ED visits declined more than 63% in New York amid COVID-19

From January to April, there was a 63.5% decline in emergency visits in New York, where the COVID-19 pandemic was most severe in the United States, according to a recent study published in JAMA Internal Medicine.

During this time, hospital admission rates increased 149% in the state, Molly M. Jeffery, PhD, scientific director of the Mayo Clinic's Division of Emergency Medicine Research, and colleagues reported.

The researchers analyzed trends in four other states — Colorado, Connecticut, Massachusetts and North Carolina — and observed similar but less pronounced patterns.

“These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings,” they wrote.

Jeffery and colleagues examined data from 24 EDs in five health care systems from January to April. The annual ED volume before COVID-19 ranged from 13,000 to 115,000 visits.

After New York, the largest decline in ED visits occurred in Massachusetts (57.4%), followed by Connecticut (48.9%), North Carolina (46.5%) and Colorado (41.5%), according to the researchers. In late April, there was a small increase in ED visits in Massachusetts, Colorado and North Carolina. Meanwhile, from January to April, hospital admission rates increased 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado and 22% in North Carolina.

Trends in ED visits were similar across the states despite differences in local transmission patterns. The largest decrease in ED visits began the week of March 11, which corresponded with public health messaging about COVID-19, according to Jeffery and colleagues.

“A possible explanation for these temporal associations is that the public responded more to national-level risk messaging about COVID-19 than to changes in the local situation with regard to reported cases,” they wrote. “For example, individuals may have avoided seeking emergency care because of a fear of being exposed to COVID-19 in the ED, concerns about the possibility of extended wait times, or a sense of civic responsibility to avoid using health care services that others may have needed.”

In a related editorial, David L. Schriger, MD, MPH, professor of emergency medicine at UCLA, said the findings offer “a starting point for a careful examination of the appropriate use of emergency services in the months and years ahead.” He cited another report from the CDC that demonstrated decreases in ED visits for ambulatory care issues, including hypertension and episodic childhood illness, and increases in visits for mental health conditions and substance use disorders during the pandemic.

“These data suggest that patients who use the ED as a safety net are staying away, likely without an alternative option, whereas those who have lost access to mental health clinics and drug rehabilitation programs because of COVID-19–related closures continue to seek care in the ED because they have no other options,” Schriger wrote.

The changes in ED use further underscore the need for universal health insurance in the U.S., he added.

“Although the many failures of the U.S. health care system were evident before the pandemic, COVID-19 has added to the evidence of its insufficiencies, inefficiencies, and fundamental unfairness for both emergency services and routine care,” he wrote.

References:

• Jeffery MM, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.3288.
• Schriger DL. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.3265.