The number of heart attack patients treated at U.S. hospital emergency rooms decreased by nearly half during the pandemic. That statistic has health officials worried that people are avoiding care because they are afraid of contracting COVID-19 at a hospital.

Kaiser Permanente researchers reviewed heart attack treatments at its Northern California hospitals before and after the first COVID-19 death was reported on March 4. The 4.4 million records showed the number of ER treatments dropped by 48% once pandemic-related deaths started occurring.

The statistic was similar when compared to the same period (March 4-April 19) in 2019. Results of the population-based study were published May 19 in a Research Letter in the New England Journal of Medicine.

Researchers say that's not because heart attacks stopped occurring. Rather, they likely increased but the elderly and people with diagnosed heart disease chose to stay home, even when experiencing symptoms, said Dr. Matthew Solomon, lead researcher on the study and a cardiologist at Kaiser Permanente in Oakland, California.

"We know there's a lot of public anxiety and stress and fear, and those things themselves could potentially be causing a higher rate of heart attack," Solomon said. "There are also a lot of reports that the emergency medical services are finding higher rates of death at home, and we worry that a good portion of those could be patients having heart attacks and strokes who did not seek care."

While this study reviewed a population in California, evidence suggests people across the country are avoiding hospitals and prolonging care.

"There have been a number of recent reports suggesting that during the COVID-19 pandemic, there has been a significant decrease in the number of patients presenting to the hospital with acute cardiovascular conditions, including heart attacks and stroke," said Dr. Gregg Fonarow, director of the Ahmanson-University of California, Los Angeles Cardiomyopathy Center.

The same pattern is occurring among stroke patients. Doctors in Washington state and Connecticut are reporting drops in stroke-related admissions between 50-70%.

Dr. Jeff Rabrich, director of emergency medicine at Montefiore Nyack Hospital in Nyack, New York, said he treated a patient with weakness in the left arm and facial drop. The patient reported that the symptoms had started two days earlier.

"Why didn't you come?" Rabrich asked the patient. "The answer you get is, ‘I was afraid to go.’"

Avoiding care will have long-term effects on community health, leading hospital systems and public health organizations to launch marketing campaigns to allay public fears.

Changing public perception that hospitals are breeding grounds for the virus is key. From videos to television advertisements to print ads and social media posts, hospitals are spreading the message that safety precautions are in place to prevent further spread of the virus.

“I honestly believe there’s a higher risk of getting the infection in the community than in our hospital,” said Dr. Alejandro Arroliga, Baylor Scott & White Health’s chief medical officer. “This is not a hospital problem. It’s a community problem because of the penetration of the virus in the community.”

While telemedicine continues to be a viable option for some conditions, ER visits are necessary for hearts attacks and strokes.

"I'm a huge fan and proponent of using urgent cares and telemedicine and private physicians when appropriate," said Dr. Phillip Coule, vice president and chief medical officer at Augusta University Health System in Georgia, where admissions have decreased by 25% to 40%.

"But if you're having … symptoms of heart attack or stroke, those are not viable solutions. Those are patients who need to be seen in an emergency department that's qualified and capable of taking care of them. That's true on any day, and that's true during COVID-19."