I have never seen my A&E department so still, so well-staffed and so uncannily calm. Usually, it’s a frenzy of swishing bodies as paramedics deliver new patients into a soundscape of PA announcements, bleeps and phone referrals. But this week, the “shop floor”, as we like to call it, is eerily quiet. Attendances in A&E departments across the country are down, in some cases by up to 80%.

We run simulations now, pounding down on the plastic chests of dummies, or click through e-learning modules. It feels a little like we have passed into the eye of the storm.

There is an obvious reason for the calm: people are not out and about. Pedestrians are not walking out in front of cyclists. Cyclists are not diving over car bonnets. Asthmatics are not wheezing through the fumes of Oxford Street. But there is something more worrying at play, too – people who need us are not coming in.

In normal times, you get used to the mix of patients who flow through the swinging doors of A&E. They come with problems relating to one of a few chronic diseases: diabetes, COPD or sickle cell anaemia. Then there’s the elderly – falling over, forgetting, or attending with care and social needs. There are patients who have had too much, or not enough, of their legal and illegal drugs of choice.

Then there are the more typical emergencies: wounds needing sutures, tummies needing surgeons, hearts needing cardiologists, a broad range of infections needing our drugs. A few weeks ago, a single entity displaced most of the above. A&E became a subspecialty, a Covid-19 ward. Those anxious days are behind us now, but we have not seen a return to normal.

In the week ending 10 April there were around 18,500 deaths in England and Wales – about 8,000 more than could be expected at this time of the year. Only 6,200 of those deaths has been attributed to Covid-19. So what of the rest? Some could be due to undiagnosed infection, a theory that marries well with the fact that Britain has failed to implement widespread testing, but there are corollaries to any outbreak and we are beginning, in this tumbleweed-week, to sense their cost.

I am worried that people who need us are not coming in, scared that hospitals are vectors for infection rather than cure. This was brought home the other day when my mum felt an intense pain in her lower leg and required my cajoling, via phone, to attend A&E, where she discovered that she’d snapped her achilles tendon.

Patients are tarrying when their chest pain kicks in, when they experience a sudden facial droop, or fall, or bleed, or faint. There is little reason to believe lockdown alone is shifting the numbers; it is more likely that the small tragedies of life are still playing out, out of sight, out of mind, only breaching the surface every now and then when we squint at statistics.

If this is the eye of the storm, the wind will pick up again soon. And then we might be dealing with a surge of patients who haven’t been able to attend their GP or regular clinic in months, whose operations have been cancelled and scans delayed, whose chronic diseases have flared.

I have sympathy with the instinct to steer clear. Despite the use of personal protective equipment, segregated wards, obsessive handwashing and the stringent infection control measures rolled out when MRSA was public enemy No 1, Covid-19 has been transmitted in hospital settings. Doctors are trying hard not to admit anyone without Covid-19, because our typical hospitalised patients – elderly and with overlapping disease – are particularly vulnerable to the virus.

But we can’t put our vulnerable people in germ-free bubbles. So, like much of medicine, this involves a delicate balance: we need to ensure that patients are admitted when they need to be, and at the same time we need to protect others by sending them home.

But to do this, we need to see you first, and the balance is getting skewed before we can make such a judgment. So if you need us now, get in touch. We’re here for you, waiting patiently, unrushed, game-faced. Please don’t let fear turn to harm. The virus will cause enough of that as it is.

• Stephen Fabes is an A&E doctor and author of the forthcoming book Signs of Life: To the Ends of the Earth with a Doctor







