Emergency department visits are down — and this is not a good thing

Update, April 21, 2020: B.C. Health Minister Adrian Dix said emergency department visits in B.C. are well below the norm. Before B.C. declared the COVID-19 public health emergency, there were 6,559 emergency department visits across the province on March 9. One month later, by April 6, emergency department visits had dropped to 2,995.  As of April 20, emergency department visits have rebounded to 4,015 but remain below the norm. 

This column is an opinion by Dr. Goldis Mitra, a family physician in Surrey, B.C.  For more information about CBC's Opinion section, please see the FAQ.

A few weeks ago, I bounded down the stairs to the emergency department at Surrey Memorial Hospital, a big, sprawling space that serves one of the fastest-growing communities in the country.

As a family doctor working there, we admit most of our patients from the emergency department. It is a place normally buzzing with activity.

We were one week into the COVID-19 pandemic, and our provincial health officer, Dr. Bonnie Henry, had ramped up physical distancing orders. Life was hectic: either I was caring for my patients, on teleconferences to coordinate care, or reading up-to-the-minute briefings from our CEO and health organizations.

When I arrived, the emergency department was eerily quiet. Emptier than I have ever seen it in the five years I have been working there.

That worries me. A lot.

Across British Columbia, hospital-based doctors are saying that fewer patients are coming in. In many ways, that's good: as a system, we are working tirelessly to free up hospital beds to ensure that we have the capacity to manage the worst-case scenario of thousands of people with complications from the coronavirus needing hospital-based care.

And in a pre-COVID-19 time, we certainly saw patients in the ER who may have been better served in a different setting, like a family doctor's office: a young woman in for a refill of her oral contraceptive pills, a man with five days of a sore throat, but who is otherwise well. Across the country, an estimated 1 in 5 visits to the emergency department are for medical issues that could be treated in a clinic.  

But I'm worried about people not coming in who absolutely need to come in. 

Across hospitals in the Lower Mainland, my colleagues and I are seeing fewer and fewer people coming into the emergency department and being admitted to hospital. We are tracking these numbers at each site, and while we hope that this reflects cautious consideration of what is truly an  "emergent" condition, better adherence to medications, and many younger people at home and able to provide care for their older, frail relatives, we know this isn't always the case. 

It is extremely unlikely that people are having significantly fewer heart attacks, strokes, or serious infections. Instead, I'm worried about disastrous consequences for patients who have avoided seeking important care because they were worried about contracting COVID-19.

A colleague told me the grim story of a patient missing multiple dialysis runs, resulting in a cardiac arrest and multiple other complications. During a virtual care visit, a family doctor pleaded with his patient to go into a hospital for assessment after she vomited several cups of blood, because she was refusing out of fear of contracting COVID-19. I recently took care of several hospitalized patients who tried to leave before it was safe to do so, because they were also worried about the risk.

As with almost anything to do with your health, every action, investigation, and medication has its potential risks and benefits.

But I can almost guarantee that if you are critically ill, or think you might be, the benefit of going into hospital seriously outweighs the risk. If you need life-sustaining treatment like dialysis, you have a serious infection, or have a fall bad enough to potentially sustain a fracture, you should go in.

Our hospitals are generally safe places. In most cases, patients with confirmed or suspected COVID-19 have been "cohorted" into specific areas, on the advice of our colleagues internationally who have been containing the disease. In my department, we even have specific doctors who only take care of our patients with COVID-19, in order to reduce the risk of spread of the virus to other vulnerable people. All of our staff — doctors, nurses, and everyone from the cafeteria to the parking lot — are practising careful hand hygiene and using appropriate personal protective equipment to reduce risk of spread to our patients and ourselves.

Across British Columbia, health officials are recommending people continue to seek care in the emergency department for conditions that might be true emergencies. Our chief provincial health officer Dr. Bonnie Henry has also said so. 

If you need to come in, don't hesitate. While the medical community is at war with this virus, we want to ensure there is as little collateral damage — from missed medical issues or delays in care — as possible.