Lessons from COVID-19 syndromic surveillance through emergency department activity: a prospective time series study from western Switzerland

Abstract

Objective: We aimed to assess if emergency department (ED) syndromic surveillance during the first and second waves of the COVID-19 outbreak could have improved our surveillance system.

Design and settings: We did an observational study using aggregated data from the ED of a university hospital and public health authorities in western Switzerland.

Participants: All patients admitted to the ED were included.

Primary outcome measure: The main outcome was intensive care unit (ICU) occupancy. We used time series methods for ED syndromic surveillance (influenza-like syndrome, droplet isolation) and usual indicators from public health authorities (new cases, proportion of positive tests in the population).

Results: Based on 37 319 ED visits during the COVID-19 outbreak, 1421 ED visits (3.8%) were positive for SARS-CoV-2. Patients with influenza-like syndrome or droplet isolation in the ED showed a similar correlation to ICU occupancy as confirmed cases in the general population, with a time lag of approximately 13 days (0.73, 95% CI 0.64 to 0.80; 0.79, 95% CI 0.71 to 0.86; and 0.76, 95% CI 0.67 to 0.83, respectively). The proportion of positive tests in the population showed the best correlation with ICU occupancy (0.95, 95% CI 0.85 to 0.96).

Conclusion: ED syndromic surveillance is an effective tool to detect and monitor a COVID-19 outbreak and to predict hospital resource needs. It would have allowed to anticipate ICU occupancy by 13 days, including significant aberration detection at the beginning of the second wave.

Keywords: COVID-19; accident & emergency medicine; public health.

Figure 1

Time series surveillance indicators. ED, emergency department; EMS, emergency medical service; ICU, intensive care unit.

Figure 2

P-charts of emergency department (ED) influenza-like syndrome during the COVID-19 outbreak at Lausanne University Hospital.

Figure 3

Time series daily emergency department (ED) general activity at Lausanne University Hospital. ICU, intensive care unit; NEWS, National Early Warning Score.