Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions — United States, January–May 2020

Abstract

On March 13, 2020, the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, states enacted stay-athome orders to slow the spread of SARS-CoV-2, the virus that causes COVID-19, and reduce the burden on the U.S. health care system. 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. These conditions represent acute events that always necessitate immediate emergency care, even during a public health emergency such as the COVID-19 pandemic. In the 10 weeks following the emergency declaration (March 15-May 23, 2020), ED visits declined 23% for MI, 20% for stroke, and 10% for hyperglycemic crisis, compared with the preceding 10-week period (January 5-March 14, 2020). EDs play a critical role in diagnosing and treating life-threatening conditions that might result in serious disability or death. Persons experiencing signs or symptoms of serious illness, such as severe chest pain, sudden or partial loss of motor function, altered mental state, signs of extreme hyperglycemia, or other life-threatening issues, should seek immediate emergency care, regardless of the pandemic. Clear, frequent, highly visible communication from public health and health care professionals is needed to reinforce the importance of timely care for medical emergencies and to assure the public that EDs are implementing infection prevention and control guidelines that help ensure the safety of their patients and health care personnel.

Endovascular thrombectomy in acute ischemic stroke patients with COVID-19: prevalence, demographics, and outcomes

“…1 In addition to a delay in AIS care, such as endovascular thrombectomy (EVT), there has been a significant decline in AIS hospitalizations and procedures. [2][3][4][5] Previous studies demonstrated an association between COIVD-19 and poor outcome in patients presenting with AIS. 6 7 The effect of COIVD-19 on the clinical outcomes of EVT-treated patients has not been adequately assessed in a diverse sample of United States' hospitals.…”

Hospital admissions for acute myocardial infarction before and after lockdown according to regional prevalence of COVID-19 and patient profile in France: a registry study

“…Interestingly, the decrease in admissions for acute myocardial infarction was unrelated to the local prevalence of COVID-19; the lockdown was applied irrespective of the local magnitude of the pandemic, and the whole hospitalisation structure was affected, with elective procedures postponed and a possible effect on health workers, including the emergency services, as has been previously observed in other countries. 11 Both the fact that the decrease was more marked for patients with NSTEMI, a condition in which chest pain is usually less intense than in STEMI, and the fact that an increase in out-of-hospital cardiac arrests has been observed during the COVID-19 pandemic, 12,13 support this hypothesis, as does the fact that the decrease was more marked in older patients. However, it is noteworthy that in the Paris cardiac arrest survey the increase in out-of-hospital cardiac arrests was limited to the first 2 weeks after lockdown, 13 whereas the decrease in admissions for acute myocardial infarctions in the FRENCHIE registry remained constant over 4 weeks in all regions, including the Paris area.…”

SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020

“…Thirty-nine out-of-hospital SARS-CoV-2-associated deaths occurred at home or in the ED among persons aged <21 years. In the United States, significant reductions in ED visits (8) and childhood immunizations (9) occurred during March-April 2020, suggesting that necessary care might be delayed or deferred during the pandemic. Although infants, children, and adolescents are more likely to have milder COVID-19 illness than are adults (3), complications, including MIS-C (6) and respiratory failure (5,6), do occur in these populations.…”