Covid-19 patients aren’t usually checking themselves into hospitals like Chris Christie, experts say

Christie’s announcement, which followed news that Trump, first lady Melania Trump and other Republican leaders had tested positive for the virus, sparked a flurry of reactions online. Chief among them: confusion.

“Regarding Chris Christie, can someone please tell me how one checks into a hospital as a ‘precautionary measure’?” one person wrote on Twitter.

Another person asked, “Can an ordinary citizen with mild symptoms just check themselves into a hospital out of an abundance of caution? Is that how this works?”

Not exactly, experts say.

“What occurred over the weekend with Governor Christie sharing on social media that he was checking himself into the hospital because of his covid-19 diagnosis, that would be extraordinarily uncommon,” said Mark Shapiro, associate medical director for hospital services at St. Joseph Health Medical Group of Sonoma County, Calif.

The process of being admitted to a hospital with covid-19, the disease caused by the virus, is much more complex than Christie’s tweet may have suggested, Shapiro added. He, and other experts, urged people who test positive for the coronavirus and are asymptomatic or exhibiting mild symptoms not to show up at hospitals seeking to be admitted for treatment.

Christie, who may have an increased chance of developing a more severe case of covid-19 because of his asthma and other potential risk factors, declined to comment on the specifics of his hospital admittance.

Atlantic Health System, which operates the hospital where Christie is receiving care, also declined to provide additional details. “Every patient we care for is carefully assessed by a physician to determine their clinical needs,” the hospital said in a statement. “Those determinations, including where care needs to take place, are based on their expert clinical judgment.”

The procedure at most hospitals, according to Shapiro, is that people who fall ill after contracting the coronavirus are admitted through emergency departments following an assessment by a team of health-care providers.

At Mayo Clinic hospitals, for instance, members of the covid-19 front-line care team, many of whom are primary care providers, call patients with positive test results and ask them questions about their condition, which helps with “risk stratification,” said John O’Horo, an infectious-disease specialist with the clinic in Rochester, Minn. In the event that hospitalization may be needed, people usually are processed through the clinic’s emergency room, where they will receive a more thorough assessment to see if they should be admitted.

“We’ll check their vitals, usually get some imaging like a chest X-ray to see if there is a clear pneumonia developing, and check some bloodwork to see how their markers of inflammation and immune function are doing,” O’Horo said. “Based on that, the sum total of looking at all of those things, plus the questions about their ability to continue this kind of care at home, a decision can be made to admit the patient to a special covid unit.”

Still, O’Horo noted, “there are no hard and fast rules really when it comes to deciding if somebody needs to be hospitalized.”

Another way people with covid-19 can become hospitalized is through direct admission, or a process in which a person’s doctor has admitting privileges to a hospital and can admit them directly from home, said Vineet Arora, a hospitalist at University of Chicago Medicine. In instances of direct admission, patients would probably be checking themselves in, Arora said.

“It’s like a cancer patient going to get chemotherapy at the hospital that requires inpatient stay,” she said.

But direct admission often requires that a number of conditions be met, including having health insurance and access to a doctor who has appropriate privileges or connections to a hospital, Arora said.

A patient’s doctor also has to agree that they should be hospitalized, which then kicks off conversations between that doctor and health-care providers at the hospital, Shapiro said. In addition to mutual agreement among the medical experts that the person should go to the hospital, the facility’s capacity and available resources must be assessed, he said.

“The amount of variability and nuance in this is extraordinary,” Shapiro said. “This is very complex decision-making that is fed through kind of tried-and-true pathways. We set it up that way so that we can mitigate risk, reduce risk of error and try to do the right thing for the patient so that they’re getting what they need.”

Instead of heading straight to the hospital or a medical clinic after testing positive for the coronavirus, doctors say people should follow widely promoted public health guidelines.

If you are asymptomatic or have mild symptoms, you should isolate at home to prevent potentially spreading the virus to others, including medical professionals, Arora said. She added that hospitals can also be “dangerous for some people.”

“I know many people who go to the hospital who feel worse after going to the hospital because of how hard the hospital stay is,” she said.

While isolating at home, it’s important to monitor your symptoms closely, Shapiro said. To help with this process, Mayo Clinic hospitals have been sending kits to patients who are flagged as high-risk, which include a medical-grade thermometer, pulse oximeter and blood-pressure cuff, said Ravindra Ganesh, an internist and director of the clinic’s covid-19 front-line care team in the Midwest. People who receive the kits are also given a cellular tablet that syncs with the monitoring equipment and sends the results to the clinic twice a day, Ganesh said.

O’Horo recommended that patients concerned about their symptoms call their primary care providers or hospital system for guidance before showing up at an emergency room.

“That’s helpful not only for that triage piece, but if they are going to be going to the emergency room or other health-care areas, it’s always helpful for the receiving facility to know, so that they can have appropriate precautions in place and try to keep other people from getting sick,” he said.

Shapiro added that “the health-care system in the United States would be overwhelmed immediately” if people start to go to hospitals because they think they have covid-19 or “they’ve tested positive and they’re otherwise doing okay.”

“We don’t have the capacity to provide inpatient care for anywhere close to those numbers of people,” he said, “and then the people that are ill with any number of other things, covid or otherwise, would not be able to get the care they need.”

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