Is it safe to go to the ER during COVID-19?

Some Canadians in need of urgent hospital care are staying away due to fears of contracting COVID-19, according to emergency physicians and hospital visit stats.

Since the beginning of the pandemic in mid-March, patient visits to emergency departments have dropped by up to a half.

In British Columbia, for example, Health Minister Adrian Dix said there were 6,559 emergency department visits across the province on March 9, but just 2,995 four weeks later on April 6. 

Emergency docs say they're worried people are too afraid to seek medical attention and that it could have serious impacts on their health.

Dr. Ken Milne, chief of staff at South Huron Hospital in Exeter, Ont., spoke with Brian Goldman, host of CBC podcast The Dose, about the problem.  

Here's part of their conversation.

You're Chief of Staff at South Huron Hospital in Exeter. I work in an ER department. Let's compare notes. What are you seeing?

Patient volumes are down in our little hospital.… It's a rural hospital. And we've also seen a decrease of about a 50 per cent decrease in our [emergency department] volume.

Normally, I would see ... a lot of patients with fractures and cuts and bruises and sprains and I'm not seeing very many of them. How about you?

Yeah, I would say that the volume for the cuts and sprains and broken bones is down. And that's probably because Canadians are doing a fantastic job of flattening the curve. And they're physically isolating. They're trying to stay indoors. And so they're not engaging in as many risky activities that they would normally do in springtime.

Besides COVID-19 symptoms, why are patients coming in?

We're not seeing much COVID. We're seeing many people concerned that they have COVID. But the actual number of patients testing positive for COVID is very, very small.

Are there other kinds of medical problems that you're also not seeing in the emergency department that you'd be expect to be seeing?

I think that's where a lot of us are getting really concerned. We're not seeing the same number of heart attacks and strokes and other serious time-dependent emergencies. Just because we have COVID-19 doesn't mean all those risk factors for heart attacks and strokes have gone away. They're still the same number of hypertensive people, same number of diabetics, same number of people that are smoking. And so where are those people? 

Why do you think they aren't coming?

Well, I think they're afraid. We've done such an amazing job of getting that message out to flatten the curve, stay home, self-isolate. But what we should have added, "but if you're concerned, or if you think you have an emergency, don't stay away."

So let's start talking about some of the many reasons why patients should be coming into the emergency department where time is of the essence. A pregnant woman with a ruptured tubal or ectopic pregnancy who's hemorrhaging into her abdomen; that's the first one that comes to my mind. What's the first one that comes to your mind?

Well, being a middle-aged man, I'm thinking heart attack. So you know if you got that, "Hmm, I wonder if this is indigestion or a heart attack," please come in. We have special tests to be able to determine, is it a heart attack or is it a heartburn situation? So if you're experiencing chest pain, heaviness in the chest ... we have effective treatments for those things, but they're time dependent. 

Worst headache you've ever had. That's another one too. That could be a subarachnoid hemorrhage or brain bleed.

Absolutely. If you're not seeing patients with headaches, how can you determine who really does have that life-threatening brain bleed?

The volume of those people coming in thinking — "hmm, could this be a stroke, or could this be a heart attack?"— it's gone down. But I'm still seeing some people that actually do have a heart attack, or do have a stroke. But those people seem to be presenting later in the disease process.

With the heart attack example, we have something called a completed heart attack. The muscle in the heart has been damaged from the outside to the inside…. Once that's happened, there's not a lot that can be done. I'm seeing people that are presenting too late after the fact because they were scared. I've had multiple people say to me, "I didn't want to come in. I was worried about the COVID."

And they're actually calling it COVID phobia on social media.

Yeah. And my response to them always is, I would rather have you come in, and let me tell you that it was heartburn and send you home, then have you stay home and die of a heart attack.

My standard line, even without COVID going on: If you're concerned, we're concerned. They know their body; they know themselves. They know what they normally feel like.… If you're concerned enough to ask the question — "could this be an emergency?" — then please come in.

What's your message to patients who asked you if it's safe, or told you that they were afraid to come because they didn't think it was safe?

I have not seen any published reports of a patient getting COVID from transmission from a health-care worker by accessing the emergency department. That doesn't mean it's not out there necessarily, because I haven't been able to read everything…. And what's our department like? We are hypervigilant. We've got our masks on. We've got our gloves on. We're washing our hands. We're isolating people…. So it might be one of the safest places to be.

What would you say to mums and dads who are wondering when they should bring their child to the emergency department in the time of COVID?

I rely on parents to be experts [in] their children. So if they think something's off with their child, they should come in. Grown-ups like you and me, we tend to go with heart attacks and strokes. That's how we sort of leave this earth. But with children, it's usually breathing. They have young healthy hearts that keep going and going and going. But if they get into breathing trouble that always piques my radar.

Right now waiting times are down because volumes are down in the emergency department where you work.

Yeah, if people are concerned that coming to the emergency department  may put them at greater risk because they're used to having long wait times, the wait times are significantly down. If you have half the volume, our efficiency is much quicker. So your time in the department will be much faster.

Patients might be feeling anxious about going into the emergency department and taking up hospital resources they may worry would be best used on other patients. What should patients be weighing when it comes to making a decision?

I think you can put it at two ends of the spectrum and have this dichotomy. There are obvious things that don't necessarily need to be in the emergency department — like if they need a medication renewed. But on the other end of the spectrum, it's clear, you know, somebody's out with a chainsaw, and they've taken their arm off. That really needs an emergency 911 call. And then there's the stuff in between. And that's where we really need to focus and say, "Listen, if you're concerned, you are the arbiter."

Because the emergency department is known as the light in the house of medicine that's always on and it's on for anyone, at any time, for anything. So please don't be afraid to come to the emergency department if you think you're having an emergency.

Written by Brandie Weikle. Produced by Arianne Robinson and Dawna Dingwall. Interview has been edited for length and clarity.