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Joaqlin Estus
Indian Country Today

Doctors are seeing a big drop in the number of people coming in for urgent and emergency care, and they don’t think it’s because people aren’t getting sick. They worry people are having strokes and heart attacks and other emergencies at the same rate as before the pandemic but are delaying coming in. Sometimes until treatment isn’t as effective.

That’s according to four doctors on an “Ask a Native Physician” COVID-19 town hall panel, hosted by the American Indian Physicians’ Association Wednesday.

Dr. Joseph Bell, Lummi, is a pediatrician with the Spartanburg Regional Medical Center in South Carolina. He said the number of people coming in for non-coronavirus care has dropped significantly.

“If you look at our numbers from what it was two months ago, you're down 40 percent, so definitely that's a big drop,” Bell said. “I mean, I'm a numbers freak. I do some comparing week to week, like 2019 April, third week, how many did we see, how many did we see this year third week in April. And so it's concerning.

“A lot of those folks, we're trying to get on telehealth to make sure that there's at least some assessment of their health to make sure that we're not backpedaling,” Bell said. Many chronic medical conditions can be monitored by telephone or teleconferencing, he said. Other patients need to be seen in person. 

As a pediatrician, he said “We’re always very worried about the kids who are high risk, diabetics, kids with cerebral palsy, kids with G-tubes, kids with [a tracheal tube].” He said hospitals and clinics have put precautions in place to prevent the spread of the coronavirus in their facilities. For instance, to create a safer environment, his hospital has kids who have tested positive for COVID-19 on one floor, separate from other kids on another floor.

He also wants parents to continue to bring their children in for their vaccinations. “We follow the American Academy of Pediatrics guidelines. And presently what they say is that if you have children who are 24 months or below, they do encourage them to come in for visits and shots and any other kids due for shots because they don't want to see any kind of decrease in vaccination rates, which can lead to other problems down the road,” Bell said.

Panel moderator Dr. Mary Owen, Tlingit, is a family practice physician for the Leech Lake Band of Ojibwe and director of the Center of American Indian and Minority Health at the University of Minnesota Medical School, Duluth.

“There's a lot of confusion around who should and shouldn't be going into our clinics.” Owen said. “I think there's this misinformation out there, or this fear [about COVID-19], kind of keeping people away when they absolutely need treatment.”

Dr. Donovan Williams, Navajo, Internal Medicine, is a Hospitalist Specialist with the Sanford Clinic in Eagan, Minnesota.

Williams said the same symptoms (listed below) that would prompt someone to seek care before the pandemic still apply. Williams also said people shouldn’t wait to see if the symptoms will go away. A delay of several hours may increase the likelihood of an adverse outcome in stroke or heart attack cases, for instance.

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He said people also can call their regular health care provider with questions. Williams said he often sees people who are anxious or have questions about the coronavirus.

“That's the area that I see a lot of worry about, that and worrying about in their home, you know, who they invite to come over ... sometimes they worry that if some of their children are going out into the city and then coming back, there's always that possibility that while they were out they could have been exposed at some point,” Williams said.

Care providers can answer questions about risk, prevention in the home, and good self-care. Pediatricians also are seeing and treating more cases of and worsening cases of anxiety and depression in kids, Williams said. That’s likely the case with adults as well.

Dr. Melvina McCabe, Navajo, is a geriatric physician in the Department of Family and Community Medicine at the University of New Mexico School of Medicine in Albuquerque.

She said cough and fever are common symptoms of COVID-19 in other age groups. But for elders, “Other things can happen. Stroke is one of them. It doesn't happen just in geriatric, stroke is also being seen in the younger population.

“The presence of confusion, that complaint in the elder population can also be a flag to say, ‘well, maybe we should take this person in. This could be COVID.’ So to me again, for geriatric and in our pediatric group also, it's just absolutely critical [that people seek care]. To me, this is a public health education issue,” McCabe said.

If you think you have been exposed to COVID-19 and develop a fever and symptoms such as a cough or difficulty breathing, call your health care provider for medical advice.

When to go to the Emergency Department

Call 911 or go to an emergency room immediately when someone experiences any of the following:

  • Persistent pain or pressure in the chest
  • Wheezing, shortness of breath, difficulty breathing
  • Fainting or dizziness
  • Sudden numbness or weakness
  • Fever with convulsions
  • Confusion or changes in mental status
  • Cough
  • Nausea, feeling light-headed or unusually tired
  • Pain or discomfort in the jaw, neck or back
  • Pain or discomfort in the arm or shoulder
  • Sudden confusion, trouble speaking or difficulty understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance, or lack of coordination
  • Sudden severe headache with no known cause
  • New confusion or inability to arouse
  • Bluish lips or face
  • Sudden numbness or weakness in the face, arm or leg, especially on one side of the body
  • Open wound fractures
  • Bleeding that cannot be stopped
  • Abdominal pain, especially intense localized pain
  • Coughing or vomiting blood
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Joaqlin Estus, Tlingit, is a national correspondent for Indian Country Today, and a long-time Alaska journalist.

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