Tyler Sandberg rushed his brother to a Denver-area emergency room on Saturday after the 33-year-old woke up unable to breathe.
The brother, sick with symptoms consistent with the new coronavirus, was using a device to measure his blood oxygen levels and the readings were concerningly low. And although he was eventually able to catch his breath that morning, he had struggled for days with difficult breathing, coughing and fever, and so after consulting with a medical provider, he sought emergency care.
But at the hospital, he was told to go home. “The doctor said ‘I’m near certain you have COVID. You have all the symptoms. But you’re young and you’re otherwise healthy and I think you can beat this at home,’” Sandberg said. “He was sent on his way to kind of stiff-upper-lip it.”
The story is one that’s increasingly playing out at hospitals across Colorado: People are going to emergency rooms because of alarming symptoms they suspect are from the new coronavirus only to be sent back home without so much as a test. Doctors, even Gov. Jared Polis, want you to know that while they understand your anxiety, the response is both appropriate and safe.
“Don’t go out and panic. Just relax. It may be COVID, it may not,” Polis said.
If symptoms worsen, then people should seek emergency care. But it can be difficult for people who are already anxious about the virus, given its well-known lethality, to know when that time comes.
How to know if you need emergency medical care for suspected coronavirus
– High fever with a bad headache
– Shortness of breath where you have trouble speaking in sentences without taking big, deep breaths
Here’s how Dr. Richard Zane, chief innovation officer and head of emergency services at UCHealth puts it: If you weren’t sick enough to go to an emergency room a year ago, before the coronavirus pandemic, you are not sick enough to go now.
“There’s nothing different today than there was a year ago from the perspective of when you should seek emergency care,” he said. “There’s nothing about COVID that makes it different from that perspective.”
Hospitals say while they currently have capacity to handle more coronavirus patients, those beds should be kept available for the most serious cases, including people who require oxygen and, in the worst of cases, a ventilator or dialysis.
But there’s not much doctors and nurses can do for people who seek care but aren’t sick enough to be admitted to the hospital.
That’s because there are no approved cures or medical treatments for people who contract COVID-19, the disease caused by the new coronavirus. Instead, doctors and nurses use those limited therapies to help improve someone’s chances of survival if their symptoms are severe.
“There are no medical therapies, there are no drugs we can give these patients,” said Dr. Marc Moss, who leads the pulmonology and critical care departments at the University of Colorado medical school. “There are clearly things we do for these patients that are beneficial and improve their chances of survival.”
But here’s the important thing to remember: Most people infected with COVID-19 will have symptoms so mild that they can recover at home. (Sandberg’s brother is on the mend.) In fact, that’s the case in more than 80% of infections according to the Centers for Disease Control and Prevention.
“The majority of patients have a brief, self-limited illness,” Zane said. “It is perfectly safe to discharge patients who don’t need to be admitted to the hospital with COVID, just like any other respiratory infection.”
Centura Health, which runs 15 hospitals in Colorado, UCHealth University of Colorado Hospital and Denver Health are among the facilities that won’t test patients for coronavirus unless they are admitted to the hospital. And with good reason, including that testing resources in Colorado remain extremely limited, as is the personal protective equipment needed for medical providers who see confirmed or suspected coronavirus patients.
“People get upset that they’re coming to you looking for an answer to whether or not they have COVID and that answer doesn’t change what I do,” said Dr. Stephen Wolf, director of service for emergency medicine at Denver Health.
Doctors are treating the symptoms, not the disease. And, again, since there are no known cures or medical treatments, the advice to patients is the same: take acetaminophen to manage fever and pain, rest and drink plenty of fluids.
And even if a negative result comes back for someone who gets a test, if they have symptoms consistent with a coronavirus infection they still must behave as though they have the disease and self-isolate. Wolf says that’s because the coronavirus test can return a false-negative reading about 30% of the time.
“I get that doesn’t allay or soothe the anxiety of people in the public who are like, ‘Everything I know about this disease is it’s super bad,’” Wolf said. “So, when they come in they would like an element of security to say, ‘Well, do a test and tell me if I have it or don’t.’”
Zane says patients at University of Colorado Hospital with coronavirus symptoms who aren’t ill enough to be admitted often have a lot of questions before they’re released. He said he wants people to know it’s perfectly normal for them to be sent home.
“They are not being turned away,” he said. “That’s really important. They are being treated and evaluated. We will treat everybody and take care of everybody. There is a very high likelihood, though, that you’ll be discharged. And it’s not being sent away from the emergency department.”
In fact, Zane says, the majority of patients who come to emergency departments — whether it’s for coronavirus or another ailment — are discharged.
Both Wolf and Zane say patients are directed to come back if their symptoms worsen. An extremely high fever with a headache or shortness of breath that becomes severe are indicators that emergency care is required. If patients are able, they are urged to use telemedicine before going to an ER.
“Mild shortness of breath is when you are walking up the stairs and you just feel like you’re a little more winded than you usually are if you run up the stairs,” Zane said. “Severe shortness of breath is where you have trouble speaking in sentences without taking big, deep breaths. That’s a good way to describe it — where you would have to take breaths midsentence where you otherwise wouldn’t.”
Zane said doctors are able to quickly tell how serious your shortness of breath is. “What we can do is see if you’re breathing faster than is safe,” he said. “We can check the level of oxygen in your blood. We’ve had patients who feel very short of breath, but the level of oxygen in their blood is normal. Although it may be a little uncomfortable, it’s very safe to be discharged home.”
Zane said Coloradans can help doctors by staying home and continuing to avoid contact with others.
“We will define our own destiny by how we can do this,” he said. “There is no ambiguity about that. As bored as they are and as hard as this is, doing this for the next two to five weeks — whatever that number is — will be absolutely destiny-defining for the state of Colorado.”