Emergency Department visits plunged as COVID-19 cases climbed, Yale study finds

August 03, 2020

New Haven, Conn. -- A new study from researchers at Yale and the Mayo Clinic found that emergency department (ED) visits dropped significantly in March as the public responded to messages about staying home as a result of the pandemic.

The study, published in the Aug. 3 edition of JAMA Internal Medicine, looked at data from 24 emergency departments in five health-care systems: in Colorado, Connecticut, Massachusetts, New York, and North Carolina. Researchers analyzed daily emergency department visits and ED hospital admissions for four months, from January to April 2020.

As COVID-19 case rates increased nationally in March and April, along with public messaging about social distancing, emergency department visits plunged in all five states compared with visits in January and February 2020. Visits fell by 41.5% in Colorado, at the low end, and by 63.5% in New York, at the high end.

During the same period, hospital admissions via the emergency department spiked, corresponding to state-level COVID-19 cases: rising by 22% in North Carolina to a high of 149% in New York.

"This is a case where public messaging appears to have worked too well," said lead author Dr. Edward R. Melnick, associate professor of emergency medicine. "We said, 'stay home,' and what people heard was: 'Stay home at all costs to avoid COVID-19.'"

The researchers concluded that, across the states, public health officials need to provide more nuance in their messaging -- to make clear that, even during a pandemic, it's crucial for people to continue visiting the emergency department for serious injuries and illnesses.

"Our new rallying cry is that hospitals are safe," Melnick said. "Few hospitals outside of New York approached going over capacity during March and April 2020. That means a lot of people suffering from non-COVID illnesses and injuries may have stayed home and unnecessarily suffered or even died because they were too scared to come in."

The 24 emergency departments included in the study varied widely in size and location, serving from small rural to large urban populations, with annual emergency department volume ranging from 12,500 to 115,000 patients per year. All five states experienced decline in ED visits beginning the week of March 11, with the greatest decline in New York (63.5%), followed by Massachusetts (57.4%), Connecticut (48.9%), North Carolina (46.5%), and Colorado (41.5%).

These declines tracked closely with the spike in COVID-19 cases in each state. The trend lasted until mid-April.

Melnick said they are continuing to expand the scope of their observations to include more states and to drill down further as to why people avoided going to the ED and what happened to them as a result. They'll be looking at "pre-hospital" data, such as people who dialed 9-1-1, he said, and examining the numbers of deaths in the field. He noted that recent studies conducted elsewhere have confirmed that people with serious conditions indeed stayed home to avoid going to the emergency department during the pandemic.

"We want to understand what happened to people who didn't make it to the hospital and the barriers to seeking and receiving care," Melnick said.

As a follow-up, Melnick looked at additional ED visit trends and hospital admission rates from April to June 30. He reported that after April 8, ED visits in all five states began to increase, but never returned to baseline.
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Other Yale researchers on the study include Dr. Gail D'Onofrio, professor of emergency medicine and chair of the Department of Emergency Medicine; Dr. Hyung Paek, lecturer in biostatistics; and Bidisha Nath, project manager at Yale University School of Medicine.

Yale University

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