Large jump in Michigan deaths outside hospitals as coronavirus raged

Deaths recorded by emergency personnel outside Michigan hospitals jumped 62 percent this spring as the coronavirus first raged through the state, according to the state health department.

The stark increase lends support to the notion that residents, including many with cardiac issues, decided to ride out chest pains or other serious symptoms at home rather than seek treatment in hospitals that were filling up with patients with suspected COVID-19. 

The 62 percent rise in “out-of-hospital” deaths was recorded between March 15 and May 23, when compared to the same period in 2019, according to the Michigan Department of Health and Human Services, which reviewed data from the state’s emergency medical services agencies.

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Over that same period, out-of-hospital cardiac arrests climbed 43 percent, according to MDHHS. EMS transports of heart attack patients decreased nearly 10 percent, while transports of stroke patients fell 12.1 percent.

Rick Dupon said he witnessed residents’ reluctance firsthand. 

Dupon, chief of Denton Township’s EMS near Houghton Lake in north central Michigan, said monthly calls dropped about 25 percent between mid-March and the end of May, as metro Detroit was considered a national hotspot for new coronavirus cases. (The state recorded a 17 percent drop in ambulance calls over roughly this same period.) 

When EMS crews were called, the person in crisis often refused to leave their home, Dupon said.

“They’ve heard ‘Stay home, Stay Safe,’ and so they’d say, ‘Can you just take my vital signs?’” He said the person would be told that a hospital is safer than a grocery story, and they would respond, “I’m not going there, either.” 

“It was worse than we thought,” agreed Ron Slagell, president and CEO of Emergent Health Partners/Huron Valley Ambulance, which operates in several counties in southeast Michigan. 

The drop in ambulance calls may have reflected more than residents who were reluctant to visit the hospital. During the state economic shutdown, there were far fewer automobile accidents as well. 

Still, Slagell said, the rising number of deaths was startling. 

“Anecdotally,” Slagell told Bridge, “we had this gut feeling that things weren’t right. It was a surprise to see the magnitude of people’s reaction to” the virus. 

As COVID-19 filled hospitals — especially in southeast Michigan — in March and April, hospitals reported precipitous declines in emergency room visits. While hospital visits for elective or otherwise non-emergency care were soon prohibited during the outbreak, public health and hospital officials urged people with serious health issues to continue to seek care, with limited success. 

The slump in non-COVID emergency room visits remains, hospital officials have told Bridge, a trend that is not unique to Michigan.

Hospital emergency department visits across the country declined by 42 percent during the early months of the pandemic — a “striking decline,” according to a report this month by the U.S. Centers for Disease Control and Prevention.

Dr. Chadi Alraies, a cardiologist at Detroit Medical Center, was concerned enough that he asked fellow heart doctors on Twitter in April whether they had noticed the same sheer drop-off in cardiac patient visits.

Cardiac visits, he learned in 524 Twitter responses, had been reduced by half at the nation’s hospitals and cath labs.

At St. Joseph Mercy Hospital in Ann Arbor, cardiac surgeon Dr. Manak Sood, said he’s also not surprised by the data supplied by the state. 

“Clearly there was a reticence (for patients) in coming into an environment where they felt they would be exposed to COVID,” he said.

The St. Joseph hospital in Ann Arbor usually performs two or three repairs each month on aortic dissections — a deadly tearing of the aorta. Since COVID-19 arrived in Michigan, he said, “we haven't had one.” 

It’s likely those people died, Sood said. Nearly one in 10 patients with aortic tears of this kind die without surgery, he said.

“This isn’t a maybe-I’ll-go-tomorrow kind of situation,” Sood said.

Complicating estimates is mounting evidence that the new coronavirus itself can make people more susceptible to cardiac events — weakening heart muscles, triggering inflammation, or causing blood clots, even as people are less likely to pick up the phone.

“It’s a double jeopardy,” said DMC’s Alraies.

But while the pandemic may have made some reluctant to dial 911, there may be other reasons behind the decline in patients seeking care, he theorizes.

Seniors isolated during the pandemic didn’t have as much contact with loved ones, for example, who might rush them to the hospital, Alraies hypothesizes. One patient, he said, endured chest pains for days before her son found out and rushed her to DMC. She was fortunate to have survived, he said.

As coronavirus cases begin to inch up in Michigan and public health officials across the country predict a second wave of cases, hospitals and other health providers say they must convince patients it’s safe to seek medical care. Hospitals and doctors offices are focusing on virus screening and sanitizing methods, separating COVID patients from others, and the availability of personal protective equipment.

In Denton Township, Dupon said EMS workers use high-pressure aerosolizing sprayer to send disinfectant throughout ambulances after each run. Patients are immediately masked. Staff wear masks, gowns and face shields. 

“This is as clean and safe an atmosphere as you can get,” he said.