When COVID-19 first spread through Arizona in March and April, local hospitals reworked facilities with outdoor triage, postponed surgeries and implemented social distancing practices. As a result, hospitals like Tucson Medical Center saw a large percentage of their population delay medical care to avoid going to medical facilities and risking infection. But now that Arizona’s stay-at-home order ended three weeks ago, minor medical appointments are increasing, as is COVID.

From late March to  May, the TMC network’s physician and nurse practitioner offices saw a 40 to 50 percent reduction in appointments and patients, their adult emergency department saw a 50 percent reduction, and their pediatric emergency department saw upwards of a 70 percent reduction. TMC also saw a reduced number of patients coming in for chest pain, stomach pain and stroke symptoms, which can be very dangerous to postpone medical care for.

“Even if they know there’s no ‘sick people’ in the waiting room, there’s still some concern about getting out of the house and into a doctor’s office,” said Dr. Rick Anderson, TMC senior vice president and chief medical officer.

During that time, almost all of TMC’s primary care network visits were conducted either over the phone or video chat. Their network offices remained open if people needed to be seen for urgent care, but  many of the telehealth visits were for chronic conditions.

They specifically saw reductions in their elderly and younger patients coming in. As COVID is particularly harmful to older populations, reduced elderly patients were to be expected. Anderson has a theory for why pediatric departments were so quiet, aside from general caution: all of the closed schools throughout the state meant that kids weren’t spreading other diseases such as the flu between each other as much.

“The physical distancing really did what it was supposed to do, which is not only lessen COVID, but lessen everything else,” Anderson said.

While their emergency department had the resources to see patients in-person, Anderson feels the patients just had concerns about staying safe. Their security measures included outdoor triage, prior COVID testing and separating patients, so that if patients came in with chest pain and no COVID symptoms, they wouldn’t be near those who were COVID-positive.

“The word is that COVID hits patients with co-morbidities and other conditions much harder, and I think those patients that have high blood pressure, diabetes and are more prone, are probably less likely to come in and get checked,” Anderson said. “But we’re starting to see a comeback in our emergency department volume, but also in our COVID volume.”

TMC and other local hospitals are seeing a “second blip” in COVID illnesses, both due to the stay-at-home order ending and an increase in testing. 

Anderson says they’ve been expecting this, and their hospital is not to the point where the system is overwhelmed. But it remains to be seen how high this second trend will go.

TMC has since resumed elective surgeries and are seeing an increase in routine appointments. To ease apprehensions, they are screening patients at the door, maintaining social distancing in elevators, only allowing one visitor per patient, segregating both COVID patients and staff caring for COVID patients, and testing for COVID prior to procedure.

“Even patients that may have a COVID test pending, we treat them as positive until we know for sure that they’re negative or not,” Anderson said.

 As a result of the delay in medical care, surgeons now have an appointment and operation backlog, and are discussing whether or not to extend elective surgery hours into the evening or weekend to take care of all these delayed cases.

 “I think part of the issue was because the primary care physicians and nurse practitioners weren’t open, they weren’t seeing as many patients to generate those elective procedures that surgeons typically see,” Anderson said. “And when I looked at the data for our employed group, we saw a drop-off in referrals, which are now starting to rebound a little bit.”

Anderson says TMC can handle the influx of those rebounded elective cases, but what remains to be seen is the size of this growing second wave of COVID cases. For this second peak, if cases should get so high that hospitals cannot adequately protect their COVID-negative patients, Anderson says they would seriously consider reducing or eliminating elective cases once again.