Hospital Avoidance and Unintended Deaths during the COVID-19 Pandemic

Abstract

The COVID-19 pandemic significantly altered individual behaviors, including the consumption of health care. I study utilization and mortality in the largest integrated healthcare system in the United States, the Veterans Health Administration, and find that between the middle of March and the beginning of May 2020, emergency department and inpatient hospital visits declined by 37 percent and 46 percent, and remained 10 percent and 17 percent below expected levels by the end of October. Declines were more pronounced for nonurgent and non-life-threatening conditions, although urgent and life-threatening conditions also dropped by a quarter during the early months. Conditional on arrival at the emergency department, conditions were more severe at presentation. In the first two months of the pandemic, veteran mortality increased by 19.5 percent, yet non-COVID-19 mortality in VA inpatient settings declined. I find suggestive evidence that hospital avoidance may have resulted in higher non-COVID-19 mortality. By focusing on counties with no official COVID-19 deaths by May 19, 2020, I estimate that an upper bound of 7.9 percent of excess veteran deaths in the first two months of the pandemic were due to hospital avoidance.

Necrotising fasciitis in the COVID-19 era: A consequence of caution – A case series

“…The ongoing COVID-19 pandemic has presented healthcare systems across the globe with unprecedented challenges 3 . In response to this, hospitals have shifted resources in an effort to meet the influx of critically ill patients 3 .…”

“…The ongoing COVID-19 pandemic has presented healthcare systems across the globe with unprecedented challenges 3 . In response to this, hospitals have shifted resources in an effort to meet the influx of critically ill patients 3 . As part of these emergency measures, patients have been strongly discouraged from attending emergency health services unless absolutely necessary 3 .…”

“…In response to this, hospitals have shifted resources in an effort to meet the influx of critically ill patients 3 . As part of these emergency measures, patients have been strongly discouraged from attending emergency health services unless absolutely necessary 3 . While this has been a valuable and worthwhile measure in ensuring that precious limited resources are available to treat a previously unencountered surge of critically ill patients in a time of crisis, this has also created the potential for ‘collateral damage’ in patients with unrelated conditions, where patients avoid ED presentation with conditions that typically may have warranted hospital admission 3 , 5 , 6 , 7 .…”

“…During the Coronavirus disease 19 (COVID-19) pandemic, the population has been actively discouraged from presenting to emergency medical services unless absolutely necessary 3 . While this has been an important step in preserving valuable and limited healthcare resources in a time of crisis, it may also have resulted in immeasurable cases of progression of manageable diseases to imminently life-threatening conditions 3 .…”

“…During the Coronavirus disease 19 (COVID-19) pandemic, the population has been actively discouraged from presenting to emergency medical services unless absolutely necessary 3 . While this has been an important step in preserving valuable and limited healthcare resources in a time of crisis, it may also have resulted in immeasurable cases of progression of manageable diseases to imminently life-threatening conditions 3 . We present three cases of patients who presented to our institution, a tertiary referral university teaching hospital which provides a high volume of emergency care to a large catchment area, with NF over a one-month period (1 st February 2021 to 28 th February 2021) during a national lockdown, all of whom had initially noted symptoms of milder soft tissue infection but delayed presentation to the hospital due to public health advice.…”