The impact of the COVID-19 pandemic on emergency department visits and patient safety in the United States

Abstract

Background: COVID-19 pandemic effects are still being elucidated. Stay-at-home orders and social distancing compounded with COVID-19 concerns have caused significant disruptions in daily life. One notable effect of these variables may be a change in the number of emergency department (ED) visits. This study aims to investigate the effects of COVID-19 on ED visits, and possible reasons for changes.

Methods: Retrospective analysis using CDC data for ED visits and percentage of visits for COVID-19-Like Illness (CLI) and Influenza-Like Illness (ILI). Google Trends was used to assess COVID-19 public awareness. Motor vehicle collision (MVC) data was collected from cities, which reported current data. A descriptive statistical analysis and two-sample t-test was performed on ED visit data to assess for significance and a descriptive analysis was conducted to assess COVID-19's impact on MVCs.

Results: The mean number of ED visits per week for the last four weeks of available data during the pandemic was significantly less than the four weeks prior to COVID-19 pandemic (p = 0.008). The ED visit decrease per week varied by region, with Region 1 having the greatest decrease (45%). MVCs decreased substantially across all cities studied, with New York City and Baton Rouge experiencing the greatest decrease (66%) during the pandemic.

Conclusion: A number of factors have likely contributed to the substantial decrease in ED visits observed in this study. In light of these findings, it is important to raise patient awareness regarding acute conditions that are deadlier than COVID-19 and require immediate medical intervention to ensure recovery.

Keywords: Acute medical conditions; COVID-19 pandemic; Emergency department visits; Medical emergencies; Motor vehicle collisions.

Fig. 1

Total number of ED visits per week and percent of total visits for COVID-19-Like Illness (CLI) or Influenza-Like Illness (ILI) from the week of September 29, 2019 to the week of April 5, 2020.

Fig. 2

Total number of ED visits per week and Google trends search interest over time for the term coronavirus (A value of 100 is the peak popularity for the term. A value of 50 means that the term is half as popular. A score of 0 means there is not enough data for the term).

Fig. 3

Mean number of ED visits per week for a four week period prior to increased COVID-19 awareness in the US, PR and GU (from the week of December 15, 2019 to the week of January 5, 2020: derived from Google search trends in the US, PR and GU) and the mean number of ED visits for the last four weeks of available data at the time of writing (from the week of March 15, 2020 to the week of April 5, 2020). The mean number of ED visits significantly [t(3) = 6.30; *p = 0.008] decreased during the current outbreak. Error bars represent standard deviation.

Fig. 4

Represents the percentage decrease in the mean number of ED visits per week by region using data from a four week period prior to increased COVID-19 awareness in the US, PR and GU (from the week of December 15, 2019 to the week of January 5, 2020: derived from Google search trends in the US, PR and GU) and the last four weeks ED visit data available at the time of writing (from the week of March 15, 2020 to the week of April 5, 2020). Region 1 (CT, ME, MA, NH, RI, VT), Region 2 (NJ, NY, PR), Region 3 (DE, DC, MD, PA, VA, WV), Region 4 (AL, FL, GA, KY, MS, NC, SC, TN), Region 5 (IL, IN, MI, MN, OH, WI), Region 6 (AR, LA, NM, OK, TX), Region 7 (IA, KS, MO, NE), Region 8 (CO, MT, ND, SD, UT, WY), Region 9 (AZ, CA, GU, HI, NV), Region 10 (AK, ID, OR, WA).

Fig. 5

The comparison of motor vehicle crashes by city from before (from the week of March 15, 2019 – the week of April 5, 2019) and during the COVID-19 outbreak (from the week of March 15, 2020 – the week of April 5, 2020).