Mega Doctor News
by Michigan Medicine – University of Michigan
Newswise — Across the country, patient volumes in emergency rooms have led to long waits and capacity concerns, even where COVID-19 cases aren’t to blame.
After a surge in cases and hospitalizations last spring, Michigan held one of the lowest national seven-day COVID-19 case averages through the summer, as more people received doses of the vaccine. Now, as fall arrives, emergency departments are beginning to see more traffic, longer waits and some overflow, said Brad Uren, M.D., an emergency physician at Michigan Medicine.
“While summer is typically a time that emergency departments get busier with seasonal injuries, the reappearance of more rapid community spread of COVID is pushing the limits yet again,” Uren said.
And it’s not just COVID-19 sending patients to emergency rooms in droves. Among children, ERs are filling up with respiratory viruses that look similar, said Marisa Louie, M.D., a pediatric emergency physician at Michigan Medicine.
“COVID infections in kids are not the main driver currently, but the viruses we didn’t see last year are now back with a vengeance. Primary care offices are overwhelmed and staffing shortages due to the pandemic across the board trickle down to affect kids,” Louie said. “The fewer resources we have, the more likely emergency care will be impacted.”
The coronavirus is constantly changing, and vaccination rates have slowed among teens and adults, while children under 12 can’t get vaccinated yet. As winter approaches, a range of models predicts that many Midwest states are already seeing spikes in cases or are headed that way. Michigan cases are slowly rising toward what would be the fourth surge since March of 2020.
As veterans of three prior surges, Uren and Louie already see signs of rising COVID-19 cases and predict more cases and hospitalizations, which could put health care systems at risk of becoming overwhelmed – again.
All these unknowns can leave individuals, parents, and caregivers with a range of difficult questions. Should I go to the ER? Should I stay home? How can I be seen safely?
Below, Uren and Louie offer tips for determining the right plan to get the proper care in the safest way possible.
Is it safe to come to the emergency room?
Louie: It is definitely safe to come to the emergency room. We have very strict protocols in place for making sure people stay masked, wash, or sanitize their hands and stay socially distanced as much as possible. We try very hard to separate patients coming in with infectious illness from those coming with other concerns as well.
Even during heightened periods of COVID-19 before the vaccine, transmission of the coronavirus in healthcare settings was very low due to the health precautions taken by hospital staff. The emergency department is a safe place to be.
When do you know you need emergency care?
Uren: The main thing to remember is that if you have a medical issue that you or a family member believes puts your life, limb, or body function at risk, come to the emergency room. If you don’t think you are in immediate danger, then you can look at other options or speak to your doctor.
There are, however, some symptoms of heart attack and stroke that should be a sign to come to the ER. If a person experiences chest pain, facial droop, weakness in the arms or legs, or altered consciousness, don’t hesitate to seek emergency care. Even though some chest pain might eventually turn out to be heartburn or a pulled muscle, the emergency department has the resources and the testing capability to quickly differentiate between life-threatening and more benign conditions.
These conditions are time-sensitive, meaning the more time that passes, the more brain or heart tissue that may be permanently damaged. Don’t delay care if you believe you may be having a heart attack or a stroke. It is always safest to call 9-1-1 or your local emergency number rather than driving yourself in such cases.
Louie: For kids, if they have difficulty breathing, that is a sign to come and get checked at the ER, whether you think it’s COVID-19 or another issue. Not drinking or urinating may be a sign of dehydration, another reason to get seen.
If your kids are having respiratory issues, what do you do?
Louie: It’s important for parents to look at how fast and hard their child is breathing. If they’re using extra muscles to breathe and are not playful or wanting to eat or drink, come to the emergency department. If they are just congested and coughing, that can probably be checked with your primary care provider or at an urgent care.
Respiratory Syncytial Virus, or RSV, an upper respiratory infection that usually hits kids in the winter, is currently surging among children in the Midwest and northeastern part of the country. COVID-19, on the other hand, has been more prevalent in kids in the south, but it is starting to pick up in the Midwest. With school coming back and most children still unvaccinated against COVID-19, we are anticipating some increase in cases.
What should you do when you get to the ER to stay safe?
Louie: Take the precautions required at the hospital: masking, handwashing and social distancing if you can. As COVID-19 cases increase, many hospitals limit visitors to protect our most vulnerable patients from the risk of infection.
Pediatric patients can expect to always have a parent or other adult with them. For adult patients, some hospitals will have visitors wait outside while patients generally stay in a designated waiting area where they can be monitored until they can be fully evaluated. It’s a good idea for the patient and any visitors to each have a phone charger and have a way to get a hold of each other to coordinate a ride home and provide updates.
Listen to the staff, as they will help you find places that are appropriate and safe. Also, be sure to share your symptoms with them and be specific, especially when things get very busy. Trust them to interpret that and get you the right care.
Uren: To make your trip go even faster, be sure to bring all your pertinent health information, including medical history, insurance information and medications you are taking. It also may help to have your primary physician call ahead to alert emergency staff about why you are coming. This does not guarantee you will be seen sooner, as they triage patients starting with the most serious conditions, but it will ensure staff get the most accurate information.
Louie: Keep in mind that emergency departments across the state are very busy, and people can wait for hours. Hopping to different emergency rooms is not a good plan and can delay your care even more. It may be counterproductive to leave one emergency department and go to another, as you may find yourself in a longer line than the one you left. If you believe your symptoms have changed or worsened, talk to the professionals in the department who can determine if you need to be seen sooner.
When should you avoid coming to the emergency department?
Uren: First, we don’t want you to avoid necessary medical care. If you feel your health is in jeopardy, please come in. But if you are having a medical problem that you don’t feel is life-threatening, that may be the time to talk with your doctor or investigate a nearby urgent care.
Louie: The emergency room is not the place to come if you are just looking for COVID-19 testing. That is available at many locations, including pharmacies and health departments. We’ve seen people come in for testing, and we’ve also seen COVID-19-positive people come in looking for monoclonal antibody treatment. Generally, that is an outpatient procedure that is used as a means of preventing hospitalization. You should speak to your primary care physician about accessing that treatment.
When do you go to an urgent care vs. an emergency department?
Uren: At times, an urgent care can act as a fill-in for your regular doctor. The clinics are often open on evenings and weekends, and they provide sorts of routine injury treatment and acute medical care one could receive in a primary care office. They treat colds, some broken bones, minor cuts, and other conditions. They usually lack an operating room, but may offer X-rays or simple lab tests, whereas an emergency department is set up to allow all the available resources of the hospital, including testing and procedural capabilities to be available for emergencies.
The urgent care, despite lesser staffing, will likely have shorter wait times due to their patients having predominantly less serious ailments. More serious conditions will receive priority at the emergency room, which may cause wait times to fluctuate.
Louie: Here’s an example: If you are going out of town for vacation tomorrow, and it’s the evening and you have a sore throat that you want to get checked out before you travel, that might be a good time to visit the urgent care. If you’re not sure which choice to make, most primary care providers have call lines you can utilize. They may advise you to go to the emergency department or wait until a clinic is open. Your health insurance company may also have an answer line that can help to direct you for non-emergency issues. This contact information may be on your insurance card, in an app or other communication from your health insurer.
Ultimately, you are the best judge of how you are feeling. If you are worried and feel that something is an immediate concern, take immediate action.
When should you use telemedicine vs. going in person?
Louie: Most hospitals and providers, like Michigan Medicine, have criteria for the types of symptoms that can be seen through telemedicine. Right now, that can include video or phone visits that are scheduled or urgent, as well as text-based encounters called E-visits that involve sending messages back and forth, but don’t require an appointment. During the pandemic, most of these types of visits can be billed to insurance. This can be very helpful for both limiting over-crowding and staying safe in non-emergency medical situations.
Your primary care provider should be able to direct you to options, and the hospital website or patient portal may offer a way to request a virtual visit or even schedule one directly online. If your doctor advises you and you have the ability, you are saving yourself time and potentially saving space for someone who needs to be seen in person. However, to set a telemedicine appointment, you often need to be an established patient.
What do you do about non-urgent health issues? Where do you go?
Uren: This is good time to consult your primary care provider and insurance company to find the proper care. While there may be longer wait times for regular appointments due to the pandemic, you can schedule one. You can also search for nearby urgent cares or seek a telemedicine appointment.
Simple problems can be treated at the emergency department and often turned around very quickly. However, it may not be the most efficient use of your time because the triage system will likely prioritize more acute cases.
What about at-home monitoring? When should you consider that?
Uren: Some hospitals, including Michigan Medicine, offer programs that allow patients to monitor their health at home after a hospital stay or emergency. We’re even testing an option that can send someone home from the emergency department with monitoring equipment. For the appropriate patients, this option can keep more beds open for other more seriously ill inpatients.
This is sometimes what happens for patients with mild COVID-19 or those who have recently had surgery or other infections. Patients may be sent home with devices that gauge blood oxygen levels or blood pressure, with their physicians telling them what numbers and symptoms to watch for. If at-home monitoring is offered and recommended by your physician, it could be beneficial.
What is the best way you can avoid COVID-19 and the ER?
Uren: As we move into the winter, Michiganders and others in cold climates will be gathering closely together indoors more often, where the virus can spread more easily. We have an effective vaccine that prevents most people from getting very sick and dying, and we should all utilize that. The vast majority of our patients sick with COVID are not vaccinated.
While I have admitted fully vaccinated patients to the hospital, many of them had significant underlying medical conditions that put them at high risk of severe COVID-19. The fact that instead they went home from the hospital in a few days is a testament to the effectiveness of the vaccines.
While there have been some concerns about the risks of COVID-19 vaccination, data from millions of people show that they are safe and highly effective, with a few rare and highly treatable cases of side effects more serious than a sore arm or mild fatigue. Vaccines are our best weapon in this fight.
The next best thing is masking. Physicians and nurses have worn masks in the healthcare setting for hours at a time for many years. Healthcare workers are now wearing them for at least eight hours a day without any untoward effects. In fact, we’ve seen masking limit the spread of COVID-19 in our hospital and beyond. There is some evidence that it is possible for vaccinated people to still spread the virus to others who are vulnerable, so we should work together to protect each other in any way that is possible.
If you have questions about the vaccines, reach out to your doctor or a health professional that you trust with your concerns. They can help you make the best choice for you.
Louie: With the Delta variant being so much more contagious, we are expecting more kids to get sick. Children often get multiple repeated viral infections over time, but most kids recover without serious or long-term problems. For the most part, this is also true for COVID-19, but there are some kids who do get severely ill, some who develop long haul COVID-19 and some who develop inflammatory syndromes after being infected with the virus.
We may soon have an opportunity to vaccinate children ages 5 to 11 years, giving us a big chance to slow transmission for that age group and the adults who interact with them. This would mean kids can continue going to school and parents can miss less work or need less emergency childcare.
In the meantime, kids are typically willing to wear a mask if it means they can participate in their activities and be with their friends. Contrary to claims you might hear, the mask won’t retain carbon dioxide; a reusable mask washed or replaced daily won’t cause a bacterial infection, and masks that are regularly cleaned are not associated with pneumonia. Wearing a mask is safe, and we want to try to avoid where we were last year with schools.
