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. 2020 Nov 28;7(1):e603.
doi: 10.1002/ams2.603. eCollection 2020 Jan-Dec.

Impact of non-pharmaceutical interventions for the COVID-19 pandemic on emergency department patient trends in Japan: a retrospective analysis

Ichiro Sekine  1 , Haruki Uojima  2 , Hiroshi Koyama  3 , Tadashi Kamio  3 , Morihiko Sato  4 , Tadatsugu Yamamoto  1 , Kiyomitsu Fukaguchi  1 , Hiroyuki Fukui  1 , Hiroshi Yamagami  1
Affiliations

Impact of non-pharmaceutical interventions for the COVID-19 pandemic on emergency department patient trends in Japan: a retrospective analysis

Ichiro Sekine et al. Acute Med Surg. .

Abstract

Aim: The coronavirus disease (COVID-19) pandemic massively impacted emergency department (ED) visits. The unavailability of specific therapies or vaccines has made non-pharmaceutical interventions (NPIs) an alternative strategy for COVID-19. We assessed the impact of NPIs (nationwide school closures and state of emergency) on ED visits during the COVID-19 pandemic in Japan.

Methods: This retrospective study compared the trends in ED visits from 1 January to 25 May, 2020 (during the pandemic) with the average during 2015-2019 (before the pandemic). The primary end-point was the change in the number of ED visits during the COVID-19 pandemic with those from before the pandemic, with the NPI application stratified across four periods in 2020: Period 0 (1-15 January), no COVID-19 cases detected in Japan; Period I (16 January-1 March), initial COVID-19 outbreak; Period II (2 March-15 April), nationwide school closures; Period III (16 April-25 May), state of emergency.

Results: Compared with before the pandemic, the number of walk-in ED visits significantly decreased by 23.1%, 12.4%, and 24.0% (4,047 versus 3,111; 3,211 versus 2,813; and 3,384 versus 2,573; P < 0.001 for all) in Periods I, II, and III, respectively. The number of ambulance ED visits during the pandemic significantly increased by 8.3% in Period I (1,814 versus 1,964, P = 0.002), whereas there was no significant change in Periods II and III with 2.7% and -3.1% (1,547 versus 1,589 and 1,389 versus 1,346; P = 0.335 and P = 0.284, respectively).

Conclusions: The application of an NPI during the COVID-19 pandemic could have significantly reduced patient attendance in the ED.

Keywords: COVID‐19; emergency department; non‐pharmaceutical intervention; severe acute respiratory syndrome coronavirus 2; state of emergency.

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Conflict of interest statement

Approval of the research protocol: This study was approved by the Tokushukai Group Ethical Committee (TGE01518‐024). Informed consent: N/A. Registry and the registration no. of the study: UMIN Clinical Trials Registry, UMIN000041073. Animal studies: N/A. Conflict of interest: None.

Figures

Fig. 1
Fig. 1
Trends in ambulance‐conveyed emergency department (ED) visits to Shonan Kamakura General Hospital (Kanagawa, Japan) before and during the coronavirus disease (COVID‐19) pandemic. The blue line represents the trends during the coronavirus disease pandemic, and the green line represents the pre‐pandemic trends (the average during 2015–2019). The analyses of the number of ED visits in the pandemic and pre‐pandemic periods are compared using the Poisson regression analysis.
Fig. 2
Fig. 2
Trends in walk‐in emergency department (ED) visits to Shonan Kamakura General Hospital (Kanagawa, Japan) before and during the coronavirus disease (COVID‐19) pandemic. The blue line represents the trends during the coronavirus disease pandemic, and the green line represents the pre‐pandemic trends (the average during 2015–2019). The analyses of the number of ED visits in the pandemic and pre‐pandemic periods are compared using the Poisson regression analysis.
Fig. 3
Fig. 3
Flowchart showing the proportion of patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) among those suggested of having coronavirus disease (COVID‐19) in the emergency department (ED) at Shonan Kamakura General Hospital (Kanagawa, Japan).
Fig. 4
Fig. 4
Graph showing the incidence of suggested coronavirus disease (COVID‐19) cases (by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) test result) at Shonan Kamakura General Hospital (Kanagawa, Japan) during the study period. ED, emergency department.
See this image and copyright information in PMC

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