April 27, 2020
I have read and seen a disturbing trend. People have been “staying home” too well. Let’s talk about the trend and its implications. The ERs Adrienne and I work at are dead. Volumes are way down. This is a national trend perhaps to the tune of 50%. Even in Canada (and I’m sure the world).
Here's the deal... that’s dangerous. I’ll break this down, but first, watch/listen to Dr. Jess Mason’s 3 min message from the April 21st EMRAP. That link skips right to the point. She uses the term STEMI. STEMI is a heart attack.
A study she references indicates a 38% decline in heart attacks. Similar issues are being seen with strokes even though COVID apparently has been linked to strokes especially in young people with mild illness. Also delayed presentations of appendicitis with resulting rupture of the appendix have been noted. And on and on.
There is no question that some of the declines are a result of decreases in visits of people “taking advantage of” ERs when they should have called their PCP or just used common sense. Adrienne saw someone yesterday that instead of taking some Motrin and/or Tylenol for their back pain tried a shot of whiskey and smoked weed. If whiskey and weed are your jam, go for it, but don’t forget the tried and true. Certainly, COVID didn’t confer any much needed common sense to our country. But I digress.
The decline in trauma from fewer car crashes and declines in pulmonary illness from less pollution makes sense. But, if you would have sought medical attention before the pandemic, you should likely be seeking medical attention during the pandemic.
One positive side effect of this strict adherence to staying home is the side effect of effectively increasing our capacity. We have been talking about flattening the curve to ensure healthcare capacity keeps up. NY and New Jersey had it rough, and they had high mortality in hospitalized patients. Let’s hope that their mortality rates will be an unfortunate exception in comparison to the rest of the country. There are a number of reasons for this including their distinguished misfortune in being guinea pigs for us to learn about the illness. But, their mortality number would have certainly been even higher had volumes from other illnesses stayed constant.
Here are some guiding principles when you are considering going to the ER:
If it could be serious, get help. Don’t just stay at home because you are afraid of getting COVID. ERs and doctors’ offices are taking a lot of precautions.
If it feels like a cold or the flu, stay home.
If you have any questions, call your PCP for guidance.
When you go into an ER or medical facility, wear a mask. Clean your hands often. Bring your cell phone to be able to call your family and give updates, ask questions etc. No one has any phone numbers memorized. This has been an issue with some patients I have seen.
Go to the with as few people as possible. This is not the time to bring everyone because people want to get out. Visitors likely won’t be allowed in any way. Adrienne and my ER have a no-visitors-policy (unless you are a kid patient). So, I’m sure wherever you go will have this limitation as well. If you are the driver, stay in the car once the person gets safely inside.
This does not mean to start scheduling your elective medical visits. If engaging with healthcare can be avoided, it should be for now. As we start the Dance, which we are and likely should be, restarting semi-elective visits and procedures should take precedence over the elective stuff. We do need to realize that the Hammer will have unintended consequences. So it's likely time to start prudent and reasonable medical interactions.
Back to the take-home message, emergencies are still emergencies and COVID doesn’t protect us from those. Seek medical attention if you need it.
Stay emotionally connected and physically distant,
PS: If you like coffee and you want to do something good for COVID efforts, check this out. One of my good friends has become involved in this effort.