The burden of the pandemic on the non-SARS-CoV-2 emergencies: A multicenter study

Abstract

Background: Governments have implemented social distancing interventions to curb the speed of SARS-CoV-2 spread and avoid hospital overload. SARS-CoV-2 social distancing interventions have modified several aspects of society, leading to a change in the emergency medical visit profile.

Objective: To analyze the impact of COVID-19 and the resulting changes on the non-SARS-CoV-2 emergency medical care system profile.

Methods: This is a retrospective multicenter cross-sectional study evaluating medical consultations, urgent hospitalizations, and deaths in São Paulo, the largest city of the Americas. Changes in the medical visit profile according to demographic data and diagnoses were assessed. The change in mortality was also assessed.

Results: A total of 462,412 emergency medical visits were registered from January 2019 to July 2020. Of these emergency medical visits, only 4.7% (21,653) required hospitalization. Of all visits, 592 resulted in deaths, equivalent to 0.1% of the sample. There was a clear decreasing trend in the number of weekly emergency medical visits as social distancing was mandated by decree (Coef. -3733.13; 95% CI -4579.85 to -2886.42; p < 0.001). The number of medical visits for conditions such as trauma, abdominal pain, chest pain, and the common cold decreased (p<0.05). However, the number of medical visits for the following conditions did not change after the onset of the pandemic (p≥0.05): ureterolithiasis, acute appendicitis, acute cholecystitis, acute myocardial infarction, and stroke.

Conclusion: The COVID-19 pandemic has changed the non-SARS-CoV-2 emergency profile. The overall number of emergency medical visits has reduced. The mortality of non-SARS-CoV-2 emergencies has not increased in São Paulo.

Keywords: Emergencies; Emergency medical services; SARS-CoV-2.

Fig. 1

Flow diagram of all the emergency medical visits registered from January 2019 to July 2020.

Fig. 2

The change in the mean number of emergency medical visits (EMV) in 2019 and 2020. A: The overall number of emergency medical visits; B: The number of hospital admissions; C: The number of deaths.

Fig. 3

The change in the mean number of emergency medical visits (EMV) in 2019 and 2020 according to the diagnosis. A: Traumatic brain injury; B: Polytrauma; C: Scalp and facial injury; D: Abdominal pain; E: Ureterolithiasis; F: Acute appendicitis; G: Acute diverticulitis; H: Acute cholelithiasis; I: Chest pain; J: Acute myocardial infarction; K: Stroke; L: Common cold.