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Observational Study
. 2021 Oct;134(10):1247-1251.
doi: 10.1016/j.amjmed.2021.06.008. Epub 2021 Jul 7.

Masking for COVID-19 Is Associated with Decreased Emergency Department Utilization for Non-COVID Viral Illnesses and Respiratory Conditions in Maryland

Zachary D W Dezman  1 , Benoit Stryckman  2 , Kori S Zachrison  3 , Ryan M Conrad  4 , David Marcozzi  2 , Laura Pimentel  2 , Margaret Samuels-Kalow  3 , Charles B Cairns  5
Affiliations
Observational Study

Masking for COVID-19 Is Associated with Decreased Emergency Department Utilization for Non-COVID Viral Illnesses and Respiratory Conditions in Maryland

Zachary D W Dezman et al. Am J Med. 2021 Oct.

Abstract

Background: Masking, which is known to decrease the transmission of respiratory viruses, was not widely practiced in the United States until the coronavirus disease 2019 (COVID-19) pandemic. This provides a natural experiment to determine whether the percentage of community masking was associated with decreases in emergency department (ED) visits due to non-COVID viral illnesses (NCVIs) and related respiratory conditions.

Methods: In this observational study of ED encounters in a 11-hospital system in Maryland during 2019-2020, year-on-year ratios for all complaints were calculated to account for "lockdowns" and the global drop in ED visits due to the pandemic. Encounters for specific complaints were identified using the International Classification of Diseases, version 10. Encounters with a positive COVID test were excluded. Linear regression was used to determine the association of publicly available masking data with ED visits for NCVI and exacerbations of asthma and chronic obstructive pulmonary disease (COPD), after adjusting for patient age, sex, and medical history.

Results: There were 285,967 and 252,598 ED visits across the hospital system in 2019 and 2020, respectively. There was a trend toward an association between the year-on-year ratio for all ED visits and the Maryland stay-at-home order (parameter estimate = -0.0804, P = .10). A 10% percent increase in the prevalence of community masking was associated with a 17.0%, 8.8%, and 9.4% decrease in ED visits for NCVI and exacerbations of asthma exacerbations and chronic obstructive pulmonary disease, respectively (P < .001 for all).

Conclusions: Increasing the prevalence of masking is associated with a decrease in ED visits for viral illnesses and exacerbations of asthma and COPD. These findings may be valuable for future public health responses, particularly in future pandemics with respiratory transmission or in severe influenza seasons.

Keywords: COVID; Emergency medicine; Epidemiology; Public health.

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Figures

Figure
Figure
Year-on-year ratio of emergency department visits in the University of Maryland Medical System for total visits, exacerbations of asthma and chronic pulmonary disease, and non-COVID-19 viral illness (NCVI) with the prevalence of masking in Maryland State (Jan-Oct 2019 and Jan-Oct 2020) and the stay-at-home order (March 30-May 15, 2020). Ratios presented are 4-week moving averages. COVID-19 = coronavirus disease 2019.
See this image and copyright information in PMC

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