truly could be an emergency. If you think you are having a heart attack or stroke, for example, delaying treatment could drastically worsen the condition. Despite any hesitation you may feel, do not delay getting emergency medical care if you experience symptoms like chest pain, neurologic changes, severe abdominal pain, or other worrisome changes in your health.

Emergency departments have made changes to keep you safe

If you require an ambulance, call 911. The medics will likely be wearing masks and face shields, regardless of what your symptoms are, to protect both you and them. If you arrive on your own, you should expect some additional questions about COVID-19 symptoms and exposures, so that the hospital staff knows where to safely place you in the ED. In the hospitals where I work, all staff members are required to wear a mask at all times. The people caring for you will likely be wearing personal protective equipment (PPE) like gowns and face shields. We have also constructed walls around several of the beds that used to be separated only by curtains, as a further precaution.

There are additional changes to expect, all to ensure that you and the community are safe. It is possible that you will be asked to wear a mask. And it is unlikely that a visitor will be able to enter the hospital with you, so bring a phone and charger. Overall, the staff will try to minimize the time they spend in the room with you. For example, I now do my initial evaluation in person with full PPE, but then call the patient on the phone in their room to report on follow-up information, when possible.

Some consultants are only seeing emergency patients by telehealth, meaning that you might see some providers on a tablet computer instead of in person. By doing so, we limit the chance of giving you COVID-19, and vice versa. Rest assured, we have access to every test and treatment needed for emergency conditions, and will treat you for your condition. And after each patient leaves their room, we decontaminate it extensively to prepare for the next patient.

If you need to be admitted to the hospital, you may be tested for COVID-19, even if you don’t have symptoms. Patients with a diagnosed case or symptoms suggesting COVID-19 may go to a special pathogens unit, while others may go to a non-COVID floor. And even on the non-COVID floors, the staff takes the utmost precautions to avoid spreading the disease.

Delaying medical care can greatly worsen your outcome. Hospitals are here and ready to care for you in a time of emergency, whether it is related to COVID-19 or not.

For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.

The post Go to the hospital if you need emergency care, even in the era of COVID-19 appeared first on Harvard Health Blog.

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