Quiet ERS could become problematic, doctors warn
People believed to be staying home despite injury or illness
When Dr. Brett Belchetz arrived at the Toronto hospital where he works Sunday for his first shift after two weeks in self-isolation following a trip to New York, he found an institution transformed, physically and emotionally, by the looming pandemic.
“Before that trip we were obviously all hearing about COVID, but everything was mostly business as usual,” he said. “Now, going into the hospital, COVID is everywhere.” Triage procedures had been remade. Videos on protective equipment had been passed around. And everywhere, in the air, anxiety lingered.
But in the emergency department where Belchetz works, he found something curious. Patient numbers were actually down, significantly, from the norm. “I am hearing this is fairly similar across other emergency rooms in the Toronto area,” he said. “We are seeing way, way, lower volumes of admissions overall.”
It is not just in Toronto either. “Emergency volumes have plummeted all over the country,” said Dr. Daniel Kalla, the head of the emergency department at St. Paul’s Hospital, in downtown Vancouver. “People are so fearful of hospitals, understandably,” he said. They just aren’t coming in.
It’s too soon to get precise numbers on exactly how far emergency admissions have fallen in this country. But half a dozen emergency doctors in four provinces who spoke to the National Post for this story say the drop offs in their departments have been significant. And, from speaking to colleagues in other hospitals, they believe it’s been near-universal too.
That jibes with data coming in from other jurisdictions where the pandemic arrived sooner, and hit harder, than it has so far here. In Seattle, emergency admissions fell between 10 per cent and 20 per cent at six large hospitals in February and March, according to a study released online this week. One hospital in the area saw its ER admissions drop by nearly 40 per cent as the pandemic swept through the region.
That could at first read like a good news story. Quiet ERS could be a sign that social isolation is working. Fewer people out in the world mean fewer car crashes, drunken brawls and other scourges of the ER. But doctors warn it could also foreshadow a significant problem to come.
“We’re certainly hearing stories of people with abdominal pains and chest pains and all sorts of bad symptoms, like stroke symptoms, who are just not coming to the hospital because they’re too afraid,” said Belchetz. “It’s actually somewhat of a tragedy.”
So, while it may be true that some patients with minor problems are listening to public health pleas and staying away, the worry among doctors is that patients with more serious conditions are staying home too.
“There are less heart attacks coming to the emergency department now,” said Dr. Ari Greenwald, who practices emergency medicine in Toronto and Hamilton. “And I don’t know why, but I presume that some of the people who are having heart attacks are just not coming in.”
That’s a big problem. Because with conditions like heart attack, stroke and appendicitis, early treatment almost always leads to better outcomes. “We can’t help you with your heart attack if you stay home,” Greenwald said. “Similarly, if you’re having your severe abdominal pain, you’re vomiting, you (have) shortness of breath, and you stay at home, we’re not going to be able to help you.”
Kalla understands why patients might be leery of the ER right now. “I’d be scared as a lay person to come in to the hospital with something unrelated to COVID,” he said. His department has put a huge amount of work into creating separate COVID-19/ Covid-19-suspected and lower-risk areas for treatment. But he knows there’s only so much they can do to allay the fear.
“I’m very concerned that there are people who are having heart attacks and strokes and significant injuries at home — deep cuts that aren’t getting sutured,” he said. Those everyday, often fatal, conditions of normal life don’t go away in a pandemic. “I think this crisis is going to (cause) huge collateral damage to the medical system for non-covid-positive patients,” he said
For some emergency medicine doctors, meanwhile, the slowdown in admissions has created something of an unexpected lull right before what could be the most harrowing stretch of their careers. “Very fortunately, we haven’t seen this big surge in the super sick, which we were prepared for, and have been expecting,” said Kalla. “God willing, we’ll never see it, but the next two weeks will tell.”