A&E chiefs believe many people who could be saved are too scared to go to hospital

The coronavirus crisis has led to a sharp rise in the number of seriously ill people dying at home because they are reluctant to call for an ambulance, doctors and paramedics have warned.

Minutes of a remote meeting held by London A&E chiefs last week obtained by the Guardian reveal that dozens more people than usual are dying at home of a cardiac arrest – potentially related to coronavirus – each day before ambulance crews can reach them.

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And as the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived.

The A&E chiefs’ minutes said that on the weekend of 4-5 April the number of 999 calls in which someone had had a cardiac arrest rose from 55 a day in normal times to 140. Most of the people concerned died, doctors said.

The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden.

“People don’t want to go near hospital,” the document said. “As a result salvageable conditions are not being treated.”

The stark warning of another hidden toll caused by the pandemic followed the Guardian’s disclosure that hundreds of victims dying in care homes were not being included in official counts – with fears that the toll has since grown to thousands.

Those dying at home of coronavirus would also not be included in the initial daily government updates.

With the number of patients attending A&E plummeting, NHS leaders moved last week to urge the public to continue to seek help if they have a serious health problem. An NHS spokesperson said: “Anybody who needs urgent help – people experiencing heart failure, or expectant mums worried about their baby – should absolutely come forward and seek help from their local NHS.

“There is no doubt that, as the chief medical officer said, coronavirus is putting more pressure on NHS services, but NHS staff are freeing up thousands more beds for critical care whilst also keeping other essential services running, so parents, relatives and anyone worried about their health should continue to use their NHS.”

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The minutes of the online meeting, held on Monday 6 April, said that “some patients [are] coming to harm as not coming in or being brought in”.

“Patients with conditions that are time critical re not presenting and concerns rising as to how we manage these patients, eg, no longer able to perform an open appendectomy [for an inflamed appendix],” they continue.

A&E doctors believe that many of the extra deaths from cardiac arrest are due to Covid-19 which, by making it difficult for someone to breathe, puts serious strain on their heart. “Of these 85 extra cardiac arrest deaths a day in London, they must be mainly Covid,” said the head of one A&E department.

Leading medical organisations have voiced anxiety that some people are inadvertently damaging their own health, and even risking their life, by shunning NHS care. People are either too scared to go to hospital or do not want to add to the strain on the NHS when it is under its greatest ever pressure with Covid-19, they said.

“GPs are noticing an increase in people dying in the community, often at home,” said Prof Martin Marshall, the chair of the Royal College of GPs (RCGP). “If patients are dying at home because they are fearful of seeking medical attention, or concerned about being a burden, then it is incredibly concerning.

“We would reassure them that the NHS is here for them, and we will do whatever we can to keep them as safe as possible when they access care.”

Quick guide What to do if you have coronavirus symptoms in the UK Show Hide Symptoms are defined by the NHS as either: a high temperature - you feel hot to touch on your chest or back

a new continuous cough - this means you've started coughing repeatedly NHS advice is that anyone with symptoms should stay at home for at least 7 days.

If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home. After 14 days, anyone you live with who does not have symptoms can return to their normal routine. But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start. Even if it means they're at home for longer than 14 days. If you live with someone who is 70 or over, has a long-term condition, is pregnant or has a weakened immune system, try to find somewhere else for them to stay for 14 days. If you have to stay at home together, try to keep away from each other as much as possible. After 7 days, if you no longer have a high temperature you can return to your normal routine. If you still have a high temperature, stay at home until your temperature returns to normal. If you still have a cough after 7 days, but your temperature is normal, you do not need to continue staying at home. A cough can last for several weeks after the infection has gone.

Staying at home means you should: not go to work, school or public areas

not use public transport or taxis

not have visitors, such as friends and family, in your home

not go out to buy food or collect medicine – order them by phone or online, or ask someone else to drop them off at your home You can use your garden, if you have one. You can also leave the house to exercise – but stay at least 2 metres away from other people. If you have symptoms of coronavirus, use the NHS 111 coronavirus service to find out what to do. Source: NHS England on 23 March 2020

Paramedics in London, other parts of England and Northern Ireland have told the Guardian how they are turning up at unprecedentedly large number of incidents where the ROLE – recognition of life extinct – procedure has been carried out because the patient is already dead.

“We are going to more people that we are pronouncing dead. We’d average one a week normally, but I had days a week ago when I was doing three or four a day,” said one London ambulance service (LAS) paramedic.

Sources at the LAS said that its crews are attending many more 999 calls than usual involving a cardiac arrest where the person has already passed away. It is unclear how many are occurring in people with Covid-19, said officials, speaking anonymously.

Those dying at home include people whose underlying health is poor because they have pre-existing conditions, and then they get Covid-19, according to a paramedic with the East of England Ambulance Service.

“For some with diabetes or chronic obstructive pulmonary disease it wouldn’t take much to tip them over the edge,” the paramedic said. “It’s quite scary. there are lots more out there that aren’t being counted.

“People are being told to self-isolate, they get poorly at home and speak to doctors or NHS 111 before they call us. They get to the point where they are already very poorly. Perhaps they’re on their own or haven’t recognised [how unwell they are].”

Dr Katherine Henderson, the president of the Royal College of Emergency Medicine, which represents A&E doctors, said she was worried that the recent 29% fall in people attending A&E may mean that people who need urgent medical help are not seeking it.

“We are concerned that some people, particularly parents of young children, might not be seeking medical help when they probably need it for fear of contracting Covid-19.

“Some may also not be seeking help as they worry about adding pressure to the NHS at a time of crisis. But patients should not risk their health – and lives – by staying away as part of an understandable but undue effort to help the NHS. They should seek help if they need it – it is what we are here for.”

Dr Simon Walsh, the British Medical Association’s lead for emergency care, voiced his unease too.

“While it’s understandable that there may be fewer broken bones and sprains because of the confinement, the reduction in patients with diseases such as heart attacks, strokes and appendicitis, which we would expect to occur at a relatively constant rate at any one time of the year, is of concern.”

Marshall, the chair of the RCGP, added: “It’s vital that during this Covid-19 pandemic people continue to seek medical attention for conditions and illnesses unrelated to the virus – and if it’s an emergency, that they call 999 for help.

“The last thing we want is for patients to wait too long before seeking help, and that help arriving too late as a result.”