Impact of the COVID-19 Pandemic on Emergency Department Visits — United States, January 1, 2019–May 30, 2020

Abstract

, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). On March 13, 2020, the United States declared a national emergency to combat coronavirus disease 2019 (COVID-19). As the number of persons hospitalized with COVID-19 increased, early reports from Austria (1), Hong Kong (2), Italy (3), and California (4) suggested sharp drops in the numbers of persons seeking emergency medical care for other reasons. To quantify the effect of COVID-19 on U.S. emergency department (ED) visits, CDC compared the volume of ED visits during four weeks early in the pandemic March 29-April 25, 2020 (weeks 14 to 17; the early pandemic period) to that during March 31-April 27, 2019 (the comparison period). During the early pandemic period, the total number of U.S. ED visits was 42% lower than during the same period a year earlier, with the largest declines in visits in persons aged ≤14 years, females, and the Northeast region. Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed. To minimize SARS-CoV-2, the virus that causes COVID-19, transmission risk and address public concerns about visiting the ED during the pandemic, CDC recommends continued use of virtual visits and triage help lines and adherence to CDC infection control guidance. To assess trends in ED visits during the pandemic, CDC analyzed data from the National Syndromic Surveillance Program (NSSP), a collaborative network developed and maintained by CDC, state and local health departments, and academic and private sector health partners to collect electronic health data in real time. The national data in NSSP includes ED visits from a subset of hospitals in 47 states (all but Hawaii, South Dakota, and Wyoming), capturing approximately 73% of ED visits in the United States able to be analyzed at the national level. During the most recent week, 3,552 EDs reported data. Total ED visit volume, as well as patient age, sex, region, and reason for visit were analyzed. Weekly number of ED visits were examined during January 1, 2019-May 30, 2020. In addition, ED visits during two 4-week periods were compared using mean differences and ratios. The change in mean visits per week during the early pandemic period and the comparison period was calculated as the mean difference in total visits in a diagnostic category between the two periods, divided by 4 weeks ([visits in diagnostic category

Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions — United States, January–May 2020

“…In the weeks following the declaration of COVID‐19 as a national emergency on March 13, 2020, NSSP identified substantial reductions in numbers of ED visits by males and females in all age groups for three potentially life‐threatening conditions: MI (23% decrease), stroke (20%), and hyperglycemic crisis (10%). These estimates are consistent with, but smaller in relative magnitude than, the 42% overall decline in ED visits observed during the early pandemic period 1 . The largest absolute differences were observed in adults aged ≥65 years for MI and stroke, and adults aged 18‐44 years and persons aged <18 years for hyperglycemic crisis.…”

“…CDC * and the Centers for Medicare & Medicaid Services (CMS) † recommended that health care systems prioritize urgent visits and delay elective care to mitigate the spread of COVID‐19 in health care settings. By May 2020, national syndromic surveillance data found that emergency department (ED) visits had declined 42% during the early months of the pandemic 1 . This report describes trends in ED visits for three acute life‐threatening health conditions (myocardial infarction [MI, also known as heart attack], stroke, and hyperglycemic crisis), immediately before and after declaration of the COVID‐19 pandemic as a national emergency.…”

Effect of the Coronavirus Disease 2019 (COVID‐19) Pandemic on the U.S. Emergency Medical Services System: A Preliminary Report

“…Patient visits to emergency departments (EDs) began dramatically trending downward. 1 The National Syndromic Surveillance Program found that from the 11th week of 2020 (March 9-15) to the 14th week (March 30-April 5) ED visits dropped from just over 2.5 million to 1.2 million. 2 Even in the region that includes New York, New Jersey, and Puerto Rico, ED visits went from 223,489 to 144,249 during that same time period.…”

Emergency Department Visits for Serious Diagnoses During the COVID‐19 Pandemic

“…Although reductions in routine outpatient visits and elective procedures were intentional in preparation for increases in COVID-19related volume, 1 National Syndromic Surveillance Program data indicate that weekly emergency department (ED) visits decreased 42% during the early stages of the pandemic. 2 This reduction may have been driven by a public fear of seeking care, 3,4 ultimately delaying interventions for time-sensitive serious conditions. A group of U.S. hospitals recently reported a 38% reduction in ST-elevation myocardial infarction (STEMI) activations, 5 and a national neuroimaging database indicated a 39% reduction in patients undergoing stroke imaging.…”