At the beginning of the pandemic, Canada’s once frenetic emergency departments went strangely quiet as patients stayed home and stayed away.
Canada-wide data obtained and analyzed by the Star shows a dramatic drop in emergency room volumes during COVID-19, with some provinces seeing roughly 50 per cent fewer patients between March 11 and April 30.
The Star spoke to more than a dozen emergency room physicians from coast to coast to coast to find out what they have experienced during the first weeks and months of the pandemic. Here, some tell us in their own words their worries and their successes and share anecdotes of patients who waited too long for care.
Dr. Scott Wilson is an emergency room physician based in St. John’s and is the former chief of emergency medicine for Newfoundland and Labrador’s Eastern Regional Health Authority. According to a Star analysis of most provinces and territories, Newfoundland and Labrador saw a 53 per cent drop in emergency patient volumes during the pandemic — the largest decline in the country.
A key thing, particularly in St. John’s, was that we had a supercluster (of COVID-19 cases) from a single individual visiting a funeral home over three days. We have a total of 260 cases in the province; 200 came from that one funeral home. Every day, public health was announcing another 10 or 15 cases directly related to the funeral home. I think it spooked a lot of people in the province and people stayed away in droves because they were afraid of emergency rooms. The impact of the supercluster really drove the message home very early in our province. Two of the province’s three COVID-19 deaths came from that funeral home.
We know people have passed away at home that probably wouldn’t have if they had come to the emergency room. We don’t have specific data to prove it. But when you hear what was presenting at homes, we feel anecdotally that patients stayed away too long. But that’s what people did. They got the message so hard, so early, that they said: ‘Unless I’m dying, I’m not going anywhere.’
Dr. Katharine Smart is a pediatrician who sees patients at Whitehorse General Hospital and is president of the Yukon Medical Association. Yukon has only seen 11 COVID-19 cases and no deaths during the pandemic, yet emergency room volumes dropped by 38 per cent between March 11 and April 30.
Our public health people have been very successful at containing COVID here. At this point, things are quiet everywhere, which is of course good news. But naturally, we wonder, where are all the other patients? I think that’s the national question: What’s going on with everyone else that doesn’t have COVID, that used to come to the hospital?
I think it’s a multifactorial thing. When you start social distancing, naturally, other infectious diseases become less. All those other diseases that spread around by people being around each other that can make people quite ill — things like influenza and other viruses — naturally decline because people aren’t around each other anymore. So, we’re flattening the curve for COVID but also doing that for other infections.
Dr. Samuel Vaillancourt is an emergency department physician at St. Michael’s Hospital in Toronto, where he has co-led the development of a low-acuity emergency clinic for patients who screen negative for symptoms of COVID-19. The hospital saw a need for such a clinic after noticing a significant drop in emergency patients. Between March 11 and April 30, St. Mike’s experienced a 41 per cent drop in patients coming to its ED.
Usually, I’ll have a case of a patient who gets intubated and resuscitated — so our sickest patients — a couple of times a month. On my last two shifts, back-to-back, we had two terribly sick patients. One of them was an isolated person who had been getting sicker at home. The other person had the worst kind of heart attack and collapsed on the sidewalk.
I had a patient with a hip fracture a couple of weeks ago. She was this very healthy and proud elderly woman and had been kind of hobbling around her apartment for a bit without seeking attention.
It can be a pretty anxiety provoking experience to be an emergency department patient right now. You go in, the first thing you see is someone who is in full PPE with a mask on, a face shield. You’re screened at the door. With all the tape around and warning signs — it really looks like you’re entering a minefield. While it is a different experience for patients, the message is important to get out there: We’re ready to provide care in a safe way and we’re definitely available for patients who need in-person care.
Dr. Rob Drummond is an emergency physician at Montreal’s St. Mary’s Hospital, which is not among the city’s designated COVID-19 centres. Emergency departments in Quebec saw a 42 per cent decline in patient volumes between March 11 and April 30, although some hospitals in Montreal have reported an influx of COVID-19 patients in recent weeks.
I’ve had two patients who delayed coming to the hospital with their complaints only to be diagnosed with metastatic cancer. One patient had chest pain and on evaluation was found to have lymphoma. I had another patient with abdominal pain who was found to have metastatic ovarian cancer.
These are anecdotes of patients who were well-meaning, who normally would have come in because they weren’t feeling well. They were uncomfortable. But they heard the message loud and clear, ‘If you can avoid coming to the hospital, don’t come in,’ and they heeded that message.
Who knows whether their treatment trajectory would have changed at all but I’m more concerned that we could have given patients a closure, made a diagnosis much sooner. It may have put their minds at ease.
Some are definitely scared, but you get the sweet, little old ladies that say, “I didn’t bother you dear, I knew you were busy.” These are the ones that we want to reach. It’s like, if you’re concerned, we want you to come in. There’s a fair number of patients who we see in the emergency department who end up having nothing of consequence. But in their minds, they did have something. We treat acute illnesses but we’re always there to provide comfort.
Dr. Michel Shamy is a neurologist and stroke specialist at The Ottawa Hospital, where he has noticed a drop in patients being referred for stroke prevention, as well as a decline in patients coming to the emergency department with acute stroke symptoms. He believes fear of contracting COVID-19 is keeping many patients away.
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My own father is in Montreal and has lots of medical problems. His local hospital is the Jewish General Hospital, which is their COVID centre. He was saying that under no circumstance would he want to go to the hospital because with his age and with his problems.
That became a problem when he started to go into worsened heart failure. All of his doctors — and me as his son — would have rather that he had gone to the hospital, but he categorically refused, because of COVID. In the end, we came up with an algorithm of what would be the situation under which it would be OK to call the paramedics. For him, it was life-threatening things and then he would grudgingly accept to go. But anything that wasn’t immediately threatening his life, then he would try to just soldier on at home.
Dr. Kirk Magee is head of emergency medicine at Dalhousie University and Central Zone Chief for Nova Scotia Health. Emergency department visits in Nova Scotia declined by 39 per cent between March 11 and April. Magee said his hospital’s ED had a significant drop in patients but the proportion of the sickest patients largely stayed the same through the pandemic.
If you look at a health-care system, it’s very complex: lots of different people, lots of different silos, all competing for a scarce resource. When COVID happened, the whole system focused on one thing — how do we respond to COVID. This singularity of purpose broke down all these barriers. Things that literally would have taken six or 10 months to do were getting done in a matter of days or weeks. When a problem came up, no one ever said: ‘No, I can’t do this’ or ‘Yeah, but …’ They said: ‘Gee, that’s a challenging problem and if I talk to these people, I think we could solve it.’ With COVID, the problem in front of us is everybody’s problem. If anything, this has taught us that health care works best when we are all playing on the same team.
Interviews have been edited and condensed for length and clarity.
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