Less Patients Visiting Emergency Department During COVID-19

Kathleen Hartnett, PhD, MPH

The article, “Emergency Departments See Unprecedented Drop in Visits During COVID-19,” was originally published on ContagionLive.

After coronavirus disease 2019 (COVID-19) was declared a national emergency, emergency department visits for reasons unrelated to the pandemic drastically decreased.

In a study highlighted in a recent Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention (CDC), a team of investigators reviewed electronic health data from the National Syndromic Surveillance Program from March 29-April 25, compared with a similar time period a year ago.

The program includes data from all states except Hawaii, South Dakota, and Wyoming.

“The COVID-19 pandemic dramatically changed the number of Americans seeking care in emergency departments,” CDC epidemiologist Kathleen Hartnett, PhD, MPH, told Contagion^®. “While the declines were sharpest among children and in regions where the pandemic was most severe, the drop-in visits occurred in all age groups and across the country.”

In the CDC’s history of tracking these data, Hartnett said, there has never been such an observed decline on this scale.

Emergency room visits dropped 42% during the 4-week time period, falling to 1.2 million visits per week from 2.1 million visits per week in 2019. The declines were greatest among children age 14 and younger (71%), females (45%) and those living in the Northeast (49%).

“CDC’s National Syndromic Surveillance Program (NSSP) collects data from emergency departments in real-time, so that allowed state health departments and CDC a critical opportunity to monitor these declines as they happened,” Hartnett told Contagion^®. “While we were able to monitor these trends in real-time, the declines we saw remain striking and highlight why it is critical to ensure people have rapid access to medical advice to help them assess when they need to go to an emergency department.”

ED visits hit the lowest point during the week of April 12-18 before beginning to climb.

“Although the number of emergency department visits has steadily increased from the low in April, it remains to be seen how the pandemic will continue to affect people’s decisions about seeking emergency medical care,” Hartnett told Contagion^®. “There may be lasting effects in individuals who postpone care for life-threatening conditions such as heart attack and stroke that can lead to death or permanent harm if not treated in time.”

Diagnostic categories that saw noteworthy declines include abdominal pain and related symptoms (-66,456), musculoskeletal pain excluding low back pain (-52,150), essential hypertension (-45,184), nausea and vomiting (-38,536), other specified upper respiratory infections (-36,189), sprains and strains (-33,709), and superficial injuries (-30,918), nonspecific chest (-24,258) and acute myocardial infarction (-1156).

Visits for some diagnostic categories increased, including COVID-19 (17,774); pneumonia not caused by tuberculosis (3911); other lower respiratory disease (1506); respiratory failure, insufficiency, or arrest (776); cardiac arrest and ventricular fibrillation (472).

“It was concerning to see an increase in the number of visits for cardiac arrest and ventricular fibrillation when the number of visits for myocardial infarction and nonspecific chest pain decreased,” Hartnett told Contagion^®. “That suggests that some people may be delaying care for life-threatening conditions.”

The report noted that the trend may disproportionately affect people who lack access to primary care and telemedicine. Limitations of the study include changes in hospitals reporting to the NSSP, with an average of 3173 hospitals reporting in April 2019, compared with 3467 in April 2020. There were also limitations in diagnostic codes, which are missing or used inconsistently in some cases.

“Patients need rapid access to medical advice to help them assess when they need to go to an emergency department,” Hartnett told Contagion^®. “Wider access is needed to services like triage lines that can help patients identify symptoms that require immediate treatment.”

Hartnett said they hope to see continued expanded services due to the pandemic, while the recommendation remains that unnecessary in-person care continues to be conducted virtually.

“Health care systems can also address public concern about exposure to SARS-CoV-2 in the emergency department through continued adherence to CDC infection prevention and control recommendations, such as immediately screening every person for fever and symptoms of COVID-19, and maintaining separate, well-ventilated triage areas for patients with and without signs and symptoms of the virus,” Hartnett said.

Further analysis of trends in emergency department visits is ongoing.

The effects the pandemic is having on health care services unrelated to the SARS-CoV-2 virus are widespread. Another recent study showed that childhood vaccination coverage has declined sharply during the pandemic.

The pandemic’s transformative effects on the health care system include an emphasis on telemedicine.