When to Seek Emergency Care During the COVID-19 Pandemic

There can be no doubt that the COVID-19 pandemic is putting unprecedented strain on the healthcare systems in the United States and abroad. In an effort to reduce the burden and prevent shortages of medical supplies and resources—not to mention the risk of transmission in hospitals, emergency rooms, and other healthcare facilities—many non-essential surgeries, medical procedures, and dental procedures have been postponed indefinitely.

But, what happens if an urgent or emergency situation unrelated to COVID-19 arises or you are desperate to be treated for a condition that is not life-threatening but you feel simply cannot wait?

Knowing the level of care you need—whether it be an emergency room, urgent care facility, doctor's office, or telemedicine—can ensure that you get appropriate treatment while allowing hospitals to make the best use of their available resources.

If you have a medical emergency, whether it is related or unrelated to COVID-19, you should call 911 and go to the emergency room. This includes any injury or illness for which a lack of immediate treatment may cause harm.

This can include, among other things:

• Choking
• Trouble breathing
• Persistent severe vomiting or diarrhea
• Coughing or throwing up blood
• Passing out or fainting
• Cardiac arrest or stopped breathing
• Severe chest pain or pressure
• Sudden weakness on one side of the body
• Broken bones, especially if pushing through the skin
• Deep wounds
• Heavy bleeding
• Severe burns
• Severe allergic reaction with swelling and trouble breathing
• Accidental poisoning or overdose
• Electrical shock
• Head injury with fainting or confusion
• Neck or spine injury with a loss of feeling or movement
• Suicidal ideation and intentions
• Seizures

If you decide that emergency care is needed, be aware that all Medicare-certified hospitals with emergency departments are required to provide COVID-19 medical screening before allowing patients into the facility.

Other clinics and hospitals are doing the same, some of which have erected tents and temporary structures outside of emergency room entrances to better identify and isolate those with the virus.

At most emergency rooms, coronavirus tests are only performed on people with overt symptoms of COVID-19. Individuals who test positive will be isolated to prevent exposure to healthcare workers and others.

Sometimes, you'll need to do a judgment call to decide if an injury or illness requires emergency or urgent care. It often helps to understand what urgent care is, as well as what it can and cannot do.

According to the American Academy of Urgent Care Medicine (AAUCM), urgent care services are intended for the treatment of illnesses or injuries that would not result in further disability or death if not treated immediately.

Urgent care is not intended as a less-costly alternative to emergency rooms. If used as such, patients may require transfer to an emergency department, wasting not only valuable time but money.

Urgent care services are qualified to treat:

• minor injuries
• wounds
• fractures
• concussion
• minor infections (including upper respiratory infections)
• rash
• diarrhea
• nausea
• vomiting
• fever

Most are equipped with X-ray and lab facilities; others have advanced diagnostic technologies. Physicians typically provide the bulk of medical services, aided by nurses and physician assistants.

The CDC has advised urgent care providers and other outpatient facilities to limit face-to-face interactions with patients in a variety of ways, such as:

• Performing preliminary telephone assessments to determine if a patient has symptoms or risk factors of COVID-19
• Providing online assessment tools for COVID-19
• Providing patients experiencing respiratory symptoms with their own dedicated waiting area
• Maintaining no less than six feet between waiting patients
• Providing face masks to anyone with respiratory symptoms
• Performing curbside triage (the evaluation of the level of urgency) by a dedicated staff member with protective gear

If a medical condition is not considered an emergency, another option is to use one of many telemedicine (a.k.a. telemedicine) providers that are offered direct-to-consumers or as a benefit of many health insurance plans, including Medicare and Medicaid.

These virtual care providers, all of whom are certified and licensed within your state, can provide medical advice, diagnosis of certain conditions, and dispense certain drugs without having to come into direct contact with you.

Telemedicine is considered a cost-effective option for consumers compared to the fees one would expect to pay at an emergency room or urgent care center. Moreover, they help alleviate the burden placed on hospitals and emergency rooms while preventing unnecessary interactions that facilitate the spread of the virus.

A 2019 study in the American Journal of Emergency Medicine estimated that the average cost of a telemedicine call in the U.S. is between $41 and $49, around half the cost of an urgent care consultation with no lab or imaging tests.

One medical concern for which optimal care is essential is pregnancy and delivery. Even so, the COVID-19 pandemic has forced many hospitals to seek alternative approaches as to how they handle scheduled and non-scheduled deliveries.

Although little is known about the actual risks that COVID-19 poses to pregnancy, experience with viruses of the same family (such as SARS and MERS) suggests that pregnant women may be at greater risk of severe respiratory illness.

To better safeguard mothers and their babies, many hospitals have changed their protocols regarding prenatal care, labor and delivery, and postnatal follow-up. In line with public health recommendations, many have limited the number of visitors allowed during delivery, while others have moved certain prenatal care services online or over-the-phone for low-risk patients.

Therefore, it is important to familiarize yourself with these changes in the event of a medical emergency during pregnancy (or even if you are going to the hospital to deliver your baby on schedule).

These considerations include:

• Calling your maternity team if you think you have COVID-19: At present, the same guidelines that pertain to the general population pertain to pregnant women. Still, it is important for your team to know about your risks so that adjustments can be made to your prenatal care plan and you can be advised of special protocols (such as face masks, COVID-19 testing, and isolation in triage and maternity units) should you need emergency or urgent care.
• Knowing who is and who is not allowed to be with you: Because of visitor restrictions, some women may decide to drop their doulas in favor of having their spouses or partners with them. The sooner you know about visitor policies, the sooner you can adjust your birth plan. Doing so also ensures that the allowed parties are present if you are rushed to the hospital for a non-scheduled delivery.
• Knowing how to act if you are in labor and are self-isolating: If you are in labor and have (or think you may have) COVID-19, call the hospital beforehand so that the staff can prepare and protect your baby and others from infection. If you have a face mask, put it on before arriving at the hospital or before emergency transport services meet you.

Because of changes in policies and/or the fear of acquiring COVID-19 in maternity wards, some mothers may consider changing their birth plan from a hospital delivery to an at-home delivery. Before doing so, it's important to consider what might happen if something goes wrong and weigh that against the safeguards already in place at hospitals, which are still prepared to care for pregnant women.

There are situations in which an elective procedure or surgery may be considered necessary during the COVID-19 pandemic. Examples include hip replacement surgery for those with a high risk of fracture or resection surgery to remove certain low-risk cancers.

During the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recommend that the decision to treat or not treat be based on two things: the available resources of the hospital and on a case-by-case review of each elective procedure.

Among the considerations, a hospital will need to determine:

• If there is enough staff to accommodate the elective procedure
• If there is ample personal protective equipment to sustain the facility through the pandemic
• If there are ample beds, including intensive-care beds, to accommodate elective patients
• If enough ventilators are available to accommodate patients undergoing elective procedures

In addition, the hospital administrator, along with the chief of surgery, needs to determine how urgent a procedure is based on the age, health, and symptoms of the patient, as well as what might happen if the procedure is delayed.

The CMS has offered guidelines to hospitals to help direct which elective surgeries are recommended during the COVID-19 crisis:

For their part, patients can work with their doctors or seek a patient advocate if a certain surgery falls into an uncertain category. Even so, the procedure may still be denied if the hospital does not have the resources to address the pandemic effectively or is faced with a sudden uptick in emergency COVID-19 cases.

The public fear surrounding the COVID-19 pandemic has led many to seek emergency care at the first sign of symptoms. This is something you should avoid unless you have emergency symptoms of COVID-19 as outlined by the Centers for Disease Control and Prevention (CDC).

Most healthy adults and children who get COVID-19 will develop cold or flu-like symptoms. Because there are no treatments approved for COVID-19, rest and home isolation remain the recommended approach for the majority of people.

When speaking to the doctor or medical staff, let them know the symptoms you have, when they started, if you've recently traveled, or if you've been in contact with anyone known or suspected of having COVID-19.

For help with talking to doctors or staff about your symptoms and the possibility of having COVID-19, use our downloadable Doctor Discussion Guide below.

If you already have a thermometer, let them know your temperature. However, if you don't currently own a thermometer, do not run to the drugstore to buy one or ask someone in your immediate household to buy one for you. This will only promote the spread of infection.

In most cases, you will be advised to stay at home and isolate yourself until symptoms pass and your doctor gives you the all-clear to leave. The same is not true if your symptoms are severe. In such cases, emergency care should not be avoided.

During a public health emergency like the COVID-19 pandemic, hospitals and emergency rooms will often need to re-prioritize their services to make the best use of their available resources. You can contribute to the effort by taking the time to formulate your own pandemic game plan if an emergency does arrive.

Start by making a list of emergency, urgent care, or telemedicine providers you can call if needed. Think ahead about your own health and what types of concerns may require these services. This is especially true if you are pregnant, live alone, or have a serious health condition. Your doctor can help you plan if you are unsure of what to do.

By thinking ahead strategically, you can act swiftly and get the appropriate care you need even in the midst of the pandemic.