Abstract
IntroductionPublic health response to the coronavirus 2019 (COVID-19) pandemic has emphasized social distancing and stay-at-home policies. Reports of decreased emergency department (ED) visits in non-epicenters of the outbreak have raised concerns that patients with non-COVID-19 emergencies are delaying or avoiding seeking care. We evaluated the impact of the pandemic on ED visits at an academic tertiary care center.MethodsWe conducted an observational health records review between January 1–April 22, 2020, comparing characteristics of all ED visits between pre- and post-pandemic declaration by the World Health Organization. Measures included triage acuity, presenting complaints, final diagnoses, disposition, and mortality. We further examined three time-sensitive final diagnoses: stroke; sepsis; and acute coronary syndrome (ACS).ResultsIn this analysis, we included 44,497 ED visits. Average daily ED visits declined from 458.1 to 289.0 patients/day (−36.9%). For the highest acuity triaged patients there was a drop of 1.1 patients/day (−24.9%). Daily ED visits related to respiratory complaints increased post-pandemic (+14.1%) while ED visits for many other complaints decreased, with the greatest decline in musculoskeletal (−52.5%) and trauma (−53.6%). On average there was a drop of 1.0 patient/day diagnosed with stroke (−17.6%); a drop of 1.6 patients/day diagnosed with ACS (−49.9%); and no change in patients diagnosed with sepsis (pre = 2.8 patients/day; post = 2.9 patients/day).ConclusionSignificant decline in ED visits was observed immediately following formal declaration of the COVID-19 pandemic, with potential for delayed/missed presentations of time-sensitive emergencies. Future research is needed to better examine long-term clinical outcomes of the decline in ED visits during pandemics.
Highlights
Public health response to the coronavirus 2019 (COVID-19) pandemic has emphasized social distancing and stay-at-home policies
emergency department (ED) visits related to respiratory complaints increased postpandemic (+14.1%) while ED visits for many other complaints decreased, with the greatest decline in musculoskeletal (-52.5%) and trauma (-53.6%)
On average there was a drop of 1.0 patient/day diagnosed with stroke (-17.6%); a drop of 1.6 patients/day diagnosed with acute coronary syndrome (ACS) (-49.9%); and no change in patients diagnosed with sepsis
Summary
Public health response to the coronavirus 2019 (COVID-19) pandemic has emphasized social distancing and stay-at-home policies. On March 22, 2020, the World Health Organization (WHO) designated the outbreak of a novel coronavirus (SARS-CoV-2) first reported in January 2020 as an international pandemic causing coronavirus disease 2019 (COVID-19).[1,2,3] COVID-19 was thought to spread from person-to-person by respiratory droplets and contaminated surfaces or fomites, with asymptomatic transmission suspected.[4,5,6] In an effort to “flatten the curve” public health response to COVID-19 encouraged social distancing, selfisolation, and stay-at-home policies, employing media campaigns that highlighted the experiences in Lombardy, Italy, and New York City, NY, where hospitals were overwhelmed by COVID-19.7. The sudden drop in ED visits caused concern that patients with non-COVID-19 emergencies were delaying or avoiding seeking appropriate ED care during this pandemic
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