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The question

I was out walking my dog when I tripped and fell on the sidewalk. I really hurt my hand. However, I’m terrified of going to a hospital emergency room because I might catch COVID-19. I realize I’m a germophobe, but are ERs safe places to be?

The answer

You can rest assured that hospital emergency departments are taking extra precautions to reduce the risk of the coronavirus being spread from person to person.

Patients are usually screened at the door for signs of infection prior to triage and registration. Once registered, they are placed in a space safely apart from other patients while they wait to be seen by a health care provider.

“If you feel like you’re having an emergency then, of course, you should come to the emergency department,” says Dr. Aikta Verma, chief of the Department of Emergency Services at Sunnybrook Health Sciences Centre in Toronto.

“If you need us, we are here,” she adds.

Unfortunately, though, that message doesn’t seem to be reaching a lot of people who require urgent medical care.

In fact, visits to some Toronto-area emergency departments plunged by 50 per cent in the first few weeks after the pandemic was declared in mid-March.

Doctors are worried patients could suffer serious complications if they don’t seek timely care.

In the case of major strokes and heart attacks, patients need to be treated within a few hours of developing symptoms in order to avoid permanent damage, disability or death.

“We are seeing a troubling decrease in things like stroke presentations and people presenting with heart attacks – they are both down by about 33 per cent,” says Dr. Erin O’Connor, deputy medical director of the Emergency Department at the University Health Network, which includes Toronto General Hospital and Toronto Western Hospital.

“We know these conditions are still happening,” she says. That suggests some patients might be dying at home. Even those who survive an initial bout of symptoms should still see a doctor, because certain medications and medical procedures can help prevent another attack that could be fatal.

Although emergency department visits are down, the patients who do show up tend to be sicker than usual. Presumably, some of them delayed seeking care and their health deteriorated in the meantime.

But it appears that patients aren’t just avoiding their local ER. Some might be skipping appointments with their family doctors, too. “My referrals are down,” says Dr. Ilana Halperin, an endocrinologist at Sunnybrook.

As part of her medical practice, she sees patients who have been diagnosed with diabetes and hormonal disorders. Many of them have been referred to her by family physicians.

“I usually receive between eight and 10 referrals a week. Now I’m getting two to four,” Halperin says. There’s no medical reason to account for the decline. “Diabetes hasn’t suddenly gone away.”

So, either patients aren’t going to their doctors or the doctors aren’t putting through referrals to specialists.

It’s worth noting that many medical clinics have run into problems obtaining adequate supplies of personal protective equipment – gloves, gowns and masks – which are essential for shielding staff from patients who might be carrying the coronavirus.

But doctors can still connect with their patients using various forms of telemedicine – such as video chats and phone calls – without the risk of infection. Of course, a doctor can’t physically examine a patient or perform a procedure in a virtual visit.

“We encourage people to reach out to their primary care providers for ongoing virtual management of new or chronic problems,” Halperin says.

She adds that the family doctor “can review the problem and determine whether there is a need for an in-person assessment and make appropriate referrals to prevent health complications down the road.”

Despite such options, it appears that all kinds of routine health care isn’t happening right now.

Halperin expects she will eventually get a surge of referrals “when everything opens up again.” The end result will likely be longer waits to see specialists, she says.

The growing backlog of deferred medical care could have profound consequences for individual patients and the health care system as a whole.

O’Connor says she is particularly worried by reports that some parents are delaying regularly scheduled vaccination appointments for their children.

“Not having children properly vaccinated means that we are going to be at risk of outbreaks for many diseases that were under control,” she says.

COVID-19 is already putting an incredible strain on health care, she notes. “We don’t need more problems.”

Paul Taylor is a Patient Navigation Adviser at Sunnybrook Health Sciences Centre. He is a former Health Editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.