Getting to the hospital during a pandemic

The 41-year-old living in Toronto had a history of kidney stones. She had been feeling some renal colic symptoms recently, a type of pain that can indicate the stones are worsening.

But during the coronavirus pandemic, routine medical appointments get a little more complicated. Was it worth it to go in? "It was a solid 'maybe,'" she said.

On April 15, she had a six-month follow-up appointment for a kidney ultrasound at Toronto Western Hospital. Although other hospital departments weren't seeing patients during the pandemic, radiology was still open -- with strict social distancing rules.

If her kidneys went unchecked, she worried there was a possibility she'd end up in the ER in June passing kidney stones.

Many of us will face our own version of Sue-Wah-Sing's decision in the coming months. So here's what you you need to know if you're going to the hospital, clinic or doctor's office in the time of coronavirus.

Call your doctor first

"Emergencies still continue to happen," said Dr. Patrice Harris, president of the American Medical Association. During the pandemic she advised patients to still call 911 for urgent needs, particularly chest pain or stroke symptoms.

Beyond that, though, Harris cautioned that there's no "one-size-fits-all" approach" when assessing whether or not you should go for an in-person hospital visit.

That's likely to be determined by your individual case, the health care available in the patient's area and the severity of the Covid-19 environment in your region.

But Harris noted there was still one constant through all of that: shared decision-making. "Patients shouldn't need to make decisions alone about whether their problem is urgent or emergent," she said.

Certain new symptoms or follow-ups for existing conditions might warrant starting with a telehealth appointment with your doctor. If it turns out you need to go to the hospital, call the hospital ahead of time to learn which entrance to use to avoid areas where Covid-19 patients are receiving treatment.

"Please don't let the pandemic stop you from reaching out to your physician," Harris said. "You don't want symptoms now to go unreviewed and then turn out to be worse later."

Decide with your doctor whether you should seek care in person or online

In the US, the Centers for Medicare and Medicaid Services has published a tiered framework to help explain how hospitals can still offer certain in-person services during the pandemic.

In the first tier, the guidelines recommend postponing in-person hospital visits for routine primary care, preventive medicine and services such as supervised exercise therapy.

In the second tier, initial visits for services such as evaluation of nonurgent symptoms consistent with Covid-19, pediatric vaccinations or early childhood care can be done via telehealth, with subsequent follow-ups at appropriate care sites.

The third tier describes the most acute issues, and the government's framework recommends proceeding directly to in-person hospital or clinic visits. In these instances, CMS urges patients to seek in-person care if forgoing it would result in harm.

One immediate rule of thumb to determine is whether you'd be capable of calling for help later if you don't now, said Doug Lindsay, a personal medical consultant who advises patients on how to seek care for complicated conditions.

If there's a likelihood of heart attack, stroke or severe injury, get the patient to the emergency room.

"If you're struggling to breathe, then you want an ambulance because the ambulance is a mini-hospital," Lindsay said. "If you're just sick, then have someone drive you."

If you're unsure whether it's the right move to go to the hospital, calling the doctor's office or their after-hours exchange can help get you answers before setting out into an uncertain situation.

"You should be calling their exchange and talking this through," Lindsay said. "There's nothing new about calling that [number]."

Stay protected, and physically distanced, at the hospital

Hospitals can be busy, high-traffic areas with lots of people, which is why Lindsay advised patients to lower risk by seeking care at smaller clinics or urgent care centers, rather than sprawling hospital centers.

And if you're choosing between urgent care clinics, look for one that provides X-rays in-house. That way you don't have to take the risk of a second trip to another health facility.

When you walk in to a clinic or hospital, you're likely to have your temperature taken or to be asked

questions about your symptoms. This is designed to screen out whether you might have Covid-19.

When Sue-Wah-Sing walked into Toronto Western for her kidney ultrasound, she was given a yellow "PASS" sticker signifying she cleared the hospital's Covid-19 symptom screening. And while the hospital has seven entrances, it had kept only four open to be able screen each person entering the building.

Patients weren't allowed to bring visitors with them, unless they were providing translation or another essential service. And the hospital's food court was still serving food, but it had taken away the chairs and tables so people couldn't congregate there to eat.

On the way up in the elevator, she saw three pairs of little yellow feet painted on the floor, showing both the number of people allowed in the cramped space and how they could position their bodies each 6 feet away from each other.

Finally, in the radiology department's waiting room, groups of five seats were all roped off, so that patients could maintain social distancing by only sitting in every sixth chair.

After seeing all the extra measures in place, Sue-Wah-Sing said she felt being at Toronto Western Hospital during the pandemic was actually "one of the safest places to be."

After Sue-Wah-Sing underwent the ultrasound in the Toronto hospital, she went straight home to have a telehealth appointment with her doctor to discuss the results.

Prioritize your own health

Start out with keeping a daily log of your symptoms. One key part of deciding whether to go to the doctor is to keep a log of your symptoms every day, noting how severe they are along with where you were or what you were doing as the symptoms came on.

"Every doctor tells every chronic disease patient to do that," Lindsay said.

Understanding her past health challenges and knowing how to monitor her own symptoms was key to Sue-Wah-Sing making the right call to go the hospital.

It was a risk to go in, especially at this phase of the pandemic, she said. She would have considered canceling the six-month follow-up had she been symptom-free. And her symptoms were still mild enough that she felt she could have afforded to wait a few more weeks for the ultrasound if it had already been scheduled further out.

"But it was totally worth it," she said. "If it had ended up being a stone, I'd have been in the ER."