Should you go to the ER as hospitals fill with COVID cases? Health experts feel your pain
Florida hospital beds are filling up as more and more patients come in with COVID-19, leaving many to wonder should they go to emergency rooms for non-COVID treatments.
South Florida hospital administrators say yes. And a hesitant no.
It can be complicated.
Here’s why: Record numbers of new patients are being seen as the delta variant continues to ravish the state, causing large peaks in coronavirus cases.
As of Thursday, Aug. 19, out of 259 hospitals in the state, more than a quarter of inpatient beds are being used for COVID-19 patients, about 29.35% of them, according to data reported to the U.S. Department of Health & Human Services.
That’s a substantially higher rate than the rest of the country. Across the U.S., only 12.07% of beds are being used for COVID-19 patients.
In early August, the record of highest Florida COVID-19 hospitalizations continued to be broken every day for two weeks straight — 14 days. The state was sitting at 17,295 people hospitalized for COVID-19 on Thursday.
Apart from hospitalizations, Florida has seen a large increase in cases during the latter half of July and most of August in a third peak of the pandemic. The state has broken the record of highest new increases in daily cases seven times this month, with the current record occurring on Aug. 12, with 25,995 new daily cases.
This record increases in hospitalizations and cases could leave people wondering what they should be going to the hospital for. Imagine facing these scenarios: Your stomach is killing you after downing that burger and you usually have a Teflon tummy. You feel a pain on the left side of your chest. That hernia you’ve scheduled for treatment is acting up again.
Amid the COVID crush, should head to the ER, hit urgent care, or tough it out?
Here’s what some experts are saying from some of South Florida’s busiest hospitals.
Should you go to the emergency room?
“It’s very difficult for someone who is not clinical to hear a complaint and sort of decide, well, this is the right thing, this is the wrong thing to do. If you feel it’s something you had before and you think you’re OK and if you don’t feel you need to visit the emergency department, by all means I would avoid it,” said Dr. Hany Atallah, chief medical officer of Jackson Memorial Hospital.
“Emergency departments all over the country are jam-packed at the moment with a number of COVID patients that are coming in. Obviously, a lot of the patients who are in emergency departments have COVID infections and if you bring yourself there it can be risky,” he said.
“That being said, especially early in the pandemic, we saw a lot of people with very delayed presentations of very bad, non-COVID-related cases and surgical problems and it made being able to care for them much more difficult as well,” Atallah said.
His counterpart at Broward County’s Memorial Healthcare concurs.
“It would be nice if a lay person could anticipate whether or not their medical condition would require any special imaging or any special treatments involving hospitalization. Unfortunately, most people and some physicians can’t anticipate what symptoms they are suffering from. If someone has an upset stomach it’s probably reasonable to go to an urgent care rather than an emergency room,” said Dr. Marc Napp, chief medical officer and executive vice president of Memorial Healthcare.
That’s the I-can’t-believe-I-ate-the-whole-thing stomach pain quandary. In such a scenario, a physician usually takes a history and tries to understand what might have precipitated the upset stomach, which could be something as simple as gastroenteritis or a virus and treated with antibiotics and you’re sent on your way home, Napp said.
Another resource to consider in this example? The Florida Poison Control Center.
“We do take calls on food poisoning and can help callers determine what they can do in terms of self care and what symptoms indicate the need for emergency care,” said Wendy Blair Stephan, health education coordinator for the Florida Poison Information Center. “Now is a great time to promote the poison center to help people access care while avoiding unnecessary hospital visits,” she said in conversation with Jackson Health System.
The number for the poison help line: 800-222-1222
But stomach pain can also be a sign of heart attack in some people, Napp warns.
Emergency room workers feel your, well, confusion. “It can be difficult to know if you need a hospital,” Napp said.
“If people are confident they don’t know for sure they need a hospital then it’s reasonable to start out in an urgent care center at this time,” Napp said. “All urgent care have transfer arrangements to hospitals so if someone shows up and the staff determines this is something we can’t do they can make arrangements to bring the patient to an area hospital. It does mean a person is adding a step but for the majority of things it might save them a very long wait in a crowded emergency department. And that’s why urgent cares are popular and exist and people use them.”
But what if it’s more urgent?
“If the evidence is chest pain or bleeding or someone fainting or having severe pain — like the worst they ever had in the head or the chest or the abdomen — I think those are warning signs that should bring them to the hospital,” Napp said. “If someone has very high fever or broken a bone, again that might be reason to go to a hospital.
“Stroke, absolutely. Slurring of speech, change in mental status. Weakness on one side. Facial droop. Change in orientation. Confused. I would suggest you go right away to the hospital in situations with strokes or heart attacks. There is not a lot of time to make multiple stops along the way,” Napp said.
Atallah agrees.
“We stand ready to take care of anyone who comes through the door 24/7,” he said. “If you think its a more minor problem then don’t come to the emergency department. If you’re concerned, or not sure, or you think it’s a more severe problem, that’s what emergency departments are there for.”
Are surgeries still happening?
Yes. And some, for major issues like cancer, organ transplants or heart surgeries are not going to be put off.
Elective surgeries are another consideration.
For instance, elective surgeries at Memorial Healthcare System hospitals in South Broward were suspended earlier in August as COVID-19 patients exacerbated a shortage of nurses and created a run on oxygen that was used to treat those hospitalized with the respiratory virus.
Broward Health North in Deerfield Beach also reduced elective procedures to outpatient only.
At Baptist Health South Florida’s 11 hospitals from the Keys to Palm Beach counties, elective surgeries and procedures that require overnight stays are being evaluated daily across its inpatient facilities based on the capacity of each hospital.
“When we announced a week or so ago we were pushing off elective surgeries what’s elective and what’s urgent is relatively gray,” Memorial’s Napp said. “If someone needs heart surgery that is not something you can put off. If it’s a transplant and an organ becomes available we’re not going to not put the transplant organ in. So surgery we definitely do.
“If there is a procedure that can wait we are recommending that people wait. An example might be a hernia, a very common condition people often have for a long time before they have them fixed. There’s usually not much harm in waiting,” Napp said.
“We are not advocating that for patients who have cancer that they wait because a delay in treating cancer can have bad consequences. Those type of procedures we will perform. We are looking at our requests for surgeries on a daily basis and trying to determine what should go forward and what shouldn’t because there are some things you have to do,” Napp said.
“We take each surgery on a case by case basis,” Jackson’s Atallah said. “We have to look at the patient’s condition and how long they have been waiting. And we have to look at [whether] they will they require an admission to the hospital for a day or two to watch them to see how they recover or is it something that can be done as an outpatient? How much of a problem is the issue that is requiring patients to have surgery? These are all things we take into consideration when deciding whether or not to continue the case doing surgery or defer to a later time ... until we get over this surge.”
“If it’s an elective case surgery that can be done outpatient and patient can go home afterward we are trying to get as many of those done as we can because we know sometimes it can be uncomfortable and no one wants to wait to have something done they know needs to be done,” Atallah said.
But delaying surgeries that may seem less urgent, like orthopedic surgeries, could have consequences, medical health publication STAT reported in mid-August.
STAT cited surveys done by the American Association of Hip and Knee Surgeons Research Committee in April and December 2020 of about 1,000 orthopedic patients that had to delay their surgeries. The surveys found that patients experienced increased anxiety and continued pain and this impacted their daily functioning. “Particularly for elderly patients, if hospitals delay orthopedic surgeries, like hip replacements, the risk of blood clotting, pulmonary embolism, and morbidity goes up,” STAT reported.
Are you scared to go to the hospital?
Beyond the normal apprehension one faces any time there is the unknown or pain or discomfort, people seem more agreeable to going to the hospital despite the ongoing COVID crisis.
“In this vein, we are taking a year ago, when this happened, people were very afraid to go to the hospital. There was no vaccination at the time,” Napp said. Last summer, pre-vaccine, many were advised to put off procedures or took it upon themselves to ignore symptoms.
“That had a deleterious effect in delaying their care. People have lived with COVID for a year and whether they are vaccinated or not, people are less scared. That’s a good thing they are not as afraid because we don’t want them putting off that care,” Napp said.
“All hospitals in South Florida, even though they are jammed, they are still taking care of a tremendous number of non-COVID patients because they need care and we are happy to take care of them as needed. If people need emergency care they shouldn’t put that off either.”
A way out
“I’d like you put this in all caps and bold and have it say: ‘GO GET YOUR VACCINE!’ I think that is a big part of the way out of this,” Jackson’s Atallah said. “We are in the neighborhood of 98% around the country where admissions are for people who are not vaccinated. I think that’s good evidence the vaccine works. We haven’t heard of people having a lot of adverse reactions to vaccines. The risk of getting COVID and dying is much greater than the risk of getting the vaccine. Whenever you think of medical procedures and vaccines you think of risk and benefit. The benefit of getting the vaccine far outweighs the risk.”
Memorial’s Napp concurs.
“Either get the vaccine or get COVID. It’s Russian roulette,” he said. “Get COVID and you get a bad case or a mild case. With the vaccine, you might get soreness in your arm or achy for a day or two but that’s it. I’d rather get the vaccine. I am a strong advocate for that and it’s the fastest way to get through this.”
This story was originally published August 20, 2021 at 11:25 AM.
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