Theories on why A&Es are quieter than normal ATM

[Hotcuppatea]

My sister works in a hospital and said that their A&E is empty at the moment. This echos the experience of a friend of mine who had to go to her local hospital's A&E and said she was the only person in there.

Now my cynical sister says that if COVID19 is keeping so many people away, then it just goes to show that loads of people were there before who didn't need to be.

I think it's about much more than that.

1. Pubs are closed and many A&E visits must be alcohol/ accidents from alcohol/fights from alcohol related.
2. No team sports at the moment- another big group must be the people who've hurt themselves playing Rugby, football, etc.

Anyone else have any theories?

A 100% no sports happening , no pubs / clubs open / no schools / no ‘fun’ ie ice skating / roller skating / messing about the with mates / no alcohol etc etc
These are will all massively impact

I was on a different parenting website the other day. A parent on there had burnt her 6 month olds hand. It had a large blister on. She was asking other parents how to treat it instead of getting medical advice. She was told to call someone repeatedly but wouldn't and decided to tape a sock onto the hand and give the baby calpol despite almost everyone begging her to get proper help. It wasn't until the next day when someone told her how her baby had got sepsis from the smallest most insignificant cut and unfortunately died that she finally called 111, who sent her straight to hospital. The baby had to have the blister cut, a dressing put on and a course of antibiotics. People are not going when they need to because they are scared, to jump to the conclusion that everyone is normally taking the piss is stupid. As you've pointed out OP there are many reasons why it is quieter. Unfortunately Coronavirus will kill people indirectly too because of the fear of going when you need to.

Nothing is happening. There is only so much injury to be had when we are all just sitting on our sofas.

Accidents happen when people are distracted, rushed or pressured. Not much of that at the moment.

And no sport. Limited binge drinking.

A lot of people aren’t going to hospitals or GPs when they should full stop not just A&E. I think at the beginning before hospitals were prepared for the pandemic that was fair enough but all hospitals now have very good infection control processes in place now.

I think it is also that people are trying not to use the NHS generally out of consideration, not just fear.

I had a bad eye infection last week that the pharmacist couldn't treat and I left it several days before ringing the GP to see if it would go away on its own. Normally if a pharmacist told me to see a dr, I'd listen right away, but I felt weird and guilty about a minor ailment when people are dying.

I bet a lot of people feel the same and are self treating stuff a dr should see.

My dad has health problems and he recently had an episode which in normal circumstances would have meant a hospital admission. We spoke to 111 and our GP and all agreed it was safer to monitor him at home rather than get him into our local hospital which has turned virtually every ward into a Covid19 ward and risk him getting infected. It’s really shit because we then spent the next week trying to monitor him with our limited knowledge on his condition. Thankfully he’s fine but I cried for a week solid. It’s a scary and horrible time and I think we are all avoiding hospitals as much as we possibly can.

Too scared to go . I belong to a Facebook group for adults and children with catheters and stomas - posters have been asking for advice on how to do minor surgeries and sterile technique, including stitches removal, care of infected and surgical wounds, changing suprapubic catheters, management of heavy bleeding etc etc ... as the assumption is the nhs won’t do any of this now.

I suppose even if they did , a lot of people wouldn’t want to ask for fear they’d die of covid 19 just from walking into hospital .

I needed to go to A&E a month ago (before lockdown) due to a car accident and genuinely cried - not because of my injuries but I was so scared about catching covid in the hospital. Had I not needed a x ray I wouldn’t have bothered as my injuries were fairly minor.

Your heart sort of drops at the thought of exposing yourself to covid at A&E so I think more people are balancing the positives/negatives and would prefer to stay home if they can. I even asked my GP for advice as I was that hesitant🤦🏼‍♀️

Before going, I had visions of a packed waiting room (from past A&E experiences) and waiting for hours and hours on end. Particularly as my GP said there is a 4-6 hour wait! So thought I’d be stuck in a room full of sick people (with potentially covid) for hours on end. I think many others may have the same assumption, they wouldn’t know how quiet A&E is if they haven’t been recently as they’d be basing it off “normal” experiences.

When I went A&E was empty and they were stringent about letting people in, so temperature checks & triage at entrance and no chaperones allowed etc so literally no one who didn’t need to visit A&E were present in the waiting room. And covid patients were completely separated of course.

I was in hospital last night with sepsis because I didn't to to hospital so I don't think that people who were there before didn't need to be there but I think like me people are too scared to go now. I think alot of people will die as a result. I could have died if I left it any longer before going. I obviously didn't know I had sepsis otherwise would have gone much sooner.

I read in The Times yesterday an estimate of 150,000 more non-covid deaths for various reasons including that people aren't attending A&E for heart attacks,strokes and injuries that really do need attention. Some are also sitting on cancer symptoms for longer which are then less successful to treat further down the line. Also operations and treatments are being delayed and suicides are likely to rise.

But I think it's pretty obvious that people are scared to go to A&E just now.

Reasons we have gone to A&E in the last couple of years

• trampoline park fracture
• football triggered asthma attack (and pollution had a part to pay I suspect and this is down)
• car accident
• cub leader mistakenly giving my son a food he allergic too

None of those things would happen during lockdown.

There's another thread on here somewhere now where someone is saying that their family member is ill and needs to go to A&E, but is refusing to go.

If your DSIS works in a hospital then she'll know that patients are being directed away from A&E rather than towards it. I know someone who was assessed by video call instead. They would usually have been directed to A&E. Instead they were told to stay at home.

I’m a member of some pregnancy groups and people are scared to go to hospital to give birth and are risking free birthing without the home birth midwife team

Nursing homes having patients that need a and e refused. My relative has passed away due untreated injuries after a bad fall

I've only ever gone to A&E when I needed an operation (obvs didn't know at the time just felt bad) & out of my control so it's quite scary that people may stay away & end up dying.

I think it's a bit of both but your sister is definitely on to something. We would normally see dozens of patients a day who need a GP or no dr at all, checking in to A&E for a sniffle, slightly sore finger (still has full movement, pain 1/10), vomited once (now fine), slight headache for an hour, dropped TV remote on foot, shoulder been sore for 5 years. We aren't seeing many of those patients at the moment.

My dm was in A&E a few weeks ago and admitted for a few nights. She was reluctant, but she has a heart condition. Dm had to have a blood transfusion in the end due to her condition. She wasn’t allowed visitors as per guidance.
The previous time we visited A&E after new year, her breathing was all over the place. In front of us in the queue was a woman demanding to be seen with seen with a fucking sty in her eye and a twat who stubbed his toe 🙄 you could make it up.

I think it's a combination of reasons.
The first being, people are afraid to go to hospital now. I'm in ireland, my friend is a paramedic. She said, they still have the call outs for the usual chest pain etc, but people are terrified of going to hospitals now for fear of getting Covid-19.

The second being, because people are nervous of going to hospitals, they are not taking up hospital beds/ trollies with ailments that can be treated successfully by gp's and pharmacists . Less wasting of resources, from this point of view .

Thirdly , less accidents. Fewer people driving, playing sports etc, so less injuries .

It does show , that an overhaul of the whole health system is needed after this !

The video call thing is good depending on your circumstances - I can think of lots of reasons why a video call might be better for someone than physically presenting at A&E (frail person who really just needs antibiotics, for example, and who would be at risk going into hospital in normal times, never mind now). Some basic tests could be done with home equipment - taking your own temperature, counting your own pulse or using a Fitbit etc to count it for you, which you could relay to the dr and they could advise. Obviously a percentage of people would need to come in anyway, but I bet lots wouldn’t.

I think for us it’s a combination of being more risk adverse and not doing some normal activities that we have sustained injuries in. Two years ago, we had a run of ending up in A&E or minor injuries over a handful of weeks. All things required medical attention and we would seek attention now if we suffered those injuries but at the minute the NHS doesn’t need us being dicks and doing something stupid. One of the injuries was that I badly scalded myself, we had a near miss with the roast dinner today but we’re trying to take a bit more time with cooking and hot things. One of the injuries was that DH had fallen as he was rushing in the morning to get to work, now there’s no rushing to catch the train so no injuries from that. The other A&E visit was because my mum fell while walking the dog, despite that track being local to us for our daily exercise, I’ve refused to use that track since lockdown because it’s so uneven. DH has stopped going cycling despite not having an accident for several years. We aren’t doing any DIY that includes risk and generally trying to take our time in doing something to prevent silly injuries (which we’re usually very good at, so this is a bit of a learning curve). I had to climb into the flower bed to weed it, usually I’d have just jumped down, which previously has resulted in a dodgy land and a twinge but no medical treatment. This time, before I climbed up there, I positioned the wheelie bin so I could use that to assist myself out of the flower bed (raised flower bed which sits about thigh high for those confused why I’m climbing into my flower bed). Previously, with something like an ankle injury, we would RICE it but then you’ve got to get work etc and you don’t actually rest it as much as you should and end up at minor injuries/GP several days later. If we had an ankle injury now, it’s a lot easier to properly RICE your injury and let it heal, rather than aggravating the injury because you’re constantly using it.

Lots of reasons already mentioned. Also, for kids, not being in school/nursery means they aren't sharing around the usual non-corona respiratory viruses that lead to lots of littlies needing assessment/admission with bronchiolitis/viral-induced wheeze.

I sadly recently heard of a local in his 40's died in the past week of a heart attack. He was having symptoms for a few days, but refused to get checked out cos of his fear of going to the hospital. So tragic, an unnecessary loss of life, but this is also caused, indirectly , by covid -19.

They are encouraging people here now, not to ignore symptoms like chest pain, lumps etc....not to delay seeking help for worrying symptoms.

Well clearly lots of people at A&E are time wasters but I do think
some end up of there because getting a GP appointment is hard. My operations would probably have been routine & scheduled if I had seen a GP earlier on with symptoms but getting an appointment was impossible or weeks away so I never bothered.

There's a lot of reasons and your sister would be aware of the strategic ones.

No structured/team sports makes a massive difference, especially at weekends

No alcohol/pubs/clubs/big gatherings like festivals, parties etc - alcohol related accidents and violence are a huge part of overnight work normally

V few extreme sports and activities going on, less climbing, mountaineering, water sports, horse riding, trail cycling etc etc

Many walk in centres and MIUs have increased their hours and scope to see more minor ailments away from main hospitals, some even increasing their usually limited xray facilities to prevent having to refer limb injuries on.

Most hospitals have set up different admission arrangements for patients so that they go straight to a ward rather than through A&E if they have been referred in by the GP.

Community and mental health services have all been beefed up to keep patients away from main hospitals, palliative care teams have been increased via redeployment too

There is real concern that many people will be being stoic when they really shouldn't be, and that many may be very unwell and not seeking the help they need. Lots of people are genuinely frightened to leave the house in case of catching c19, but they may die of their untreated health problems sooner because of that.

Many many 'uneccessary' A&E visits in non pandemic circumstances are because of poor health/social care provisions in general - people unable to get a gp appointment, unable to get referred to mental health services or CAMHS, unable to access NHS dentistry, unable to see a health visitor or school nurse, unable to get food/drink/blankets and living rough, unable to get parenting support, unable to get palliative care support. The list goes on. Many people come to a&e because it's open and someone will listen. It's convenient to blame the vulnerable and explain the misuse of emergency care as someone's fault but it's often a lot more complicated than that.

Rather than being pleased that none of those people are coming in now, we should all be worried about where those people are, how they are and what on earth we're going to discover when the world gears back up again.