Kathleen Rice is an Assistant Professor in the Department of Family Medicine at McGill University.
On Thursday, March 19th my nine-month-old son, Thomas, became irritable and developed a runny nose. The crankiness intensified, and early Saturday morning he work up with a barking cough. My husband and I assumed that Thomas had a cold, but we were moderately concerned that it could be COVID-19 given it had been 14 days since we’d returned to Montreal from South Africa via Vienna. I called Quebec’s provincial telehealth service for advice on whether we should take Thomas for testing.
The telehealth nurse heard Thomas coughing in the background while I explained the reason for my call. Concerned, the nurse had me count Thomas’ breaths for 30 seconds, then announced that he was calling paramedics to take us to the Children’s Hospital. When the paramedics arrived they listened to Thomas’ lungs, then informed us that he needed to be checked out by a doctor. On that advice, we took Thomas to the Children’s Hospital via ambulance. While in the ambulance the paramedics called the hospital to warn them that a possible COVID-19 patient was on the way.
Upon arrival Thomas was given a mask to wear, which covered his eyes and was too long to loop over his ears. He pulled it off immediately. We were then taken straight to an isolated examination room where, over the next hour, we spoke over-the-phone with a physician who asked us to describe Thomas’ symptoms. Once we had answered her questions, she said that she would to examine Thomas. A few minutes later we saw two smiling women peeking us through a clear break in the frosted glass that separated us from the rest of the Emergency Department. We then received another phone call, and were told that Thomas would be tested for COVID-19 and would then be sent home. Confused, we asked if someone was coming to examine him. We were told that the examination had already taken place – the physician had looked at him through the glass. We remarked that we thought he would actually be physically examined by someone, and were told that the Emergency Department was trying out a new method of communicating with potential COVID-19 patients by phone, to minimize contact. Thomas, apparently, was the first patient they were trying this with. “If it’s not COVID-19, it’s probably croup,” said the doctor. “Cold air will help.” Shortly afterwards a nurse came in and swabbed Thomas’ nose, then sent us home with instructions to quarantine. We left the hospital in a taxi.
Mid-day Sunday we received a call from the hospital: Thomas’ COVID-19 test was negative. We were relieved, but also concerned about Thomas’ increasingly laboured, crackly breathing and growing lethargy. I tried calling telehealth again, this time waiting a long time before giving up. Now quite concerned about Thomas’ deteriorating condition, I phoned a friend who is a family doctor.
As I described Thomas’ symptoms to my friend over-the-phone, she interrupted me to ask, “Is that him that I can hear breathing?”
“Yes,” I said.
“Okay,” she responded, “I would take him back to the Children’s Hospital, and I would pack a bag for staying overnight. And I would do it in, like, the next thirty minutes.”
We were in a taxi back to the hospital fifteen minutes later.
At the Emergency Department we were quickly seen by a doctor who asked why we waited so long to bring Thomas in. We responded that he had deteriorated quickly, but also that we had brought him in the day before and had been sent home after an over-the-phone consult. Thomas was admitted, and we were moved up to the general ward.
Sunday night was rough, despite the great care that Thomas received from the doctors, nurses, and respiratory therapists on the pediatric general ward. At one point the PICU team came to examine him; there was discussion of moving Thomas to intensive care. But he managed to stabilize by morning, and by Tuesday he was able to breathe room air during the day. He was discharged on Thursday, March 26th.
Would my son have been sent home on Saturday morning were it not for the COVID-19 pandemic? I don’t know. But what I do know is that the imperative for caution when confronted with a potential COVID-19 patient meant that Thomas was not examined as thoroughly as he would have been had he presented at the Emergency Department prior to the COVID-19 pandemic.
The COVID-19 pandemic presents new and pressing challenges for the Canadian health care system. Meeting those challenges requires prudent, meticulous, and committed care for COVID-19 patients. Such care, however, cannot be at the expense of patients who present with more routine conditions. Not every cough is COVID-19, but a cough that is not caused by COVID-19 may still be a symptom of something serious. And the fact that a cough might be COVID-19 is certainly no reason to “phone it in.”