As if there wasn’t already enough to deal with, our emergency rooms are back to the overcapacity situation that they had been in pre-pandemic. The daily number of new patients coming to be seen in our emergency rooms is lower than they were back in January and early February, but the hospitals are running out of place to admit patients.
The same factors that existed back then haven’t been resolved but in the midst of the pandemic, less patients coming in to the emerg — and the closure of clinics and doctor’s offices — meant that we could accommodate those who needed to stay. Unfortunately, our beds are filling up again. And it’s even worse now because the CHSLD’s rehab and convalescent facilities aren’t accepting patients back as easily as they did.
As the emerg fills up with patients with nowhere else to go, crowding increases. Patients were being separated into zones that reduced the risk that the virus would spread — green for “no Covid-19 infection”; yellow for “rule it out as a possibility”; and red for “ infected with the virus causing the Covid-19 illness”. That safe spacing is becoming more and more difficult to achieve so the risk of the virus spreading through the hospital is increasing.
So, to re-ask the question: should you go to the emerg? The answer is yes, without hesitation — if you need to. I have seen far too many people who came to the emerg very sick because they waited too long. If it’s a chronic condition that your doctor follows you for and you aren’t seriously unwell, your first step should be to reach your doctor. Leave a message. Doctors’ offices are reopening. The doctor can decide if they need to see you physically or can adequately assess the problem on the phone or through videoconferencing.
If, however, you are seriously ill — symptoms of a stroke (sudden paralysis of a part of the body, difficulty speaking, etc); a heart attack (chest pain, shortness of breath, etc); bleeding from the gut (vomiting blood or bloody or black bowel movements); unexplained shortness of breath, weakness or lethargy among others — call 911 so you can be transported.
If you go yourself, if you are already actively being followed at a hospital, go to it. This makes your evaluation simpler and more accurate. You will most likely be on your own as most hospital emergency rooms do not allow anyone with the patient except for very special situations. If someone is being sent to the emerg who isn’t able to communicate, send a note with them including how you can be reached.
These are very difficult times. Statistics from New York state and New Jersey document that death rates have increased not just from COVID-19 but from heart disease, cancer and all the other diseases that were already threatening us. With office follow-up difficult and hospitals focused on dealing with COVID-19, a significant number of people may be falling by the wayside. We don’t want to see that trend continue.
So, take the best possible care of yourself but if you need to, get to the emergency room before it’s too late.
Dr Mitch Shulman is an Associate Professor in the Department of Emergency Medicine at McGill Medical School as well as an Attending Physician in the Emergency Department of the McGill University Health Centre. He’s also the CJAD AM 800 Medical Consultant.