Wellstar cardiologist cautions against avoiding needed treatment

Dr. Barry Mangel, in article about delayed treatmentDr. Barry Mangel (photo courtesy of Wellstar Health Systems)

The Courier had a conversation with Dr. Barry Mangel, the chief cardiology officer at Wellstar Health Systems.

“I lead the cardiovascular service line for the health system,” Dr. Mangel said. “I am a cardiologist. I’ve been in the community here for about 26 years.”

“I’m an interventional cardiologist by training,” he said. “Currently I practice general cardiology.”

Dr. Mangel spoke about the effects the COVID-19 pandemic has had on the willingness of people exhibiting symptoms of stroke or heart attack to seek emergency care.

Mangel described a disturbing trend that has developed since the COVID-19 pandemic had broken out.

“What we’re seeing is about a 40 to 60 percent reduction in the number of patients who are presenting to the hospital emergency rooms across the country and also here at Wellstar, with both heart attack and stroke,” said Mangel.

“And that’s pretty consistent across the board,” he said. “What we’re also seeing is patients who are coming to the hospital with heart attack and stroke, but they are patients who have delayed their treatment or avoided treatment, and they come to the hospital much sicker than if they had come originally when the symptoms began.”

He said there are two reasons patients were avoiding the hospital.

“We’re hearing from those patients that they’re afraid to come to the emergency room,” Mangel said.

“They’ve been hearing a lot in the news, and they don’t feel like they want to overburden folks in the emergency room who are dealing with COVID patients,” he said. “But also, they’re concerned about exposing themselves to the virus, and so they’ve been delaying care for that reason as well.”

He said emergency room trips to Wellstar overall have decreased by around 50 percent.

The Courier asked if there had been a corresponding rise in death rates because of the drop in emergency room trips.

Mangel said he didn’t know whether the mortality rate was higher.

“I can only say that for the patients that have come to the hospital and had delayed treatment, that the ones that we’re seeing are significantly sicker than they would have been had they come in earlier,” he said.

The Courier asked if there had been any difference in the drop in emergency room visits between the two hospitals: Wellstar Cobb and Wellstar Kennestone.

Mangel said no, that within the Wellstar facilities the drop had been around 50 percent.

The Courier asked Dr. Mangel what precautions are being taken to prevent patients arriving for treatment from being infected by the coronavirus.

“We’ve taken many different precautions,” he said. “We screen everyone who comes into the hospital.”

“We’re doing temperature screens as well as questionnaire to look for folks who who might be infected in and we’re we’re also cohorting those patients away from the other population,” said Mangel.

“We’re using personal protective equipment (PPE) for all patients who are either coded positive or suspected of having COVID infection,” he said.

“And so I guess the point I would make is that I understand why there would be concern, but I think that we we have been taking all the necessary precautions to be able to provide safe care for the non-COVID patients.”

“We’re not really allowing visitors to come to the hospital except with rare exception,” he said. “We’ve limited the numbers of people who are coming to the hospital besides the patients that need to be there, so I think I think we’ve really spent a lot of time trying to be certain that not only do we keep patients safe, but we keep our, our staff, our providers safe.”

“Overall in healthcare and here at Wellstar, the numbers of health care workers that developed infection has been exceedingly low,” he said. “And so that’s really, I think, a testament to all of the precautions that we’ve taken.”

Mangel said that patients do not need to worry about putting strain on the resources.

“We have adequate PPE, and more than adequate testing,” he said. “I would tell anyone that’s having worrisome symptoms that we are fully prepared to take care of them in a different track , in a safe way, and that having them in the system is not going to put an undue burden on our providers.”

“We take care of patients during flu season where we have lots of flu patients, and we take care of everyone else. In a lot of ways, this is very similar to that. We still have to take care of the heart attack, stroke patients, (and) the trauma patients,” Mangel said. “There just seems to be a lot fewer of them coming in.”

The Courier asked Dr. Mangel if there were anything else he’d like to tell the public.

“I would, I would make just one or two points,” he said.

“First, we do have the ability for non-urgent, or emergent situations, to do virtual health, telehealth, visits with our patients,” he said. “And we’ve been increasing the volume of those visits really significantly over the last month or six weeks.”

“That allows us to take care of those patients in the same way that we would otherwise, but you can’t take care of a stroke or heart attack patient over the phone,” he said. “And so when you have concerning symptoms, just like I would tell you if we weren’t having a pandemic, if you have concerning symptoms, go to the emergency room, call 911 and let them take care of you and bring you in so we can evaluate you because, again, we can’t take care of those critical problems.”

“And with the heart, time is muscle,” he said.

“The more time that you wait and delay, the more heart muscle that’s damaged,” he said. “It’s irreversible.”

“Damage to the brain is the same. And so if you’re having those symptoms, the longer you delay care, the more serious your condition will be, and the and the more long-lasting it will be,” he said.

“So it’s critically important in those situations to pay attention to the time, because we can help folks early on, but if care is delayed, and irreversible damage occurs, we really can’t do very much and beyond supporting those patients,” said Mangel. “But we can’t reverse the damage that’s occurred.”