Coronavirus: doctors alarmed by emergency fall-off

The incidence of cases of chest pain and stroke at emergency departments has fallen markedly during the COVID-19 pandemic.

An amublance is seen at Westmead Hospital. Picture: Dean Asher

The incidence of cases of chest pain and stroke at emergency departments has fallen markedly during the COVID-19 pandemic, with fears sufferers may be experiencing disability in isolation from healthcare providers.

Doctors are baffled as to whether the decreased incidence of stroke in emergency departments means fewer people are suffering them, or whether people are having strokes in the same numbers but not seeking care.

PDF: Daily change in ED presentations at Western Sydney Local Health Districtit

A paper published in the Medical Journal of Australia found that at four Western Sydney hospitals, there was an overall 25 per cent decrease in the number of presentations at emergency departments. At the same time, mental health presentations and substance misuse had risen by almost a quarter.

The study analysed triage and separations data for the period between March 29 and May 31 in 2019 and 2020 in the four hospitals with EDs in the Western Sydney Local Health District.

A man wearing a mask walks out of Westmead Hospital Emergency department in Western Sydney in January.

The paper found the proportion of patients discharged from the ED was 7 per cent greater in 2020, and there were fewer patients admitted to hospital. There were fewer incidences of ­patients who went to ED and did not wait for treatment in 2020.

Cases of infectious intestinal illness such as gastroenteritis in 2020 fell 60 per cent compared with the previous year; pneumonia cases were down 57 per cent; and leg fractures fell by 40 per cent.

Doctors say it is not surprising, given lockdowns and social distancing, that the incidence of infectious disease and accidents causing fractures and injury had plummeted, but it was the decrease in presentations for stroke and chest pain that surprised them. Incidence of stroke in Western Sydney Local Health District emergency departments fell by 31 per cent and there was a 12 per cent drop in people presenting with chest pain.

Senior resident medical officer at Westmead Hospital Andrew Kam, the author of the MJA study, said the findings were concerning. “It’s possible there are fewer numbers of strokes,” Dr Kam said, “but there’s a very real possibility people are just not presenting. We need to consider whether people are being isolated in the community and if they’re not able to present to hospital.

“It’s hard to say from the data … if that is the case but I think that’s something we need to ­dissect.”

Researchers say the drop in cases of chest pain and stroke at emergency might have something to do with the closure of outpatient clinics, elective surgery suspensions and social distancing. “A lot of these outpatient clinics or primary care providers like GPs, they refer a lot of these patients in to ED. If we don’t have those services available to the community, it may increase the barriers to accessing appropriate medical care,” Dr Kam said.

He said the overall drop in patient presentations at emergency departments of 25 per cent was a worry for doctors. “We are concerned that patients who have symptoms that potentially represent quite serious medical conditions … aren’t coming in to seek appropriate medical advice when they need it most.

“It’s important that anyone seek immediate medical help if they are experiencing serious symptoms such as chest pain, weakness or numbness in face, arm or leg, difficulty speaking or understanding language, decreased or blurred vision, or unexplained loss of balance … these are time-sensitive and potentially life-threatening conditions.”