High Non-COVID-19 in-Hospital Deaths during the First Lockdown in Israel Compared with the Second and Third Lockdowns

Abstract

During the first lockdown in Israel, citizens were instructed to visit community clinics only for urgent cases. However, they were not informed that emergency departments (EDs) were safe. Reports from the National Ambulance Services showed a 22% increase in at-home deaths during the lockdown. Perhaps, the reason is because some critically ill patients postponed referrals and came "at the last minute". After the first lockdown, the Ministry of Health (MOH) declared that hospital EDs were safe. The objective of the study was to examine the rates of admission from EDs to hospital wards, and non-COVID-19 in-hospital deaths during the first lockdown in Israel, compared with the second and third lockdowns. From the business intelligence software of the Rambam Medical Center in Israel, we collected data about the rates of admission to the ED, the non-COVID-19 in-hospital deaths during the three lockdowns, during the same periods in the previous three years, and the main five causes of non-COVID-19 deaths. Data comparison was done using multiple chi-square tests. ED admission numbers were significantly higher during the first lockdown than during the second (χ² (1, n = 36,245) = 24.774, p = 0.00001) and third lockdowns (χ² (1, n = 36,547) = 8.7808, p = 0.0030). We found a significantly higher number of non-COVID-19 in-hospital deaths vs. discharges during the first lockdown than in the second and third lockdowns (χ² (2, n = 26,268) = 7.794, p = 0.0203) The number of deaths due to respiratory diseases was significantly higher during the first lockdown than in the second lockdown (χ² (1, n = 572) = 8.8185, p = 0.0029) and in the third lockdown (χ² (1, n = 624) = 9.0381, p = 0.0026), and deaths from infectious diseases were higher during the first lockdown than during both the second and third lockdowns (χ² (1, n = 566) = 5.9479, p = 0.0147, and χ² (1, n = 624) = 9.5978, p = 0.0019), respectively. The onset of CVA and CVD are abrupt, while respiratory and infectious diseases may have an insidious pattern; this may have led patients to postpone referrals to hospitals to the "last minute" during the first lockdown, perhaps due to fears of contracting COVID-19, and as a result of vague instructions. Citizens and policymakers must be made aware of this point during future pandemics.

Keywords: COVID-19; admission; discharges from hospital; hospital deaths; lockdown.

Figure 1

The prevalence (percent) of main five causes of death among non-COVID-19 patients during the first, second, and third lockdowns. * Indicates statistically significant difference among the three periods; n = the total number of non-COVID-19 deaths.