39 Emergency Department Visits for Serious and Painful Conditions Markedly Decreased after the Arrival of COVID-19

Study Objectives: Our syndromic surveillance system of patient chief complaints from 35 emergency departments (EDs) in the New York City area showed a marked rise in respiratory disorders after March 10, 2020 as Covid19 arrived in our region Shortly thereafter, total emergency department (ED) visits markedly decreased Our goal was to determine whether ED visits also decreased for serious and painful conditions for which patients in most other circumstances would certainly have sought emergency care Methods: We used a retrospective cohort The setting was EDs of 28 hospitals within 150 miles of New York City Hospitals were teaching or non-teaching and rural, suburban or urban Annual ED volumes were from 12,000 to 122,000 Our population was consecutive patients seen by ED physicians between January 1 and April 30 in 2019 and 2020 We chose to compare monthly visits in 2020 to 2019 for total visits and visits for serious and painful conditions We arbitrarily chose some serious and painful conditions: congestive heart failure (CHF), appendicitis, myocardial infarction (MI), transient ischemic attack (TIA), stroke (CVA), renal colic, and back pain We then chose the visits using ICD-10 codes We computed the changes in monthly visits from 2019 to 2020 We used chi-square to test for statistical significance Using the Bonferroni correction for multiple comparisons, we set alpha at 0 002 Results: The database contained 956,116 visits In January and February 2020 (corrected for length of February in 2020) there was little change in total visits from 2019 [January + 7%, February +1%] Total ED visits decreased after COVID-19 appeared in our region In March and April 2020 compared to March and April 2019, ED visits dropped by 16% and 50% respectively Compared to 2020, visits for serious conditions also decreased In March and April, CHF decreased 22% and 66%, respectively For appendicitis these values were 24 and 33%;for MI, 25% and 41%;for TIA, 36% and 62%;and for CVA, 40% and 46% We also evaluated the decrease in visits for painful conditions Renal colic visits decreased by 40% and 46% and back pain visits decreased by 49% and 81% All p-values for comparisons were statistically significant, p \u003c 0 0005 Conclusion: In March and April 2020, there was a decrease in ED visits after Covid-19 arrived in our area This was also associated with a marked decrease in visits for both serious as well as painful conditions, suggesting that many patients with these conditions did not seek medical care We suspect this is due to reluctance to come to the ED because of recommendations for quarantine and fear of being exposed to the virus