British Columbia

Invisible COVID-19 patients are not out there, says emergency room doctor who had feared a flood

Emergency room doctors say their confidence in loosening lockdown restrictions is growing, as the number of COVID-19 patients admitted to intensive care falls

Doctor urges people not to interpret relaxed restrictions as 'carte blanche' to go back to normal

Doctors wait for patients at a COVID-19 testing facility in New Westminster, B.C. (Maggie MacPherson/CBC)

Emergency room doctors say their confidence in loosening lockdown restrictions is growing, as the number of COVID-19 patients admitted to intensive care falls.

A month ago, Dr. Jeff Eisen feared there were thousands of invisible patients in the community with mild or no symptoms.

"It was legitimate to wonder if there was a flood of patients out there that we weren't aware of. Over the past month, that has not panned out," said Eisen, who works at Victoria General and Royal Jubilee hospitals.

"The fact that we are seeing fewer and fewer patients coming in with respiratory symptoms tells me that they are not out there."

He said in novel coronavirus outbreaks around the world a certain percentage of people get sick enough that they show up in hospital.

To him, the tally of confirmed COVID-19 cases is less interesting than the number of infected people admitted to ICU with severe breathing problems.

"The concern that everybody is worried about is that there are thousands of people walking around in the grocery store that are actually sick. I don't think that's actually the case," said Eisen.

Despite declining ICU admissions, doctors would like more information and that comes from more testing and eventually serology or blood testing for antibodies that they say is needed to be sure the community is safe.

'There's no way to know if you have herd immunity — unless you test the herd," said Eisen.

Dr. Daniel Kalla, the head of the emergency department at St. Paul's and Mount Saint Joseph Hospital, agrees

"I hope we'll catch up with Alberta. But I do think we're going in the right direction when it comes to testing. I don't think you can know where you're out, till you have a proper sampling of the whole community. I'm hopeful we will do that," said Kalla. 

Want to know what it's like to get tested for COVID-19 in a drive-thru? Watch this:

As of April 9 anyone with symptoms of COVID-19 in B.C. can be assessed and tested for the disease caused by the novel coronavirus. 0:16

He said serology testing in California and other places suggest that the virus may be much more widespread than official case tallies reflected. In one preliminary study by Stanford researchers of Santa Clara County in California, results suggested 50 to 85 times more COVID-19 cases than those confirmed. A preliminary study by the University of Southern California and the L.A.County Department of Public Health also suggested community spread could be 28 to 55 times higher than the total confirmed cases.

But the methodology used in both California studies is now being criticized.

Front-line doctors doubt community spread is anywhere near these rates in B.C.

"Since April 1st, we've seen a decline in that number which suggests to me there is no way that the rate of the infection is increasing in the community, or we could see the curve go very much in the opposite direction," said Kalla.

The hospital occupancy rate also fell to 62.5 per cent on Thursday, another comforting number.

But the total number of British Columbians exposed to the virus remains unknown.

On April 9, doctors got a provincial health directive allowing them to broaden testing to any patient with symptoms.

Kalla says that's the right direction, but not enough. Up until now, B.C. has averaged about 1,200 tests a day and health care front-liners would like to see that number match Alberta's goal for May of 20,000 tests a day.

Will not spread as wide going forward

Kalla said he is less fearful about a second wave of the virus, if health officials loosen the lockdown.

Initially, B.C. was mainly testing travellers and vulnerable populations, but Dr. Henry says anyone who has symptoms of COVID-19 can now be tested for the disease. 1:47

"I'm much more confident about that because the problem is we were going blind when the first outbreak happened. We were playing catch up the whole time."

Now, he says, public health has better surveillance, contact tracing and people know the rules. Plus localized quarantining could be used to deal with new waves of virus.

"If we open things up and relax social distancing and there's another outbreak, I think we'll recognize it quickly. I don't think it will ever spread as widely and freely in the community again going forward," said Kalla.

Eisen says he's also more confident but adds a note of caution. The virus won't vanish.

"The thing that worries me is that the general public will take any relaxation of restrictions as carte blanche to carry on with the old normal life."

Watch a demonstration of COVID-19 testing:

A look at what patients could expect if they end up in an emergency room with COVID-19 symptoms. 1:59

About the Author

Yvette Brend is a CBC Vancouver journalist. Yvette.Brend@CBC.ca @ybrend

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