Judith Long, MD, is a 54-year-old internal medicine doctor and chief of Penn Medicine’s Division of General Internal Medicine. She’s healthy and religiously rides her Peloton bike three times a week. So when a terrible stomach pain woke Dr. Long in the early morning hours, it concerned her.
When the pain was still there two hours later, she faced a decision: go to the emergency room (ER) or stay home and hope for the best.
“I didn't want to go to the emergency room in the middle of a pandemic and have them say, ‘Oh, it's just a mild gastrointestinal bug, and you'll be fine.’ But I wasn’t getting any better, so I went,” says Dr. Long. “But just before I went in, I remember thinking, ‘Do I really want to? Is this really the right thing to do?’"
How COVID-19 Has Affected Emergency Rooms
Many people face a similar decision as the COVID-19 pandemic continues — and nationwide hospital data shows that, unlike Dr. Long, most choose to avoid emergency care.
“Early models had predicted that we would be doing anywhere from 20 to 40 intubations per day at each one of our downtown hospitals by mid-May,” says Ben Sun, MD, MPP, chair of Penn Medicine’s Department of Emergency Medicine.
“Some extrapolation also said that we would see up to 100 patients needing admission and up to 400 to 500 patients needing evaluation of milder symptoms each day. That literally would have been a fourfold increase in our daily volume. In reality, our overall ER volumes dropped quite significantly. We saw a 40 to 50 percent volume decrease. We saw more patients with respiratory symptoms—the very sick COVID-19 patients—but a dramatic decline in all other patients. And around the country, patients experienced a total volume drop between 30 and 60 percent [for non-COVID patients].”
Experts believe that fear of getting the coronavirus at the emergency department is behind the trend.
“Anecdotally, we've had patients who have delayed care for new and concerning symptoms. Then, by the time they came to the hospital, they would have quite advanced disease, such as heart attack, stroke, appendicitis and heart failure. These all could have been potentially prevented,” notes Dr. Sun.
“As a doctor, I've been doing some telemedicine appointments, and even my patients who have COVID-19 think it's now bad and dangerous to go to the hospital,” relates Dr. Long. “When I was experiencing my stomach pains, I even worried if going to the ER was worth the risk of exposing myself, and I knew there was very little transmission of patients to doctors and virtually none from doctors to patients at Penn Medicine. This is because of Penn Medicine’s careful use of personal protective equipment (PPE).”
How Penn Medicine Is Making Emergency Care Safer During COVID-19
Since the start of the pandemic, Penn Medicine has proactively adjusted, implemented and changed protocols to ensure the safety of patients and frontline staff.
“COVID-19 has required us to completely change how we provide emergency care services,” explains Dr. Sun. “The very beginning of March was when we started to see a rapid increase in community transmission, and our peak was sometime in mid- to late March. Over that short period, we changed everything we do, from PPE for health care workers to visitation policies, universal masking and how we screen for coronavirus. We’ve even altered how we do critical care, including how we make decisions about ventilators and discharge.”
In all Penn Medicine emergency departments, you can expect:
- PPE on providers: Health care providers will wear full PPE — including masks, eye protection and gloves — while caring for you.
- Universal masking for all patients: No matter your health concern, you receive a mask to wear when you arrive. “You can come in with a sprained ankle, and you still will get a mask if you're not already wearing one,” says Dr. Sun. “That’s probably the most effective measure. It means that whether you're not infected, infected without symptoms or infected with symptoms, everyone is wearing a mask, which reduces the risk of transmission.”
- Social distancing in waiting rooms: While ER wait times are down across Penn Medicine, if you do have to wait, the waiting room is configured so there's at least six feet of space between patients.
- COVID-19 screening and testing: All patients and visitors answer COVID-19 screening questions when they arrive and have their temperatures checked. “We have much better testing capabilities than we did at the very beginning of the pandemic. For patients who appear ill and require hospital admission, we can get COVID test results within two hours on average. Patients who get discharged after a COVID test self-quarantine and receive results in six to eight hours,” says Dr. Sun. Patients who test positive go to a separate COVID-19 unit within the hospital — away from those without the virus.
When to Seek Emergency Care During COVID-19
Dr. Sun says it’s critical to seek care for any symptoms, including pain and loss of function, that are new and concerning. He notes that almost a third of Penn Medicine’s ER patients end up with conditions that require hospitalization, such as strokes and heart attacks. That’s a higher risk than the nearly 0 percent chance of getting COVID-19 in the ER.
“If you're having chest or serious abdominal pain that you've never had before or problems speaking, those are all medical emergencies requiring immediate evaluation,” he says. “We have seen several patients who most likely delayed their care with serious consequences. For example, we have seen several patients with a ruptured appendix. This condition put them at risk for both short- and long-term complications. Had they come in sooner with simple appendicitis, we could have taken out the appendix before it ruptured.”
If you’re not sure if your symptoms are serious enough for a trip to the ER, Dr. Sun says your primary care office or nurse advice line are great resources to connect with.
Dr. Long’s Medical Mystery Solved
When Dr. Long arrived at the ER that night, she waited five minutes in an empty waiting room before ER staff examined her.
“The nurse came in pretty quickly, and then a doctor came in. The one thing that was different is they don't do as much physical examination as they used to,” she relates. “Right away, I got a bunch of blood tests, which all came back normal. But by this point, I was really starting to be in a lot more pain.”
After getting a CT scan to look for a kidney stone, her pain continued to worsen, and she began to vomit. It was then that she learned what was wrong.
“I had a small bowel obstruction. I don't think anybody was expecting that, myself included,” she says. “Then came the decision to consider surgery or something more conservative. It was now 6:00 a.m.”
After a phone call to her husband — Penn Medicine had a no-visitor policy at the time — Dr. Long opted for laparoscopic surgery. Her providers tested her for COVID-19, admitted her to the hospital and sent her home the next day. Nearly one month later, she’s doing great and back to work and exercising.
“I received excellent, kind, caring, efficient care from everyone working on the surgery floor of the emergency room,” says Dr. Long. “If I hadn’t gone to the ER that day, some of my bowel could have died or even exploded if it got too distended. My experience shows that you're safe coming to the hospital, you're not going to get COVID, and if you wait on serious medical conditions, bad things can happen. It's better to take care of them quickly and appropriately.”
As Penn Medicine emergency department volumes gradually return to normal, Dr. Sun maintains that the hospital remains one of the safest indoor settings to avoid getting COVID-19.
“Compared to any other setting that I can think of, we're going to have the best infection control, PPE and universal masking. The level of infection control in a hospital is light years ahead of a non-health care facility,” adds Dr. Sun. “If you feel comfortable going to the grocery store, you should be even more comfortable coming into the hospital. It's very, very safe.”