Question: I was out walking my dog when I tripped and fell on the sidewalk. I really hurt my hand. However, I’m terrified of going to a hospital emergency room because I might catch COVID-19. I realize I’m a germophobe, but are ERs really safe places to be?
Answer: You can rest assured that hospital emergency departments are taking extra precautions to reduce the risk of the novel coronavirus being spread from person to person.
Patients are usually screened at the door for signs of infection prior to triage and registration. Once registered, they are placed in their own separate space – away from others – while they wait to be seen by a health care provider.
“We are reassessing the situation daily to ensure we are providing the safest possible care,” says Dr. Aikta Verma, Chief of the Department of Emergency Services at Sunnybrook Health Sciences Centre in Toronto.
“If you feel like you’re having an emergency, then of course, you should come to the emergency department,” she adds. “If you need us, we are here.”
Unfortunately, though, that message doesn’t seem to be reaching a lot of people who require urgent medical care.
In fact, visits to some Toronto-area emergency departments plunged by as much as 50 per cent in the first few weeks after the pandemic was declared in mid-March.
Doctors are worried that many patients could suffer serious complications if they don’t seek timely care.
In the case of major strokes and heart attacks, patients need to be treated within a few hours of developing symptoms in order to avoid permanent damage, disability or death.
“We are seeing a troubling decrease in things like stroke presentations and people presenting with heart attacks – they are both down by about 33 per cent,” says Dr. Erin O’Connor, Deputy Medical Director of the Emergency Department at the University Health Network which includes Toronto General Hospital and Toronto Western Hospital.
“We know these conditions are still happening,” she says. That suggests some patients might be dying at home. Even those who survive an initial bout of symptoms should still see a doctor because certain medications and medical procedures can help prevent another attack which could be fatal.
Although emergency department visits are down, the patients who do show up tend to be sicker than usual. Presumably, some of them delayed seeking care and their health deteriorated in the meantime.
“If you wait two weeks at home with appendicitis, it can certainly get much worse and require more complex treatment,” says Dr. Verma.
But it appears that patients aren’t just avoiding their local ER. Some might be skipping appointments with their family doctors, too.
“My referrals are down,” says Dr. Ilana Halperin, an endocrinologist and internist at Sunnybrook.
As part of her medical practice, she sees patients who have been diagnosed with diabetes and hormonal disorders. Many of them have been referred to her by their family physicians.
“I usually receive between eight and 10 referrals a week. Now I’m getting two to four,” Dr. Halperin says. There’s no medical reason to account for the decline. “Diabetes hasn’t suddenly gone away,” she observes.
So, either patients aren’t going to their doctors or the doctors aren’t putting through referrals to specialists.
It’s worth noting that many medical clinics have run into problems obtaining adequate supplies of Personal Protective Equipment – gloves, gowns and masks – which are essential for shielding staff from patients who might be carrying the coronavirus.
But doctors can still connect with their patients using various forms of telemedicine – such as video chats and old-fashioned phone calls – without the risk of infection. Of course, a doctor can’t physically examine a patient or perform a procedure in a virtual visit.
“We encourage people to reach out to their primary care providers for ongoing virtual management of new or chronic problems,” says Dr. Halperin.
She adds that the family doctor “can review the problem and determine whether there is a need for an in-person assessment and make appropriate referrals in a timely fashion to prevent health complications down the road.”
Despite such options, it appears that a lot of routine health care isn’t happening right now.
Dr. Halperin expects she will eventually get a surge of referrals “when everything opens back up again.” The end result will likely be longer and longer waits to see specialists, she adds.
The growing backlog of deferred medical care could have profound consequences for individual patients and the health care system as a whole.
Cancer diagnoses might be delayed for some people, while others may suffer a further decline in their medical conditions.
Dr. O’Connor is particularly worried by reports that some parents are delaying regularly scheduled vaccination appointments for their children.
“Not having children properly vaccinated means that we are going to be at risk of outbreaks for many diseases that were under control,” she predicts.
COVID-19 is already putting an incredible strain on health care, she notes. “We don’t need more problems.”