One morning last week, psychiatrist Steven Khoubian learned one of his patients — an older man Khoubian had grown to know over the past year – was at Mission Hospital in critical condition. Khoubian, who works mornings at Mission, decided to visit. The man was unconscious when Khoubian arrived and died the next day.

At the bedside, the deceased man’s wife later told Khoubian what had happened. Her husband had been gardening at home when he fell and hit his head hard. As hours passed, he expressed feeling worse and worse. Then he started vomiting.

“Maybe you should go to the hospital?” his wife asked. “No, no, no,” the man replied. “I don’t want to get coronavirus.”

Eventually, the man acquiesced to a hospital visit, but Khoubian wondered whether the intervening hours before his wife called emergency services might have been fatal.

“When this happened, it really hit home for me,” Khoubian said. “It made me want to put the message out there: If you're having an emergency, you should go to the hospital.”

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The cost of staying away

The story told to Khoubian illustrates a troubling narrative repeated by health care providers both nationwide and in Asheville. People are getting sicker and even dying because they are afraid of going to hospitals during the COVID-19 outbreak. In the race to treat accidents, heart attacks and strokes, essential hours and days are wasted as some delay necessary trips to seek care.

“We have had patients tell us that the symptoms would start, and they were afraid to come to the hospital because they heard the messaging that you don't want to come to the hospital during this period of time because you don't want to expose yourself to a virus,” said Robin Jones, manager of the stroke program at Mission. “And so, they stay home out of fear.”

On an average month, Jones said the hospital treats around 60 emergency stroke patients, but that number dipped to 38 in March. She said total stroke discharges were much lower too, and Mission’s heart department says their patient volumes have plummeted.

“Here at Mission, I started noticing at the beginning of March a significant decrease in patients coming,” said Angela Solesbee, STEMI coordinator at Mission Hospital. “I've seen patients that are hiding out in their homes for two, three, five to seven days. Their fear is so heightened.”

Across the U.S., hospitals and physicians are raising alarms over the absence of heart attack and stroke patients. These conditions restrict blood flow from reaching the heart and brain, respectively, and early intervention is imperative to mitigate long-term damage or stave off death.

“We certainly see a decrease in hospital census,” said Dr. Greg McCarty, chief of medical staff at Pardee Hospital in Hendersonville. “We see a decrease in the emergency department volumes by about 50% since basically the middle of March. And we certainly see a drop in our cardiac patients.”

Though Mission, Pardee and AdventHealth postponed most elective surgeries in March, area health care providers say their facilities are safe and open for vital treatments.

“We are prepared to care for you,” Jones said. “We have protocols in place to implement if need be if someone does come to the hospital that we suspect of having the virus. Then we have protocols in place to care for that patient safely, so that it does not affect other patients or ourselves.”

More:Shifting course again, Mission makes masks mandatory for staff

The benefit and danger of distancing

While trepidation over the coronavirus is the leading hypothesis for this widespread reduction in emergency hospital visits, Rick Stouffer, chief of cardiology at UNC Medical Center, said there may be other reasons.

A byproduct of Stay at Home ordinances is lower air pollution, which Stouffer credits for potentially triggering fewer heart attacks. He said serious respiratory infections may also be rarer as people practice social distancing.

Yet social distancing could also be causing severer health ramifications due to less detection. More people may suffer from accidents, strokes and heart attacks alone as family and friends who once were visiting regularly have now stayed away.

“There's no one checking on them or not checking on them frequently, and the stroke may occur and they can't call, they can't get to the phone, or they don't know how to use the phone because their brain is not functioning,” Jones said. "It's exacerbated right now because your family may be isolating from you.”

Jones recommends people make daily calls to check in on loved ones who live alone.

More:Tents and temperature checks: Mission issues new coronavirus steps for staff, patients

Brian Gordon is the education and social issues reporter for the Asheville Citizen Times. He can be reached at bgordon@citizentimes.com, at 828-232-5851, or on Twitter at @briansamuel92.