Emergencies and medical offices deserted for fear of the Covid-19… Where are the “other” patients?

A child in consultation with his doctor – CLOSON DENIS / ISOPIX / SIPA

  • Since the strong progression of the coronavirus epidemic in France and the establishment of containment, medical offices and emergency departments have been deserted by the sick.
  • A desertion largely explained by the fear of contracting the coronavirus in a medical environment, and which also affects parents, more cautious about the idea of ​​going with their child to the pediatrician.
  • But doctors are worried about the lack of follow-up for the chronically ill and those who could turn away from the emergency room when their state of health would mean going to the hospital.

Coronavirus contamination figures. Hospitalizations due to coronavirus. Twenty-second day of indefinite confinement to protect us from the coronavirus. And even
race budget exploding due to confinement linked to the coronavirus. In recent weeks, our entire daily life has been governed by the consequences of the pandemic. Between the fear experienced by those who have loved ones contaminated with Covid-19 and the fear for others of contracting it, our mind is legitimately obsessed.

But even if part of our life seems to be on hold, chronic diseases and other health problems have not disappeared by the simple ubiquity of the coronavirus. Still, the fear of contracting Covid-19, very present, pushes many patients to sulk the doctors. Deserted cabinets. Less saturated emergency services. Where did the sick go?

Fear of going to the emergency room

The time when you sometimes had to wait hours in the emergency room seems distant today. In addition to breaking the Covid-19 broadcast chain, containment leads to lower than usual “accidentology”, with fewer road and work-related accidents. Result: “Emergency services are only running 30% or 40% today. Suddenly, the beds dedicated to classic pathologies are not saturated, “said the president of the
Federation of Private Hospitals (FHP), Lamine Gharbi. “Emergency room admissions are much lower than usual,” said Dr. Sébastien Gette, head of the intensive care unit at CHR Metz-Thionville.

But there is another reason for the drop in traffic in the emergency services. “We see fewer chronic patients, fewer stroke victims … It is therefore possible that patients will give up coming, perhaps for fear of being infected,” says Professor Etienne Gayat, head of service and medical director of crisis at Lariboisière hospital in Paris. Same observation in Seine-Saint-Denis: “There is a 50% drop in stroke and myocardial infarction in emergencies, observed a few days ago, on France 5, Pr Frédéric Adnet, medical director of Samu de Seine-Saint-Denis and head of the emergency department of the Avicenne hospital, in Bobigny. People are afraid to go to the emergency room. “

“You shouldn’t say” I’ll go later “”

However, heart attacks, strokes, acute poisoning or serious forms of cancer remain a reality. “The daily life of intensive care units did not stop with the coronavirus,” said Dr. Gette. Thus, in hospitals, every precaution is taken to isolate “Covid” patients from others. In most establishments, beds and even resuscitation units have been sanctuarized to deal with “classic” problems. In Ile-de-France, 500 beds are thus reserved for standard pathologies, out of a total of 2,700 resuscitation beds, according to the Regional Health Agency. In the Grand-Est, the proportion of “non-Covid” beds reaches 20%.

So, “if there’s an emergency, you have to keep going to the hospital and not say” I’ll go later “. Hospitals are there for that, ”insists Lamine Gharbi, of the FHP. This is why, “in the event of symptoms suggestive of myocardial infarction (chest pain most often, sometimes feeling of lack of air, both during exercise and at rest, palpitations, malaise) or of vascular accident cerebral (sudden onset of weakness of a limb or face, a speech disorder, a vision disorder, or a balance disorder), it is imperative to continue call 15 “, insist the French Society of Cardiology and the
French Neurovascular Society.

Continue treatment and medical follow-up despite confinement

Fear of Covid-19 also pushes many patients to turn away from city medical offices, even when their state of health requires regular medical monitoring. “This Monday, I had half the consultation than usual, and my colleagues make the same observation,” said Dr. Jacques Battistoni, general practitioner and president of the MG France union. For the doctor, “in addition to the fear of the Covid-19, the desertion of medical offices is also the consequence of inappropriate government communication: it was said to consult only in the event of an emergency. This communication error resulted in loss of chance and risk-taking for the patients, regrets Dr Battistoni. Some did not dare to consult despite significant symptoms, which led to a potentially very serious delay in diagnosis, for example in the management of appendicitis or various infections. “

And containment measures have also led many chronically ill people to dare not go to their doctor. However, “patients who have a chronic disease, such as diabetes, hypertension or other, should not stay for several months without seeing their doctor, notes Dr. Battistoni. Everything is organized in the cabinets to ensure the security of the consultation: there is no full waiting room, and cases of suspected Covid-19 are received separately. “

Important follow-up also in pediatrics

A message that seems not to have been heard by many parents, who also shun pediatric offices. “On Monday, I may have had a quarter of a normal day of consultation,” confirms Dr. Brigitte Virey, pediatrician and president of the National Union of French Pediatricians. However, even the youngest must be taken to certain essential consultations. “For fear of Covid-19, young parents are afraid of bringing their newborn baby to us, while maternity leave is very early, and the baby must be subject to special vigilance,” insists the pediatrician. We must rule out any risk of
congenital heart disease, which can appear a few days after birth ”. A fear that is present that pushes other parents to “cancel the consultations planned for the vaccination of their children. However, they are essential to build the immunity of toddlers against different viruses, “said Dr. Virey.

As with adults, children can also have chronic illnesses that require regular medical attention. “There are children with asthma whose parents stopped taking corticosteroids because they heard that anti-inflammatory drugs were dangerous against Covid-19,” said Dr. Virey. Or cases of children suffering from
type 1 diabetes in ketoacidosis, a complication that can be very serious. This situation is of great concern to us. ” “We are afraid of the future, the consequences of the lack of follow-up on the health of our patients, fear Dr Battistoni and Virey. The recovery may be complicated and reveal unpleasant surprises. “

“This is why it is very important to maintain the link, to ensure continuity of care for our young patients,” says Dr. Virey. So, to ensure safe follow-up, “everything that can be a vector of the virus – toys, magazines – has been removed from the office, and everything is disinfected between each consultation,” says the pediatrician. In addition, parents should only come with one child, and appointment scheduling is organized so that patients do not meet. ” And for cases where face-to-face consultation is not essential, and for patients who cannot overcome their fear of moving, teleconsultation helps maintain the link between doctor and patient.

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