Emergency Departments Now the Quiet Eye of the COVID Hurricane

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As the United States sees a steep rise in cases across several states like Arizona, California, Florida, and Texas, there is increasing concern for long-term implications within healthcare. Perhaps one of the most challenging aspects of healthcare’s response to coronavirus disease 2019 (COVID-19), is the ongoing fatigue and readiness as cases rollercoaster.

For so many of us, one rather odd piece to infection prevention in the time of COVID-19 is the more quiet moments when elective surgeries are cancelled, but COVID-19 units are busy and the hospital is a mixture of chaotic and quiet. When hospitals cancel elective surgeries to hold for surge capacity, it creates a unique situation in which we are busy while simultaneously being emptier.

In Arizona, this was the case and the stress of the COVID-19 units was drastically different than the quiet areas in the hospital that would normally be teeming with people due to have surgeries. Another piece to this though is that during the spring, many people avoided hospitals for two reasons. First, there was fear of catching COVID-19, which is always a misconception during outbreaks. Second, they hear on the news that hospitals are stressed and don’t want to add to it or were worried about quality of care.

A new study from the Center for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) points to this very issue by looking to the indirect effects of the pandemic on use of emergency departments for acute life-threatening conditions. By utilizing national syndromic surveillance data, they found that in the ten weeks following the declaration of COVID-19 as a national emergency, those emergency department visits were significantly impacted.

Overall, emergency department visits dropped 42% during the initial months of the outbreak. Their analysis focused primarily on myocardial infarction (MI), stroke, and hyperglycemic crisis, that occurred before and after the declaration. While this list is not exhaustive, it provides a good representation of the impact the pandemic had on emergency departments and thus hospitals. The authors note that “in the 10 weeks following the emergency declaration (March 15–May 23, 2020), ED visits declined 23% for MI, 20% for stroke, and 10% for hyperglycemic crisis, compared with the preceding 10-week period (January 5–March 14, 2020). EDs play a critical role in diagnosing and treating life-threatening conditions that might result in serious disability or death.”

Interestingly, the decline of these ED visits was similar across all age groups for MI and stroke, but for hyperglycemic crisis, those younger who were female tended to avoid the emergency departments. When looking across all ages and conditions, the researchers found that the largest differences were in those adults over 65 years of age going to the emergency department for MI or stroke, those between 18-44 and less than 18 years of age who would visit for hyperglycemic crisis.

While these findings aren’t particularly surprising, they do shed light on the implications for people experiencing medical crises and their willingness to seek care during a pandemic. It is critical that efforts be made to communicate to the public the safety of hospitals and not to avoid seeking care during events, like the COVID-19 pandemic. Delays in seeking care can result in potentially avoidable severe illness or death.