Emergency Department Patients in the Early Months of the Coronavirus Disease 2019 (COVID-19) Pandemic-What Have We Learned?

While attention was focused on the alarming increases in the number of patients going to emergency departments (EDs) in Seattle, Detroit, Chicago, and New York City in March and April 2020, visits to EDs throughout the rest of the US plummeted. As public health interventions to minimize the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) took effect, ED visits moderated even in cities hit hard by the first wave of the coronavirus disease 2019 (COVID-19) pandemic. These dramatic shifts in ED use raise questions about changes in care-seeking behavior among the public when experiencing acute illness and the recalibration that will occur in the months to come while we await an effective treatment for or vaccine against SARS-CoV-2. Although there are no immediately available US national data to fully measure the magnitude of the effects of COVID-19, the lay press described decreases in ED visits by as much as half the normal volume. A report from the United Kingdom1 mirrored these trends, with a 25% countrywide drop within 1 week of their national lockdown. From these early experiences with the pandemic, we have learned 3 lessons regarding the demand for ED care. These lessons have important implications for health systems adapting to changing health care use patterns as the epidemiology of COVID-19 evolves and communities reopen. First, ED demand is sensitive to factors related to the physical and social environment. Public health measures to counter the COVID-19 pandemic reduced the need for ED care by curtailing the spread of other infections and altering the epidemiology of injuries. A report from Japan2 described decreases in seasonal influenza activity concurrent with the COVID-19 response. Interventions such as closures, physical distancing, use of masks, and handwashing can be expected to reduce the transmission of many infectious diseases. These illnesses, particularly in children, are often why the public seeks care in EDs. In addition, the epidemiology of injuries treated in EDs shifted. Reports using location tracking data confirmed that the public generally adhered to the initial calls to stay home. Less vehicular travel translated into fewer collisions. Cities reported decreases in violent crime incidence with social distancing, although this observation was not uniform. In contrast, concerns have been raised regarding increases in childhood injuries and poisonings given greater exposure to the home setting as well as domestic violence related to the stresses of lost wages, food insecurity, and social isolation. Second, ED demand is sensitive to health care administrative and policy decisions. The COVID-19 pandemic disrupted norms for care delivery across all sectors of the US health system. In a matter of days, scheduled operations, procedures, and diagnostic tests were suspended to create additional hospital capacity.3 Meanwhile, primary and specialty care providers made rapid adjustments in practice models,4 including the use of centralized call centers and telehealth visits, while deferring less urgent encounters. Many of these tactics were specifically intended to better support patients at home and to divert them from the ED. These responses have major cascades to ED care. When fewer health services are offered overall, there are fewer adverse effects from medical and surgical treatment and fewer opportunities for clinicians to direct patients to the ED. In turn, there is less reliance on the ED for management of complications such as sepsis, wound infections, and symptoms like pain and nausea linked to surgical procedures. Author affiliations and article information are listed at the end of this article.