Difference in impact on emergency department visits following four major peaks of COVID-19 cases

Abstract

Objective: Several variants of SARS-CoV-2 have emerged since its first appearance in 2019, greatly impacting healthcare systems across the globe. Previous literature indicated a substantial decline in emergency department (ED) visits in hospitals since the start of the COVID-19 pandemic. However, little research has been done to compare different variants’ (Ancestral, Alpha, Delta, Omicron, etc.) impact on patients presenting to the ED. Thus, the purpose of this retrospective observational study is to compare the changes in total ED volume following four major peaks of SARS-CoV-2 infection within a multi-hospital health system.
Methods: Utilizing electronic healthcare record (EHR) data, total ED visits (484,268) and COVID-19 case counts (24,358) were collected and analyzed to compare ED census and COVID-19 trends across four years and four variant peak periods, from January 2019 to June 2022.
Results: Results showed that ED visits declined after the first two major peaks (Ancestral and Alpha) in COVID-19 cases, which was consistent with national trends and prevailing literature. In contrast, ED visits increased following the fourth major peak (Omicron) in COVID-19 cases.
Conclusions: The increase in ED visits following the fourth major peak was inconsistent with previous literature and trends. This may be attributed to the severity differences between variants, increased vaccination uptake, newly adopted public countermeasures, and evolving perceptions of safety and fear regarding COVID-19. These results underscore the critical importance for health administrators and policy planners to be cognizant of new strategies that alleviate barriers to receiving emergency care, especially during times of crisis.

Keywords

COVID-19 / Emergency department / Census trends / SARS-CoV-2 variants

ACKNOWLEDGEMENTS

The authors would like to thank all AHMC facilities and staff involved with the research and writing of this document, and would like to extend a special thanks to Luong T. Ly, Thida Win, Jessica Mantilla, Nick Kwan, Wen-Hsiang Teng, JJ Stewart, Ketty Chiu, Allan Leung, and William Huang.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

References

[1] Hartnett KP, Kite-Powell A, DeVies J, et al. Impact of the COVID-19 Pandemic on Emergency Department Visits - United States, January 1, 2019-May 30, 2020. Morb and Mortal Wkly Rep. 2020; 69(23): 699-704. PMid: 32525856. https://doi.org/10.15585/mmwr.mm6923e1

[2] Baugh JJ, White BA, McEvoy D, et al. The cases not seen: Patterns of emergency department visits and procedures in the era of COVID-19. The American J of Emerg Med. 2021; 46: 476-481. PMid: 33189517. https://doi.org/10.1016/j.ajem.2020.10.081

[3] Adjemian J, Hartnett KP, Kite-Powell A, et al. Update: COVID- 19 Pandemic-Associated Changes in Emergency Department Visits - United States, December 2020-January 2021. Morb and Mortal Wkly Rep. 2021; 70(15): 552-556. PMid: 33857069. https://doi.org/10.15585/mmwr.mm7015a3

[4] Kwan N, Giordano S, Chiu CHK, et al. Trends in outpatient emergency department census during the COVID-19 pandemic at a California health system. The American J of Emerg Med. 2022; 51: 424-425. PMid: 33812761. https://doi.org/10.1016/j.ajem.2021.03.065

[5] Jeffery MM, D’Onofrio G, Paek H, et al. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Intern Med. 2020; 180(10): 1328-1333. PMid: 32744612. https://doi.org/10.1001/jamainternmed.2020.3288

[6] Sürme Y, Özmen N, Ertürk Arik B. Fear of COVID-19 and Related Factors in Emergency Department Patients. Int J Ment Health Addict. 2021; 1-9. PMid: 34220384. https://doi.org/10.1007/s114 69-021-00575-2

[7] Ornell F, Schuch JB, Sordi AO, et al. “Pandemic fear” and COVID- 19: mental health burden and strategies. Braz J Psychiatry. 2020; 42(3): 232-235. PMid: 32267343. https://doi.org/10.1590/1516-4446-2020-0008

[8] Paul P, France AM, Aoki Y, et al. Genomic Surveillance for SARSCoV- 2 Variants Circulating in the United States, December 2020-May 2021. Morb and Mortal Wkly Rep. 2021; 70(23): 846-850. PMid: 34111060. https://doi.org/10.15585/mmwr.mm7023a3

[9] Lambrou AS, Shirk P, Steele MK, et al. Genomic Surveillance for SARS-CoV-2 Variants: Predominance of the Delta (B.1.617.2) and Omicron (B. 1.1.529) Variants - United States, June 2021-January 2022. Morb and Mortal Wkly Rep. 2022; 71(6): 206-211. PMid: 35143464. https://doi.org/10.15585/mmwr.mm7106a4

[10] Yale Medicine. Omicron, Delta, Alpha, and More: What To Know About the Coronavirus Variants. 2022 Retrieved March 4, 2022. Available from:

[11] U.S. Department of Health and Human Services. COVID-19 Vaccines. 2022. Retrieved March 4, 2022. Available from: https://www.hhs.gov/coronavirus/covid-19-vaccines/index.html

[12] Our World in Data. State-by-state data on COVID-19 vaccinations in the United State. 2022. Retrieved March 4, 2022. Available from: https://ourworldindata.org/us-states-vaccinations

[13] Centers for Disease Control and Prevention. CDC Museum COVID- 19 Timeline. 2022. Retrieved March 4, 2022. Available from: https://www.cdc.gov/museum/timeline/covid19.html#:-:text=January%2020%2C%202020%20CDC,18%20in%20Washington%20state