Coronavirus, flu or anxiety? ER visits are up in South Florida, but we don’t know why
As state and local health officials have struggled to expand testing for COVID-19, the disease caused by the novel coronavirus, more people are showing up in Florida’s hospital emergency rooms with fever and cough, according to state data.
But is that from COVID-19 — or anxiety?
For the past two weeks, hospital emergency room visits for cough and fever have risen steadily statewide. In South Florida, the state epicenter of the COVID-19 outbreak, those cases have gone up even more than the state average, surveillance data published by the Department of Health indicates.
The number of influenza-like illnesses, a separate metric monitored by state health officials, also rose significantly in recent weeks, even as the number of confirmed flu cases has declined.
Epidemiologists and public health experts are watching the statistics — and say that although the numbers might reflect more coronavirus, they might also be an indicator of widespread anxiety.
Javier Perez-Fernandez, a pulmonologist with Baptist Health South Florida, said that’s what he’s seeing in the emergency room of Baptist Hospital Miami.
“We’re seeing that everywhere in the world, people get a little anxious and fearful of what’s going on,” Perez-Fernandez said. “They need answers and they’re seeking information. Sometimes you want to get reassurance that you’re OK.”
The data streams were built as early warning systems for public health officials to be aware of emerging illnesses, and they could also be serving that purpose.
About half or less of Miami-Dade and Broward County’s cases have known links to travel — 35 of Miami-Dade’s 86 cases and 50 of Broward’s 96 cases. That raises the likelihood that the novel coronavirus is now spreading in communities, and the spikes in ER visits and influenza-like illnesses may reflect that, said Derek Cummings, a University of Florida biology professor whose research includes transmission of infectious diseases and patterns of pathogen spread. But there’s no way to prove it.
“Part of that stream, very likely, is people who have coronavirus,” he said. “It’s just hard to tease out how much at this point. That’s why we need testing.”
So far, testing for COVID-19 in Florida has been largely restricted to those with known links to travel, other confirmed cases or people who require hospitalization.
Cummings said the pandemic has changed the way people seek healthcare, and that the rise in ER visits and flu-like illness could just as likely reflect that people are worried. It’s a “serious caveat,” he said.
Florida’s health department maintains at least five surveillance systems designed to monitor flu outbreaks, so-called reportable diseases — such as Hepatitis A, HIV, rabies — and other illnesses.
The state’s surveillance system for detecting outbreaks and unusual cases is called the Florida Electronic Surveillance System for the Early Notification of Community-based Epidemics, or ESSENCE. It includes data about patient complaints at hospital emergency rooms and urgent care centers, reportable disease data and other information.
ESSENCE was designed to give epidemiologists data sources to identify outbreaks or unusual trends more rapidly, ideally leading to a more timely public health response, said Mary Jo Trepka, an epidemiologist with Florida International University.
“The system was developed really to be an early warning system to identify an outbreak before we start getting diagnosed cases,” she said. “It wasn’t designed to monitor the progress of a pandemic like this, but we can learn from this.”
The U.S. had an advanced warning of an outbreak, first in China, and then in Europe, Cummings said, so it didn’t take a lot of guesswork to figure out when the virus had arrived stateside. Ultimately, both Trepka and Cummings agreed that widespread testing of both symptomatic and asymptomatic people is the only way to truly measure the spread of the novel virus.
“We were already anticipating that coronavirus would be here,” he said. “That sort of downplayed the sort of the detective role that ESSENCE or these other surveillance system should play, because you already knew you should be looking for these novel coronaviruses.”
This story was originally published March 19, 2020 at 5:37 PM.
