Proportion of Emergency Department Visits for Alcohol Abuse Increased After the Arrival of COVID-19

Objectives: The goal of our study was to determine whether there was a change in the proportion of ED visits for alcohol abuse following the arrival of COVID-19. Background(s): In March of 2020, COVID-19 arrived in the New York Metropolitan area. Total ED visits decreased markedly, likely because of fear of exposure to the virus as well as social isolation mandates. Concerns have been raised regarding the possible adverse effects that COVID-19 may have on increased abuse of alcohol. COVID-19 triggered bouts of anxiety, isolation from peers, and increased family tensions because of job disruptions and quarantining within families. A CDC study showed that despite decreased total ED visits, compared to 2019, the proportion of ED mental health related visits in 2020 increased. The goal of our study was to determine whether there was a change in the proportion of ED visits for alcohol abuse following the arrival of COVID-19. Method(s): Design: Retrospective cohort. Setting(s): EDs of 27 hospitals within 150 miles of New York City. Hospitals were teaching and non-teaching in rural, suburban, and urban areas. Total annual ED volumes ranged from 12,000 to 122,000. Population: Consecutive patients seen by ED physicians. The database contained visits between March 1 and November 30 in 2019 and 2020. Data analysis: We identified patients with alcohol abuse using International Classification of Disease codes, version 10 (ICD-10). We tallied the number of ED visits for ICD-10 codes with at least 100 visits in the database. We calculated the proportion of these visits to total ED visits in 2019 and 2020. We report the relative change in this proportion from 2019 to 2020, along with the 95% CI. Result(s): The database contained 1,161,080 visits in 2019 and 814,252 in 2020. Of these, 15,057 and 12,467 patients had a diagnosis of alcohol abuse in 2019 and 2020, respectively. For patients with alcohol abuse diagnoses in 2019 and 2020 the average ages were 46 and 47 years and females comprised 25% and 23%, respectively. The relative change in the proportion of visits for alcohol abuse from 2019 to 2020 had a statistically significant increase of 18% (95% CI: 15%-21%). Conclusion(s): The proportion of ED visits for alcohol abuse increased following the arrival of COVID-19 in the New York metropolitan area. Our results are consistent with the CDC study showing the proportion of ED mental health related visits increased.

Effect of the COVID-19 Pandemic on ED Adult Psychiatric Visits

Objectives: Our goal was to determine whether the proportion of ED visits for specific psychiatric conditions, namely anxiety disorders, depression, self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders, changed after the arrival of COVID-19. Background(s): In March 2020, the COVID-19 pandemic reached the New York tri-state area, which, at the time, was one of the regions in the United States (US) that the virus most severely affected. ED visits dramatically declined, likely due to social isolation mandates and fear of exposure to the virus. Quarantining at home, fear of becoming sick, and job disruptions caused the level of stress in the population to increase. In a previous US study, the proportion of ED visits for some psychiatric conditions increased. Method(s): Design: Retrospective cohort. Setting(s): EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching and non-teaching in rural, suburban and urban areas. Total annual ED volumes were 12,000 to 122,000. Population: Consecutive ED patients = 21 years old from March 1 to November 30 in 2019 and 2020. Data analysis: We tallied the number of patients in 2019 and 2020 with anxiety disorders, depression, selfharm/ suicidal thoughts, bipolar disorder, and psychotic disorders, identified using International Classification of Disease codes (version 10). We calculated the proportion of these visits to total ED visits in 2019 and 2020. We report the changes in these proportions from 2019 to 2020, along with 95% CIs. Result(s): Total ED visits decreased 27%, from 844,017 in 2019 to 618,195 in 2020. In 2019 and 2020 combined, the number of patients were: 13,151 with anxiety disorders, 6884 with depression, 8886 with suicidal ideation/self-harm, 3252 with bipolar disorder, and 7129 with psychotic disorders. The changes [with 95% CIs] in the proportion of visits from 2019 to 2020 were: anxiety disorders -1% [-4,+3%], depression -5% [-10,-1%], self-harm/suicidal thoughts +23% [+18,+29%], bipolar disorder +14% [+6, +22%], and psychotic disorders +23% [+18,+29%]. Conclusion(s): The proportion of adult ED visits for selfharm/ suicidal thoughts, bipolar disorder, and psychotic disorders increased following the arrival of COVID-19, whereas the proportions for anxiety and depression changed minimally. These results are somewhat different from the findings in the previously reported study. Our study highlights the need for continued surveillance of the impact of COVID-19 on mental health.

Sociability, Social Isolation, and Social Interaction During the First Months of COVID-19 Pandemic: a Qualitative Analysis of Brazilian, Finnish, and American Adults

The social distancing imposed by the pandemic transformed how people interact with others, and little is known about how it has impacted new ways of sociability and if culture influences this process. This is a qualitative study exploring changes in the configurations of social interactions and the resources for sociability that adults in Brazil, the USA, and Finland have developed during the initial stage of quarantine. A total of 95 participants (ages between 20 and 60) experiencing social isolation either living alone or with their partners (without children) completed online questionnaires about their interactive experiences. The questionnaire was composed of multiple choices, addressing the frequency, types, and length of social interactions before and during the pandemic, and open questions focusing on the participants’ experiences on online interactions during the pandemic. Frequencies were analyzed through a paired-sample t -test, and open-ended responses were thematically analyzed. Results revealed, first, that social isolation did not represent a significant change in the composition of the participants’ social network, but family bonds became the main connection during the period, and other sources of social interaction were kept due to the possibility of interaction through virtual means. Although the frequency of social interactions reduced, their significance increased. Second, virtual environments reframed social interactions, influencing individual’s bodily perceptions such as differences in attentional demands, communication processes, and awareness of their own image, and the interaction itself. Third, cultural values seemed to influence the way participants signified their interactive experiences. This study suggests that although virtual environments changed the ways interactions happen, virtual encounters were essential for maintaining participants’ social networks.

Emergency Department Visits for Pulmonary Embolism and Deep Venous Thrombosis After the Arrival of COVID-19

Study Objectives: COVID-19 infection has been shown to be associated with increased numbers of pulmonary embolisms (PE) and deep venous thromboses (DVT). COVID-19 arrived in the New York City area in early March 2020. We hypothesized that the number of ED patients diagnosed with PEs and DVTs increased after the arrival of Covid- 19. Methods: Design: Retrospective cohort. Setting: 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. Population: Consecutive patients seen by ED physicians from March through November in 2019 and 2020, as COVID-19 arrived in this region in early March. Data analysis: We tallied the number of patients diagnosed with PEs and DVTs using International Classification of Disease (version 10) codes. We computed the changes in visits from 2019 to 2020. We used chi-square to test for statistical significance, with alpha set at 0.025using the Bonferroni correction for multiple comparisons. Results: The database contained a total of 1, 975, 332 visits, 1, 161, 080 in 2019 and 814, 252 in 2020 (a 30% decrease from 2019 to 2020). There were 3, 552 and 2, 529 patients diagnosed with PE and DVT respectively. The median age [interquartile range] and the percent female for PE and DVT were: 62 [48-72] and 62 [49-74];52% and 50% respectively. The number of visits for PE from March through November in 2019 and 2020 were 1349 and 1180, respectively. For DVTs these numbers were 1, 977 and 1, 575. Thus, visits for PE and DVT decreased from 2019 to 2020 by 20% and 13% respectively (p <0.001). Conclusion: Contrary to our hypothesis, we found that after the arrival of COVID-19 in the New York City area, visits for PEs and DVTs did not increase. We speculate that ED visits in 2020 decreased due to public fears of exposure to COVID-19 infection during hospital visits. Furthermore, testing for diagnosis of PE and DVT was often deferred because of the challenges in performing these studies on patients under investigation for COVID-19 infection. These factors could explain the decrease in number of PE and DVT cases that we found, despite the possible increased incidence of these conditions in the population.

Emergency Department Visits for Pediatric Infectious Conditions Decrease After COVID-19

Study Objective: Following the arrival of COVID-19 in the New York metropolitan area in March 2020, pediatric ED visits markedly decreased. Possible reasons for this include parental reluctance to bring their children to the ED due to fear of exposure and mandates to socially isolate (which may have also decreased infectious disease transmission) and increasing use of telemedicine. Our goal was to determine whether ED visits for some common pediatric infectious conditions changed following the arrival of COVID-19 in our area. Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Of these, 5 hospitals had dedicated pediatric EDs. Hospitals were teaching or non-teaching and rural, suburban or urban. Annual ED volumes were from 12,000 to 122,000. Population: consecutive ED patients ≤ 18 years old between March 1 and November 30 in 2019 and 2020. Data analysis: We arbitrarily chose to examine the following conditions: otitis media, bronchiolitis, streptococcal pharyngitis, croup and diarrhea, identified by the International Classification of Diseases codes, version 10. We tallied total visits and visits for each of these diagnoses in 2019 and 2020 time periods. We report the percentage changes in visits from 2019 to 2020 along with their 95% confidence intervals (CIs). Results: The database contained 300,627 visits in 2019 and 2020. From 2019 to 2020, total visits decreased by 58%, from 211,018 in 2019 to 89,609 in 2020. Visits in 2019 and 2020 respectively, were: otitis media (7080, 1775);bronchiolitis (2041, 267);streptococcal pharyngitis (2813, 863);croup (2547, 389) and diarrhea (3533, 900). This represents the following decreases from 2019 to 2020: otitis media 75% (95% CI 73-76%), bronchiolitis 87% (95% CI 85-88%), streptococcal pharyngitis 69% (95% CI 67-71%), croup 85% (95% CI 83-86%) and diarrhea 74% (95% CI 73-76%). Conclusion: Total pediatric ED visits and visits for specific infectious conditions markedly decreased following the arrival of COVID-19 in our area. Further studies are needed to investigate the impact that the reduction in ED visits had on patient clinical outcomes.

Effect of the COVID-19 Pandemic on Emergency Department Adult Psychiatric Visits

Study Objective: In March 2020, the COVID-19 pandemic reached the New York tri-state area, which, at the time, was one of the regions in the United States (US) that the virus most severely affected. ED visits dramatically declined, likely due to social isolation mandates and fear of exposure to the virus. Quarantining at home, fear of becoming sick, and job disruptions caused the level of stress in the population to increase. In a previous US study, the proportion of ED visits for some psychiatric conditions increased. Our goal was to determine whether the proportion of ED visits for specific psychiatric conditions, namely anxiety disorders, depression, self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders, changed after the arrival of COVID-19. Methods: Design: Retrospective cohort. Setting: EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching and non-teaching in rural, suburban and urban areas. Total annual ED volumes were 12,000 to 122,000. Population: Consecutive ED patients ≥ 21 years old from March 1 to November 30 in 2019 and 2020. Data analysis: We tallied the number of patients in 2019 and 2020 with anxiety disorders, depression, self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders, identified using International Classification of Disease codes (version 10). We calculated the proportion of these visits to total ED visits in 2019 and 2020. We report the changes in these proportions from 2019 to 2020, along with 95% CIs. Results: Total ED visits decreased 27%, from 844,017 in 2019 to 618,195 in 2020. In 2019 and 2020 combined, the number of patients were: 13,151 with anxiety disorders, 6884 with depression, 8886 with suicidal ideation/self-harm, 3252 with bipolar disorder, and 7129 with psychotic disorders. The changes [with 95% CIs] in the proportion of visits from 2019 to 2020 were: anxiety disorders -1% [-4, +3%], depression -5% [-10, -1%], self-harm/suicidal thoughts +23% [+18, +29%], bipolar disorder +14% [+6, +22%], and psychotic disorders +23% [+18, +29%]. Conclusion: The proportion of adult ED visits for self-harm/suicidal thoughts, bipolar disorder, and psychotic disorders increased following the arrival of COVID-19, whereas the proportions for anxiety and depression changed minimally. These results are somewhat different from the findings in the previously reported study. Our study highlights the need for continued surveillance of the impact of COVID-19 on mental health.

Emergency Department Visits for Ovarian and Testicular Torsion After the Arrival of COVID-19

Study Objective: To evaluate whether the decrease in visits for ovarian and testicular torsion was less than the overall decrease in ED visits following the arrival of COVID-19 in the New York metropolitan area. There was a marked decrease in ED visits after COVID-19 arrived in the New York metropolitan area in the United States in early March 2020. This was likely due to public health mandates and fear of exposure to the virus. Because torsion of the ovaries or testes is usually heralded by sudden onset of severe pain, patients with these conditions may have overcome this general reluctance to go to the ED. We hypothesized that, following the arrival of COVID-19 in the New York metropolitan area, the decrease in torsion visits was less than the decrease in ED visits overall. Methods: Design: Retrospective cohort. Setting: 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. Population: Consecutive ED patients from March through November in 2019 and 2020. Data analysis: We tallied the number of patients diagnosed with ovarian or testicular torsion using the International Classification of Disease codes (version 10). We calculated the difference in the decrease in total visits compared to the decrease in torsion visits from 2019 to 2020, along with the 95% CI. Results: The database contained a total of 1,587,246 visits, 898,850 in 2019 and 688,396 in 2020 (a 23% decrease from 2019 to 2020). The number of patients diagnosed with torsion was 203 in 2019 and 185 in 2020 (a 9% decrease from 2019 to 2020). The median ages [IQRs] for ovarian and testicular torsion were: 28 [18-37] and 15 [13-19] years, respectively. The difference in the decrease in total visits compared to the decrease in torsion visits was 14% (95% CI:10% to 18%). Conclusions: Consistent with our hypothesis, we found that following the arrival of COVID-19 in the New York metropolitan area, the decrease in torsion visits was less than the overall decrease in ED visits. We speculate this difference was because of the sudden onset of severe pain associated with torsion. Additional studies are needed to determine if patients who have sudden onset of severe pain from other conditions had less of a decrease in visits than overall ED visits.

COVID-19 Life Events Spill-Over on Family Functioning and Adolescent Adjustment.

We examined US parent and youth perceptions of how life events, both positive and negative, associated with COVID-19 resulted in changes in family and youth functioning. Families (n = 105, 80% white, 48% male, and 87% mothers) completed surveys during the pandemic (May to July 2020) and 3 years prior (for youth ages M = 10.6, SD = 1.17 and M = 13.6, SD = 1.19). Declines in youth, though not parent, report of open family communication, parental support, and family satisfaction were found. Declines were associated with various domains of pandemic-related stress in parent report, though positive life events served as buffers. Pre-pandemic family functioning also predicted pandemic stress. Spillover effects in turn impacted youth functioning. The current findings shed light on how experiences of the pandemic are linked with family functioning and have implications for how to support families during this time.

Emergency Department Visits for Cerebral Venous Thrombosis After the Arrival of COVID-19

Study Objectives: Cerebral venous thrombosis (CVT) has garnered attention recently because of reports of cases following COVID-19 vaccine administration. Even before vaccinations began, COVID-19 infection has been shown to be associated with increased incidence of venous thromboembolic diseases. Since CVT is a thromboembolic disease, we hypothesized that the number of ED patients with CVTs increased after the arrival of COVID-19 in the New York City area in early March 2020. Methods: Retrospective cohort design. 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. The database we had available included consecutive patients seen by ED physicians from March through November in 2019 and 2020. We tallied the number of patients diagnosed with CVTs using International Classification of Disease (version 10) codes. Results: The database contained a total of 1,975,332 visits, 1,161,080 in 2019 and 814,252 in 2020 (a 30% decrease from 2019 to 2020). In 2019 six patients were diagnosed with CVT and in 2020, three patients. For these CVT patients, the median age [interquartile range] was 44 [36-50] and 78% were female. Conclusion: Contrary to our hypothesis, we found that after the arrival of COVID-19 in our area, visits for CVTs did not increase. We speculate that total ED visits decreased in 2020 because of public health mandates and fear of contracting COVID-19. The decrease in visits for CVTs that we found may have been due to the overall decrease in ED visits. Another factor may have been that ED testing was reduced to move patients out of the ED expeditiously, to lower the risk of exposing personnel and other patients to infection.

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction

OBJECTIVE: The Novel Coronavirus19 (COVID19) arrived in northern New Jersey (NJ) in early March 2020, peaked at the beginning of April, and then declined. Starting in March, some patients who called 911 and required advanced life support (ALS) may have decompensated more rapidly than would have been expected, possibly because of concomitant COVID19 infection and/or delays in seeking medical care because of fear of exposure to the virus, and social isolation. In this study, our goal was to determine if there was an increase in prehospital ALS pronouncements and a decrease in ED visits for potentially serious conditions such as MI and stroke during the peak of the COVID-19 pandemic in northern NJ. METHODS STUDY DESIGN: Retrospective cohort of prehospital patients pronounced dead by paramedics and patients with MI and stroke in the EDs of receiving hospitals of these paramedics. Study Setting and Population: Ten ground ALS units in northern NJ and nine receiving hospital EDs. Each ALS unit is staffed by two NJ-certified mobile intensive care paramedics and respond with a paramedic flycar in a two-tiered dispatch system. DATA ANALYSIS: We identified prehospital pronouncements using the EMSCharts electronic record (Zoll Medical, Chelmsford, Massachusetts). We tabulated the number of pronouncements by week from January 1 to June 30 in 2019 and 2020. We tabulated the combined total number of pronouncements and ED visits by month along with visits for MI and stroke and calculated the changes during the same timeframe. We used Chi-square to test for statistical significance for the monthly changes from 2019 to 2020. RESULTS: For January through June in 2019 and 2020, there were 12,210 and 13,200 ALS dispatches, and 366 and 555 prehospital pronouncements, respectively. In 2020, pronouncements rose from a weekly baseline of 13 in early March, reached a peak of 45 at the beginning of April, then returned to the baseline level by the end of May. April 2020, the month with the most pronouncements, had 183% more pronouncements than April 2019 but total ED visits and visits for MI and stroke were 49%, 46% and 42% less, respectively (p < 0.0001 for each of these changes). CONCLUSION: Following the arrival of the COVID-19 pandemic in northern NJ, we found pre-hospital ALS death pronouncements increased and ED visits for MI and stroke decreased. Although we have speculated about the reasons for these findings, further studies are needed to determine what the actual causes were.

Coping and Mental Health in Early Adolescence during COVID-19.

The current longitudinal study examines changes in overall mental health symptomatology from before to after the COVID-19 outbreak in youth from the southeastern United States as well as the potential mitigating effects of self-efficacy, optimism, and coping. A sample of 105 parent-child dyads participated in the study (49% boys; 81% European American, 1% Alaska Native/American Indian, 9% Asian/Asian American; 4% Black/African American; 4% Latinx; and 4% other; 87% mothers; 25% high school graduate without college education; 30% degree from 4-year college; 45% graduate or professional school). Parents completed surveys when children were aged 6-9, 8-12, 9-13, and 12-16, with the last assessments occurring between May 13, 2020 and July 1, 2020 during the COVID-19 outbreak. Children also completed online surveys at ages 11-16 assessing self-efficacy, optimism, and coping. Multi-level modeling analyses showed a within-person increase in mental health symptoms from before to after the outbreak after controlling for changes associated with maturation. Symptom increases were mitigated in youth with greater self-efficacy and (to some extent) problem-focused engaged coping, and exacerbated in youth with greater emotion-focused engaged and disengaged coping. Implications of this work include the importance of reinforcing self-efficacy in youth during times of crisis, such as the pandemic, and the potential downsides of emotion-focused coping as an early response to the crisis for youth.

91 Where Have All the Children Gone? The Effects of COVID-19 on Pediatric Emergency Department Visits

Study Objectives: Our syndromic surveillance system of patient chief complaints showed a marked rise in respiratory complaints on March 10th, 2020 as Covid19 arrived in our region. Subsequently, pediatric visits to the emergency department (ED) markedly decreased, likely due to recommendations for quarantine and fear of contracting the virus. Our goal was to determine the extent of decrease in ED visits for several common pediatric conditions for which parents normally would have sought emergency care. Methods: This was a retrospective cohort design. The setting was at the EDs of 28 hospitals within 150 miles of New York City. Hospitals were teaching or non-teaching and rural, suburban or urban;7 hospitals had separate pediatric EDs. Annual ED volumes of pediatric patients were from 3000 to 43,000. Population: Consecutive pediatric patients (age ≤ 21yrs) seen by ED physicians between January 1 and April 30 in 2019 and 2020. Data analysis: We chose to examine the monthly visits for the following using ICD-10 codes: anxiety, appendicitis, asthma, headaches, seizure, and urinary tract infection (UTI). We computed the changes in monthly visits for March and April from 2019 to 2020. We used chi-square to test for statistical significance. We set alpha at 0.002, using the Bonferroni correction for multiple comparisons. Results: Our database contained 222,302 total pediatric visits. Compared to 2019, total visits in January and February 2020 increased by 15% and 4%, respectively, but in March and April they decreased by 36% and 81%, respectively. Visits in March and April 2020, compared to the same months in 2019, decreased by 17% and 76%, respectively, for anxiety;by 29% and 34%;for appendicitis;by 40% and 91% for asthma;by 17% and 76% for headache;by 13%, and 60% for seizures;and by 46% and 79% for UTIs. All p-values for comparisons were statistically significant, p<0.002, except, in March, for seizures (p=0.25), appendicitis (p=0.007) and headache (p=0.02). Conclusion: We found a marked decrease in ED visits for several common pediatric conditions after COVID-19 arrived in our region. We suspect that this decrease was due to recommendations for quarantine during this pandemic as well as fear of exposure to COVID-19. Further studies are needed to determine if this has led to complications due to delay in seeking medical care.

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 < 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.

21 Monitoring the Incidence of COVID-19 Using Syndromic Surveillance of Emergency Department Visits

Study Objectives: COVID-19 was initially detected in Wuhan, China, and has since spread throughout the world. In the United States, Washington State was the first state affected but by March 2020, New York and New Jersey were the two states with the greatest number of cases. We had previously instituted an ongoing syndromic surveillance system (SSS) in 35 hospitals in New York and New Jersey. Our goal was to investigate whether monitoring the respiratory emergency department (ED) visits by syndromic surveillance could be used to follow the incidence of COVID-19 in our area. Methods: This was a retrospective cohort of consecutive ED visits. It took place at 35 hospitals within 200 miles of New York City from January 1, 2019 through May 15, 2020.Protocol: We identified respiratory visits using a “RESP” syndrome filter for patients’ chief complaints developed for the New York State Department of Public Health. We used the CUSUM28 Statistic to identify a “signal” day. We defined a “signal” day as the day when “RESP” daily visits exceeded the 28-day moving average plus 3 times the 28-day moving average standard deviation. We also plotted the percent of total ED visits that were “RESP” visits. Results: The database contained 2,302,432 total ED visits of which 305,512 were “RESP” visits. The first signal day in 2020 occurred on March 10. The twenty-eight day moving average of “RESP” visits on March 10 and the number of “RESP” visits on March 10 were 658 and 953, respectively. The peak number of “RESP” visits, 1252, occurred on March 30. See figure for percent of total ED visits for “RESP” visits. Conclusion: In hospital EDs within 200 miles of New York City syndromic surveillance of ED respiratory visits showed a marked increase in the beginning of March and peaked at the end of March. This mirrored the pattern of COVID-19 cases in our area. Syndromic surveillance of ED respiratory visits may be useful in monitoring COVID-19 in other settings. [Formula presented]