Published on Mar 25, 2020

  • Published on Mar 25, 2020
  • At present, there's no true therapy for COVID-19, so you should only go to the ER if you have chest pain, trouble breathing, difficulty keeping in fluids, high fever, or any feelings extreme sickness.
  • If you're healthy, don't have significant underlying disease, and can eat, drink, and tolerate your symptoms, there's no advantage to going to the ER.
  • If you're over age 70 and running a fever, you're in a much higher risk group and should go to the emergency room.
  • Emergency rooms are following safey and social distancing protocols to protect staff and patients.

Video Transcript

JOHN WHYTE: Hello, I'm Dr. John Whyte, Chief Medical Officer at WebMD, and welcome to Coronavirus in Context. Today, we're going to talk about whether or not you should be going to the emergency room. And my guest is Dr. Corey Slovis. He's Chairman of the Department of Emergency Medicine at Vanderbilt. Thanks for joining me today.

COREY SLOVIS: It's my pleasure.

JOHN WHYTE: Well, let's start with the obvious. If you think you have coronavirus, when do you go to the emergency room?

COREY SLOVIS: Really a great question. In general, the emergency room is a great place to go if it has a therapy that can help you and you need it. Unfortunately, at the present time, as of today, there is no true therapy for COVID-19 coronavirus. And so you should only go to the emergency room if you cannot manage at home. And I think --

JOHN WHYTE: What would that be? Like, what those examples be? Is it shortness of breath? Is it high fever? What would it be?

COREY SLOVIS: I think there are two groups of people that we ought to talk about. And the first one is the vast majority of, I believe, our listeners and the vast majority of the population. And that is if you are healthy, without significant underlying disease, you shouldn't go to the emergency department if you're able to eat, drink, keep down fluids, and function reasonably well. If you have a fever, if you're feeling sick, but you're able to tolerate those symptoms, there is no advantage to going to the emergency room. They're not going to be able to provide any therapy for you at a time that they're being overwhelmed, potentially, in many cities with really sick people. And I am so sorry.

JOHN WHYTE: What if you feel you can't breathe?

COREY SLOVIS: So the symptoms that would say I need to go to the emergency department-- the inability to think or act normally. The inability to breathe normally -- the -- the inability to catch your breath. Chest pain like you've never had before. Or if you have nausea, vomiting, or diarrhea, and you're not able to keep up with fluids, and you're getting weaker and weaker. Maybe one other example would be a fever that's becoming uncontrolled, getting high with either chills, or shakes, or rigors, where you have never felt like this before. Those are the people that go -- people that are truly ill.

JOHN WHYTE: Is there a fever temperature that is different or that you have in mind? It might be different for seniors who may not be able to mount as high of a temperature.

COREY SLOVIS: Yeah, so --

JOHN WHYTE: You know, kids or adults?

COREY SLOVIS: When you look at the mortality data, when you look at how people tolerate illness, people that are in the younger age groups can tolerate temperatures 101, 102 relatively well. They need to take Tylenol, they need to consider Motrin or ibuprofen or any of NSAIDs. But if you're over the age of 50 or 60, especially as you approach 60 to 70, you're not going to tolerate fever well. And you may, as you're saying, not mount a very high one. Those people need to go to the emergency department if they're not able to keep their temperature below somewhere between 100, 101, people talk 100.8.

I don't think it's exact. I think if you're running a fever, and you're getting sicker, and you're elderly, you are in a much higher risk group.

JOHN WHYTE: Should you call 911 ahead of time or should you go to the ER? We've been telling people, don't just show up -- you know, call your doctor, call your health department, call your ER. What do you recommend that people do if they're at that point where they feel they need to go in?

COREY SLOVIS: If you have a physician, absolutely call her or him unless it's an absolute emergency, and you're worried about your life -- reasonably worried about your life. Some emergency departments want to know whether you're coming or not. But I'll tell you -- as this epidemic and pandemic spreads, most emergency departments have a screening procedure right out front. And so as you get to the ED, tell them, I'm worried I have coronavirus, this is why.

JOHN WHYTE: OK. How do you do social distancing in the ED?

COREY SLOVIS: Well, we try our best. But what most of us are doing are keeping a mask on, because we're in such a high risk area. And if any patient has any symptoms, putting a mask on she or he. And then trying to be as far away as possible. Try to have the least number of people in the room and close to the patient, minimizing patient contact. Unfortunately, when we're dealing with people that are getting more critically ill, we're going to have to be very close by, and we try to wear as much protective gear as we can.

JOHN WHYTE: What are you seeing in terms of the availability of personal protective devices? How are things at Vanderbilt right now?

COREY SLOVIS: So I -- I want to say the good and the bad. The good is we have equipment, we have masks, we have gowns. That's the good. The bad is they're in very short supply. We are rationing. No one is going without -- that is, seeing patients. However, we worry about running out. We -- we're told that we were going to be getting some more in in the next couple of days. And so we're hope -- excuse me -- we're hopeful, but we're concerned. That this is the first time in my emergency career -- and I've been doing it now for two years -- where I've ever given a second thought to putting on a gown and mask, thinking, I sure hope I have one the next time.

JOHN WHYTE: Now what about people's attention to other conditions, given that everyone's focused right now on COVID-19? People still are going to have heart attacks. People still break bones. Do they need to have different expectations when they present to the ER for something other than COVID-19? We can't be naive and think people aren't going to have to come to the ER anymore.

COREY SLOVIS: Well, what we've seen it -- are a significant drop in patients who could have been seen in the walk-in clinic or could have waited till next week. That volume is down. If you have something seriously wrong with you, come to the ED. But only come if you need us. Don't come because you haven't seen your doctor recently and just wanted to see how you are doing. But if you're having a heart attack or a stroke, if you have pneumonia, if you're seriously ill, our emergency departments are open. And in general, in most cities, are open and ready to see you very quickly.

JOHN WHYTE: But their expectations might need to differ right now in terms of --

COREY SLOVIS: Be prepared for less people to rush to you. Be prepared to have a mask put on at either the least provocation or in some hospitals, immediately upon arrival. Be aware that people are very cautious and that touch that you might be used to, and seeing the nurse close by, having the doctor come in and sit down, and spend time with you -- those times are gone for the time being.

JOHN WHYTE: And what's been your experience the last couple of days in your emergency department? What have you been seeing?

COREY SLOVIS: I've seen a couple of things. One is a sense of pride and teamwork among all of our members -- the doctors, the nurses, the staff, respiratory -- all of us knowing we're in a battle and we're in together. I see a little bit of fear. I see rumors try to spread that we need to make sure everyone's aware of what's really going on. And I see patients, some of whom are coming in because they need help, and some of whom are come in expecting to be tested when they're asymptomatic and becoming angry when they're not tested.

JOHN WHYTE: What do you tell them?

COREY SLOVIS: We tell them the truth. That at the current time, asymptomatic patients do not need to be tested. That we have a limited number of tests. That there are many days wait because so many people that urgently need to be tested are awaiting their results and we are not testing asymptomatic patients, and apologize.

JOHN WHYTE: Well, this is very helpful information Dr. Slovis. I want to thank you for taking the time to educate our listeners and I want to thank our viewers for watching Coronavirus in Context. I'm Dr. John Whyte.

COREY SLOVIS: Thank you so very much.

JOHN WHYTE: Thank you.