Is the ER Safe During COVID?
It may be more dangerous to stay home.
As an emergency physician, I pride myself on taking care of anyone, anytime, for anything, no matter their condition, race, culture, beliefs, or ability to pay. It is perhaps the most important reason I chose emergency medicine as a career.
But right now I’m scared. Not because of COVID-19 or the chance of falling ill. Sure, it’s possible. But I’m scared because patients are choosing not to come to the emergency department. And while this decrease in patient volume presents a conundrum for emergency physicians across the country, it’s the patients who are suffering the most.
They’re suffering in spite of the fact that their risk of catching the virus in an ER is quite low. And there are many that still require emergency care. However, the entire country has been told — “Don’t come to the emergency department unless you absolutely need to.” This makes sense for those who have mild upper respiratory symptoms or even a mild form of coronavirus. But not for more concerning symptoms.
Why are they choosing to stay at home? Because they’re worried they’ll catch the virus. As we’ve seen, this is a virus of fear.
Who should be coming into the ER?
On a recent shift, I saw a patient with shortness of breath. I asked when it began. The patient said the symptoms started with chest pain 5 days prior. They didn’t want to come into the ER for fear of catching COVID-19.
So they battled through the pain at home until 5 days later when they were so short of breath, they could barely walk from the chair to their bathroom. It turns out the patient had a heart attack 5 days prior, which caused significant damage to their heart. Now their heart couldn’t pump blood to the rest of the body efficiently, causing terrible shortness of breath. The unfortunate reality is that this all could have been prevented if they had come into the ER as soon as the chest pain started.
What was especially lucky for this patient was that they didn’t die. A recent study in Italy showed that out-of-hospital cardiac arrests were up as much as 58%. In New York alone, the FDNY reported a 400% increase in cardiac arrests outside of hospitals. While some may have succumbed to COVID-19, it can be postulated that a number of the patients did not seek timely care for other conditions, leading to their death.
In another study, severe heart attacks are currently down 38%. It’s hard to believe people are not having heart attacks. It’s more likely that they’re just not coming into the ER. Stroke visits are also down, as much as 50% in some areas. As we say in emergency medicine, time is brain. Stroke patients have limited time to get medicine or a procedure to reverse their blocked artery. It’s irreversible once the damage is done.
This is extremely alarming. We save lives every day. But patients have to feel empowered to seek care. If patients don’t feel comfortable coming to the ER, they are putting themselves at a much higher risk than the low probability that they will contract the virus itself.
What are ERs doing to prevent the risk of catching COVID-19?
Hospitals are taking the COVID pandemic very seriously.
Anyone who has been in an ER sees every healthcare worker in fresh-pressed clean scrubs with masks worn at all times. The janitorial staff is working harder than ever, scrubbing down rooms extra well with proven coronavirus killing cleaners. They are trained to clean disease-ridden rooms and they are the experts. I like to tell my wife that the floors of an emergency department are cleaner than our floors at home. She rolls her eyes at me. They’re certainly cleaned more frequently and thoroughly.
When a potential COVID-19 patient arrives at the ER, they are immediately transported to the COVID area, away from those patients that do not have Coronavirus symptoms. But can’t anyone have COVID even without symptoms? Yes, so everyone is required to wear a mask at all times in the ER and sit at least 6 feet apart from each other.
In fact, in the majority of ERs, volumes are down so much — as much as 50% in many areas — that patients are likely to be taken back to a room quickly without spending much time in the waiting area. I have heard the analogy that you are less likely to catch COVID in an ER than in a grocery store. And while I know grocery stores are taking incredible precautions to prevent transmission of the virus, it is still difficult to keep your distance from others. That is simply not the case in the ER.
And these are only a handful of precautions healthcare workers are taking. Our hands are raw from washing them more than ever. And we take the time to clean off all of our equipment, including stethoscopes, after seeing every patient. While this seems obvious, it was not necessarily routine before the pandemic. Many hospitals are also creating COVID teams to prevent cross-contamination so that patients without symptoms are evaluated by providers who have not seen potential COVID patients that day.
Rest assured, COVID is decreasing in many parts of the country.
Finally, COVID cases are on the downtrend in many parts of the country. This is great news for states and cities that have followed strict social distancing or stay-at-home declarations. While we’re not out of the woods, this decrease makes it more unlikely that you will catch the virus while seeking the care that you need.
I implore you to make the right decisions when you feel that you need emergent medical help. You have the right to seek care anytime for anything. And the ER is the catchment net that is always open and ready to serve. Don’t let your fear of catching the virus prevent you from going to the ER when you might have a life-threatening condition. If your gut tells you something is wrong, let the professionals in the ER evaluate you, take care of you, and treat you when it could mean saving your life.