Almost a million fewer emergency room visits. The figure strikes the imagination and testifies to the magnitude of the crisis experienced in 2020. Many Quebecers avoided hospitals during the pandemic for fear of contracting COVID-19. Some have done it at the cost of their health and even their life, deplore doctors.

The Ministry of Health and Social Services (MSSS) recorded a drop of 906,039 emergency room visits in Quebec between April 2020 and February 2021, compared to the same period the previous year, learned The duty. From 3,164,862, the number of visits plummeted to 2,258,823. A decrease of 29%, which does not mean that Quebecers are in better health.

Too many patients have delayed presenting to the emergency room for fear of contracting COVID-19, says Dre Annie Lavigne, intensivist at Charles-Le Moyne Hospital, located in Greenfield Park. Like this lady, victim of a pain in the chest, who died at the end of the week, in spite of the intensive care which was lavished on her, she says. “We managed to unblock his artery, but his condition had degenerated too much. She never woke up after the operation. “

According to the Dre Lavigne, this woman could have been saved if she had seen a doctor a few months ago. “She was a caregiver,” she says, “and she stayed home for months to care for her husband. “

Emergency physician at the Jewish General Hospital, the Dre Laurie Robichaud cites an equally distressing case, that of a woman with ovarian cancer, admitted to the emergency room because of a painful stomach ache. His appointments had been postponed due to the load shedding. “Her ovarian tumor had quadrupled in size in a few weeks,” says the doctor.

According to her, the effect of the load shedding, combined with the wave of patients who have been slow to seek treatment, has recently been greatly felt in the emergency room. “We now see in our cases the impact of the delays experienced in outpatient clinics and surgeries. We see patients waiting for chemo, or who have lumps, internal pain or shortness of breath, says Robichaud. Some have had silent heart attacks. “

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Difficult to measure exactly the effect of desertion of emergency patients. No data on cardiovascular mortality during the pandemic is yet available for Quebec, according to Dr Arsène J. Basmadjian, President of the Association des cardiologues du Québec. However, at least two studies have shown “clearly an increase” in it in the United States during the first wave of COVID-19, he reports.

Shy recovery

In the field, this drop of nearly a million visits is hardly surprising. Patients fled hospitals like the plague in the spring of 2020. Emergency room attendance has since resumed, but has not reached the tide before the pandemic. “At the moment, we are at about 70-75% of the usual volumes”, estimates the Dr Gilbert Boucher, President of the Quebec Association of Emergency Medicine Specialists.

According to the MSSS, emergency room visits have resumed gradually since mid-January. But patients are still slow to consult, notes Dr Butcher. “When you ask patients, ‘Why didn’t you come before? You’ve had a stomach ache for three months ”, they reply:“ I was afraid to come to the hospital ”. One in three patients tell us this. This worries us, because it’s important that people feel it’s safe to come to our hospitals. “

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At the MSSS, it is indicated that “a high proportion” of the drop in emergency room visits concerns “outpatients”, that is to say patients with less serious health problems.

These patients may have chosen to turn to a walk-in clinic or a telemedicine consultation, notes Dr.r Pascal Renaud, President of the Association of General Practitioners of Quebec. “In this region, family physicians have done a lot of population“ walk-in ”which was no longer reserved for their clientele registered in FMGs [groupe de médecine familiale] », He emphasizes.

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Another explanation for this significant decrease: hospitals were spared the flu and gastroenteritis season this winter and last season. With confinement, work and road accidents and traumas linked to the practice of various sports have declined, observes Dre Laurie Robichaud. So are the cases of intoxication and injuries related to parties and typical “Saturday night” battles.

Longer stays

Despite the marked decrease in emergency room visits, the average length of stay on a stretcher increased slightly, to 15.8 hours, between April 2020 and February 2021, compared to 15.2 hours for the same period the previous year.

The MSSS explains this increase by the creation of hot and cold units, which reduced “accessibility to beds for emergency room users awaiting hospitalization”. Common rooms have also been transformed into single rooms. This is not to mention that at the start of the pandemic, the “waiting period [pour les] COVID-19 analysis results “was also” significantly higher than at this time, “reports the MSSS.

But according to Dr Gilbert Boucher, the problem of staff shortages contributes to the overcrowding of emergencies. Patients must remain on stretchers until a space becomes available on the floors. There are too few caregivers to open more beds. However, surgeries are resuming.

“Unfortunately, we say to ourselves that it might be better for patients to stay in the emergency room a little longer to allow for surgeries and chemotherapy treatments to be performed,” says Dr.r Butcher. We have to face the facts that this is probably the right thing to do for now. “

Nonetheless, the doctors interviewed urged patients to go to the emergency room or to consult a telemedicine doctor in the event of worrying symptoms. The Dre Annie Lavigne believes that the government should even make the population aware of these new services.

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