Maine Medical Center in Portland, photographed on April 17, has had an “across-the-board decline” in emergency department admissions, said the hospital’s chief of emergency medicine, from a typical 200 patients a day to about 120 or less. Derek Davis/Staff Photographer

Mainers who may have critical health needs are shying away from doctors’ offices, hospital emergency rooms and other health care settings over fears of being exposed to coronavirus.

Emergency department admissions in some Maine hospitals have dropped by 40 to 50 percent since the novel coronavirus pandemic began, doctors say.

While hospitals have delayed elective procedures to ensure they have the capacity to care for a surge in COVID-19, the disease caused by the novel coronavirus, an unintended consequence appears to be that people are putting off taking care of their chronic conditions or getting life-saving emergency care.

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, emphasized during his Tuesday and Wednesday news briefings that patients still need to see their doctors even during a pandemic, and not be afraid to go to the doctor’s office.

“What we don’t want to do is create a silent sub-epidemic of  people who need care but dare not come in,” Shah said. He said he’s been hearing such anecdotal reports of fearful patients in Maine and across the nation.

Maine has reported 907 COVID-19 cases through Wednesday, with 39 deaths and 144 hospitalizations. Slightly more than half of the total COVID-19 cases – 455 – have recovered.

Shah said patients with chronic conditions may need help to manage their diabetes, for instance, and should still be seeing their doctor.

At emergency departments, the decrease cannot be explained by fewer people getting into car accidents or avoiding other injuries because they are more likely to stay at home.

“We are seeing an across-the-board decline,” said Dr. Michael Baumann, chief of emergency medicine at Maine Medical Center in Portland. Baumann said normally in April about 200 patients are admitted into the emergency department daily, but this year the daily count has been about 120 or less.

So patients who have mild heart attacks, strokes or appendicitis – three of the more common conditions a hospital emergency department might see – may ignore the symptoms instead. That’s a recipe for worse problems down the line, Baumann said.

“I worry about these patients,” Baumann said. “If you’re having chest pains, its not something to wait out. We are here for these populations.”

News reports show a similar phenomenon is playing out across the country – in Philadelphia, Los Angeles, Baltimore, Denver – patients are avoiding hospitals when they shouldn’t be.

Baumann said for heart patients, even if they survive a mild heart attack at home, they may be living with a heart with impaired functioning, which could have been avoided with an early intervention at the ER.

Baumann said the hospital is safe for patients, and Maine Med has put in place a number of protocols to avoid infections, such as separating COVID-19 patients from other patients. The COVID-19 patients are in negative pressure rooms, which prevents cross-contamination with other rooms.

Steven Michaud, president of the Maine Hospital Association, said that just because certain procedures, such as a knee replacement, might be delayed during the pandemic, that doesn’t mean health care services should slow to a standstill.

“We are hearing anecdotally all over the state that people are afraid to go,” Michaud said. “But if you need to go to the hospital, you better go.”

The American Heart Association and several other medical groups issued a statement Wednesday urging patients to call 911 when needed.

“What we’ve seen over the course of the last six to eight weeks is that there are a decreasing numbers of heart attacks and strokes showing up at U.S. hospitals,” Dr. Robert Harrington, a cardiologist and president of the American Heart Association, said in a statement.

Dr. Ranjiv Advani, director of the Mid Coast Hospital emergency department in Brunswick, said that “patients are not coming in like they normally are.” He said daily counts are down from about 85 ER patients to about 40-50 patients at Mid Coast.

For a stroke patient, it’s crucial that they arrive at the emergency department as soon symptoms appear.

“If you come in early, you are more likely to be eligible to receive clot-busting medications, which can not only be life-saving, but save you from a permanent disability,” Advani said.

He said Mid Coast prepared for COVID-19 and can treat all patients safely.