Concern over the sick avoiding Emergency Dept

There are serious concerns that people who are sick and require hospitalisation may be avoiding hospital Emergency Departments due to Covid-19 anxiety – risking long-term but potentially preventable damage to their health.

That’s according to Saolta Hospital Group Clinical Director for Medicine, Dr Ramona McLoughlin, who told the Connacht Tribune that attendance to the ED at University Hospital Galway had dropped significantly in recent weeks.

“Our big worry is that people are not going to ED or to their GP because of coronavirus,” she explained.

Dr McLoughlin said that conditions such as MI (myocardial infarction or heart attack), stroke or kidney infection were not any less likely to occur now, in the midst of this global pandemic, than they were beforehand.

“This pandemic does not prevent any other diseases,” she stressed, adding that EDs nationwide had seen similar decreases in the number of people attending with common conditions that would still be occurring, despite the lockdown.

All necessary precautions had been taken at UHG to ensure that patients presenting to the ED with any symptoms indicating the presence of Covid-19 were kept separate from those with other illnesses, said Dr McLoughlin.

“We have put in pathways at the entrance to the ED – if you have [flu-like] symptoms, you go down one pathway; if you have a suspected MI, stroke or appendicitis, you go down a separate pathway,” she continued.

Daily presentations to the ED at UHG – the main acute hospital in the region – have been around 50 people for day; the norm was about 180 to 250 people per day, said Dr McLoughlin.

As talk turns to how the country will return to some semblance of normality in coming weeks, Dr McLoughlin said people had to prepare for a return to what would be a new normal – and this was particularly relevant for medicine.

“We have been really lucky in Ireland with how social distancing has helped.

“The death rate in Ireland is about half that in the UK, but the big worry is how we are going to get back to life with Covid-19 – it’s not going to be normal life,” she said.

While there were hopes that a vaccine will be available, it was at least 12 months away – a timeframe Dr McLoughlin called optimistic – and there was still a lot unknown about achieving immunity to this novel virus.

Other areas of healthcare have been impacted, with many elective surgeries cancelled; many clinics have been moved to virtual fora due to concerns over keeping people in waiting rooms; while the reluctance to attend GP surgeries or ED could result in delayed diagnosis, she said.

“With cancer, there is a whole range of concerns. If a patient doesn’t present with symptoms, that could delay diagnosis.

“Because we were preparing for a pandemic surge, we did reduce elective activity to free up space so that did reduce clinic activity and elective procedures. That could well have an impact on diagnosis.

“We can open back up those activities and utilise the Galway Clinic and Bon Secours so that procedures can be operated in a non-Covid hospital, as far as you can say that about anywhere,” she said.

For patients having chemotherapy for cancer, provision had been made to administer treatment in clinic rooms at UHG which provided better protection, given that they were immunosuppressed.

People presenting to the ED in psychiatric emergencies were also being taken straight to the new Adult Acute Mental Health Unit, said Dr McLoughlin.

She advised that people exercise their own judgement and to seek medical assistance when they needed it or, “they may end up with more serious difficulties”.