ROCHESTER, Minn. -- As COVID-19 swept into the U.S., hospitals across the country have reported that their emergency departments are emptying out. In a new study published Monday in JAMA Internal Medicine, a team of researchers from multiple institutions provides insights into this phenomenon.
"We knew there were major changes in ED (emergency department) visit volume, but we didn't know how different communities were affected. It was especially important to know how much ED visits declined in areas that had a lot of COVID-19 cases, compared to those with fewer cases. Health care providers and our communities need real evidence for decision-making," says Molly Jeffery, Ph.D., scientific director of Emergency Medicine Research at Mayo Clinic. Dr. Jeffery is the study's lead author.
The investigators collected information on emergency department visits and subsequent hospital admissions from Jan. 1 to April 30. Study data came from 24 emergency departments across five health care systems. Included in the study were four emergency departments in Colorado and five emergency departments in each of these states: Connecticut, Massachusetts, New York and North Carolina. These emergency departments spanned rural, urban and suburban settings, and included regions with a high COVID-19 caseload and regions with lower case counts. Annual baseline volume across these emergency departments ranged from 12,500 to 115,000 visits.
"We found a substantial decline in emergency department visits -- between 42% and 64% -- during the four-month period of our study, but most of that decline happened over just a few weeks in March," says Dr. Jeffery. "The largest declines were seen in the areas that had a lot of COVID-19 cases. If you think about that, it means that even more people with problems other than COVID-19 must have avoided the ED during this period."
These declining visit numbers corresponded to growing awareness of COVID-19 through increasing coverage in the national and local media, as well as the timing of a good portion of state-issued stay-at-home orders. Although the researchers were unable to determine specific numerical reductions from particular causes, they offered three likely explanations.
"Reductions in ED utilization could reflect: (1) failure to seek care by patients with serious or life-threatening conditions, including those unrelated to COVID-19; (2) avoidance of the ED for nonemergent conditions; or (3) displacement of ED care to other venues, such as telemedicine visits."
Conversely, the researchers noted that hospital admission rates from the emergency department remained relatively stable across the health systems until there was a local increase in COVID-19 cases, at which time there was an uptick.
"This increase in hospital admissions was dramatic," says Edward Melnick, M.D., an emergency medicine physician at Yale New Haven Health in Connecticut. Dr. Melnick is the study's senior author.
"Here at Yale New Haven, we saw a 36% increase, the median increase across the five systems," he says. "In New York, the epicenter of the largest outbreak of COVID in the U.S., the relative increase of hospital admissions at Mount Sinai Health was 149% -- so two-and-a-half times the usual rate of emergency admissions."
The other systems also showed significant relative increases of emergency hospital admissions: