Emergency department (ED) visits dropped significantly in March as the public responded to shelter-in-place messages as a result of the coronavirus 2019 (COVID-19) pandemic, according to a new study from researchers at Yale University and the Mayo Clinic.

The study looked at data from 24 EDs in 5 health care systems in Colorado, Connecticut, Massachusetts, New York, and North Carolina. The researchers analyzed daily ED visits and ED hospital admissions from January to April 2020, according to the study.

The data showed that as the COVID-19 case rates increased nationally in March and April, along with public messaging about social distancing, ED visits plunged in all 5 states compared with visits in January and February 2020. Further, visits fell by 41.5% in Colorado, at the low end, and by 63.5% in New York, at the high end.

During the same period, hospital admissions via the ED spiked, corresponding to state-level COVID-19 cases, rising by 22% in North Carolina to a high of 149% in New York.

“This is a case where public messaging appears to have worked too well,” said study author Edward R. Melnick, MD, in a press release. “We said, ‘stay home,’ and what people heard was: ‘Stay home at all costs to avoid COVID-19.’”

The researchers concluded that public health officials need to provide more nuance in their messaging across the states to clarify that it is crucial for people to continue visiting the ED for serious injuries and illnesses, according to the study.

The 24 EDs included in the study varied in size and location, serving from small rural areas to large urban populations with annual ED volume ranging from 12,500 to 115,000 patients per year. In addition, all 5 states experienced a decline in ED visits beginning the week of March 11, with the greatest decline in New York (63.5%), followed by Massachusetts (57.4%), Connecticut (48.9%), North Carolina (46.5%), and Colorado (41.5%). This declining trend lasted until mid-April, according to the study.

Melnick said they are continuing to expand the scope of their observations to include more states and to further analyze why people avoided going to the ED and what happened to them as a result. According to Melnick, they will be looking at “pre-hospital” data, such as people who called 911 and examining the numbers of deaths in the field. He noted that recent studies conducted elsewhere have confirmed that people with serious conditions did stay home to avoid going to the ED during the pandemic. 

“We want to understand what happened to people who didn’t make it to the hospital and the barriers to seeking and receiving care,” Melnick said in the press release. 

As a follow-up, Melnick examined additional ED visit trends and hospital admission rates from April to June 30. He reported that after April 8, ED visits in all 5 states began to increase, but never returned to baseline.  

REFERENCE
Emergency department visits plunged as COVID-19 cases climbed, Yale study finds. Yale News. https://news.yale.edu/2020/08/03/emergency-department-visits-plunged-covid-19-cases-climbed-study-finds. Published August 3, 2020. Accessed August 5, 2020.