Why are Bay Area emergency rooms so empty?

Usually packed parking lots are empty. Hallways are silent. Vacant cafeterias are eerie.

In the absence of an anticipated coronavirus surge, Bay Area emergency room doctors and nurses say the ongoing pandemic has transformed hospitals into deserts.

Emergency visits have declined by more than half at Kaiser and Stanford. Santa Clara County's three public hospitals have seen just 35 percent of their typical daily ER traffic. Visits also have dropped substantially at Sutter, John Muir and at other health care systems across the region.

“It's kind of creepy, actually,” said Andra Blomkalns, chair of the Department of Emergency Medicine at Stanford, “particularly when we spent so much time really gearing up for this surge and all this flurry of activity and mental activity and supplies and things - and now it's sort of like, ‘OK, what do we do now?' ”

The surreal lulls in Bay Area ERs are even more stunning when contrasted with the tragic images of chaotic hospital wards overcrowded with gurneys as doctors and nurses scramble to keep up with a torrent of COVID-19 patients in New York and New Jersey.

In the Bay Area and California, the number of coronavirus patients appears to have peaked near the end of the first week of April before gradually trending lower. It has yet to reach anywhere near what health officials feared.

Experts say the Bay Area's coordinated first-in-the-nation, stay-at-home order March 17 is likely responsible. But the virus may be keeping others from the ER. Fewer heart attack and stroke patients are arriving, although there's some sobering data to suggest more people are dying at home instead. Car accidents are down, presumably because fewer people are on the roads.

And Stephen Parodi, associate executive director of the Permanente Medical Group at Kaiser Permanente Northern California, posited that the shelter-in-place ordinance is reducing broadly the spread of infectious diseases in the community aside from coronavirus.

That has some hospitals beginning to schedule necessary surgeries and tests that had been put off in preparation for an onslaught of very sick COVID-19 patients.

On Wednesday, Gov. Gavin Newsom said hospitals could begin scheduling some procedures but warned against bringing patients in for plastic surgery and other truly elective things.

At UC San Francisco, where the number of coronavirus patients has held relatively steady in recent days, doctors are beginning to plan to bring people in.

“That surge (of coronavirus cases) so far has not reached the level we had feared, so we are scheduling higher-priority surgeries for our oncology, neurology and cardiology patients,” said spokeswoman Suzanne Leigh.

The situation is similar at Stanford, Santa Clara County, Sutter Health and elsewhere.

“Ironically, it's actually easier to do some things now than it was six months ago,” said David Tong, director of the Mills-Peninsula Medical Center Stroke Program and regional director of stroke programs for Sutter's West Bay Region - whether that's a CAT scan or an MRI.

Still, doctors are concerned that some people may be taking the shelter-in-place mandate too far.

“For stroke in particular, the faster you treat the patient, the better the outcome is,” Tong said. “This is not the time to say I'll put off this weakness or slurred speech because you're going to miss the opportunity to be treated, and there's no reason to be concerned. We have the protocols in place to manage you in a safe way.”

Russell Rodriguez, director of emergency medicine for John Muir Health, has seen patients with chest pain, appendicitis, severe back pain and other maladies wait to come to the emergency room.

“We do not want patients to delay necessary care and come to us when a situation that could have been addressed earlier is now a much more complicated or debilitating injury or illness,” Rodriguez said. “We can safely care for any patient right now.”

Blomkalns from Stanford agreed.

Whether people are taking the shelter warning too seriously or are afraid to come in, she said, “that's what we're trying to combat. Being in the hospital is really safe.”

At Stanford, which has been ramping up coronavirus testing, all surgery patients are undergoing a test a few days before they are scheduled to come in for a procedure and get results within a few hours.

The data suggests it's too early to declare victory in the fight against the deadly disease and go back to normal.

According to an analysis by the Bay Area News Group, the overall number of hospital patients either suspected or confirmed to have the coronavirus in the Bay Area has dropped 26 percent, from a high of 839 on April 7 to 623 on April 20. But the April 20 total is slightly up from 611 the previous day, and the number of confirmed patients has remained relatively steady throughout this month. Across California, the number of coronavirus patients has dropped about 16 percent since its early April peak but ticked up in recent days.

What those numbers do in the future isn't certain.

“Eventually we have to open our lives back up,” Blomkalns said, “and the implications of that aren't necessarily very clear.”

Staff writer Harriet Blair Rowan contributed to this report.