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1.
J Acute Med ; 12(3): 105-112, 2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2100318

ABSTRACT

Background: The decrease in emergency department (ED) patient visits during the COVID-19 pandemic was reported by various studies. Our study aimed to investigate whether a similar trend can be observed in a country with a low incidence of COVID-19 as well as the impact caused by the pandemic on ED patients in different triage levels and categories. Methods: This multicenter retrospective study collected data from three regional hospitals between March 2019 and December 2020. We evaluated the differences between patient volume, disease severity, and patient composition in ED before and after the COVID-19 pandemic among these hospitals. Results: There was a 23% reduction in ED patient volume in the urban hospital (hospital A) as well as a 16% reduction in suburban hospitals (hospitals B and C) during the pandemic period, respectively. The regression analysis showed a high correlation in the change in monthly patient volume among these hospitals. In terms of severity, there was a 24% reduction in ED visits with high severity levels (Taiwan Triage and Acuity Scale [TTAS] I, II) in hospital A, as well as 16% and 12% in hospitals B and C during the pandemic period, respectively. Similarly, there was a 23% reduction in ED visits with low severity levels (TTAS III, IV, V) in hospital A, as well as 20% and 16% in hospitals B and C during the pandemic period, respectively. In terms of patient types, there was a significant decline in non-traumatic adult patients (19%, 17%, and 10%), and pediatric patients (49%, 50%, and 46%) in hospitals A, B, and C, respectively. Conclusions: Despite the low incidence of COVID-19 in Taiwan, a decrease in total ED visits was still found during the pandemic, especially in non-trauma adult visits and pediatric visits. In addition, ED visits in both high and low severity levels decreased in these regional hospitals.

2.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-344331

ABSTRACT

Background: In the United States, national ecological studies suggest a positive impact of COVID-19 vaccination coverage on outcomes in adults. However, the national impact of the vaccination program on COVID-19 in children remains unknown. To determine the association of COVID-19 vaccination with U.S. case incidence, emergency department visits, and hospital admissions for pediatric populations during the Delta and Omicron periods. Methods: We conducted an ecological analysis among children aged 5–17 and compared incidence rate ratios (RRs) of COVID-19 cases, emergency department visits, and hospital admissions by pediatric vaccine coverage, with jurisdictions in the highest vaccine coverage quartile as the reference. Findings: RRs comparing states with lowest pediatric vaccination coverage to the highest pediatric vaccination coverage were 2.00 and 0.64 for cases, 2.96 and 1.11 for emergency department visits, and 2.76 and 1.01 for hospital admissions among all children during the Delta and Omicron periods, respectively. During the 3-week peak period of the Omicron wave, only children aged 12–15 and 16–17 years in the states with the lowest versus highest coverage, had a significantly higher rate of emergency department visits (RR=1.39 and RR=1.34, respectively). Interpretation: COVID-19 vaccines were associated with lower case incidence, emergency department visits and hospital admissions among children during the Delta period but the association was weaker during the Omicron period. Pediatric COVID-19 vaccination should be promoted as part of a program to decrease COVID-19 impact among children;however, vaccine effectiveness may be limited when available vaccines do not match circulating viral variants. Funding Information: This work was supported by the CDC’s regular operating funds. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This activity was reviewed by the U.S. Centers for Disease Control and Prevention (CDC) and was conducted consistent with applicable federal law and CDC policy.

3.
Am J Emerg Med ; 58: 100-105, 2022 08.
Article in English | MEDLINE | ID: covidwho-1866782

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic situation is a state that has had a great impact on the medical system and society. To respond to the pandemic situation, various methods, such as a pre-triage system, are being implemented in the emergency medical field. However, there are insufficient studies on the effects of this pandemic situation on patients visiting the emergency department (ED), especially those with cardio/cerebrovascular diseases (CVD)1 classified as time-dependent emergencies. METHODS: We performed a retrospective analysis of a cohort of patients from April 2020 to December 2020 (April 2020 was when the pre-triage system was established) compared to a parallel comparison patient cohort from 2019. The primary outcome was in-hospital mortality. CVD was defined by the patient's final diagnosis. RESULTS: During the same period, the number of patients who had visited the ED after COVID-19 had decreased to 79.1% of the number of patients who had visited the ED before COVID-19. The overall patient mortality and the mortality in the patients cardiovascular disease had both increased, while the mortality from cerebrovascular disease did not increase. Meanwhile, the ED length of stay had increased in all patients but did not increase in the patients with cardiovascular disease. CONCLUSION: As with prior studies conducted in other regions, in our study, the total number of ED visits were decreased compared to before COVID-19. The overall mortality had increased, particularly in the patients with cardiovascular disease.


Subject(s)
COVID-19 , Cardiovascular Diseases , Cerebrovascular Disorders , COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Cerebrovascular Disorders/epidemiology , Emergency Service, Hospital , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
4.
Intern Emerg Med ; 17(6): 1699-1710, 2022 09.
Article in English | MEDLINE | ID: covidwho-1844457

ABSTRACT

BACKGROUND: A substantial drop in emergency department (ED) visit volume was previously demonstrated at the onset of the COVID-19 pandemic. OBJECTIVE: To examine changes in the number of non-COVID adult ED visits and their associated 30-day mortality during 14 months of the pandemic in Israel. METHODS: This is a retrospective cohort study including 1,285,270 adult ED visits between 1st March, 2018 and 30th April, 2021 to the internal and surgical EDS in eight general hospitals of the largest healthcare organization in Israel. The 14 months of the pandemic period (March 2020-April 2021) were divided into seven periods according to dates of the three lockdowns. Exposure to each of these periods was compared to the parallel period during the two previous years. March 2020-April 2021 was compared to the parallel periods in 2018 and 2019. RESULTS: During the pandemic period, the largest decline in ED visits (44.6% and 50.9% for internal and surgical EDs, respectively) and the highest excess 30-day mortality following an ED visit (internal EDs Adjusted OR (ORadj), 1.49; 95% CI, 1.34-1.66 and surgical EDs: ORadj 1.50; CI, 1.16-1.94) were 95%, observed during the first lockdown. Both gradually levelled-off subsequently until near-normalization was reached in March-April 2021 for both parameters. CONCLUSIONS: A substantial decline in non-COVID ED visits and excess mortality at the beginning of the pandemic, are probably the results of social distancing restrictions alongside patients' fear of exposure to COVID-19, which gradually moderated thereafter, until near normalization was reached after 14 months. Gradual return to pre-pandemic ED utilization patterns were noticed as the population and the healthcare system acclimatize to life alongside COVID.


Subject(s)
COVID-19 , Pandemics , Adult , COVID-19/epidemiology , Communicable Disease Control , Emergency Service, Hospital , Humans , Israel/epidemiology , Retrospective Studies
5.
J Am Coll Emerg Physicians Open ; 3(3): e12728, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1819356

ABSTRACT

Background: The COVID-19 pandemic has resulted in over 6 million deaths worldwide as of March 2022. Adverse psychological effects on patients and the general public linked to the pandemic have been well documented. Methods: We conducted a retrospective analysis of adult emergency department (ED) encounters with diagnoses of anxiety, depression, and suicidal ideation using International Classification of Diseases, Tenth Revision (ICD-10) codes at a tertiary care hospital in New York City from March 15 through July 31, 2020 and compared it with ED encounters during the same time period in the previous 3 years (2017-2019). The relative risk (RR) of these diagnoses was calculated comparing a prepandemic sample to a pandemic sample, accounting for total volume of ED visits. Results: A total of 2816 patient encounters met the inclusion criteria. The study period in 2020 had 31.5% lower overall ED volume seen during the same time period in the previous 3 years (27,874 vs average 40,716 ED encounters). The risk of presenting with anxiety during the study period in 2020 compared to prior 3 years was 1.40 (95% confidence interval [CI] 1.21-1.63), for depression was 1.47 (95% CI 1.28-1.69), and for suicidal ideation was 1.05 (95% CI 0.90-1.23). There was an increase in admissions for depression during the pandemic period (15.2% increase, 95% CI 4.6%-25.7%). Conclusion: There was a relative increase in patients presenting to the ED with complaints of anxiety and depression during the height of the COVID-19 pandemic, while absolute numbers remained stable. Our results highlight the importance of acute care-based mental health resources and interventions to support patients during this pandemic.

6.
Addiction ; 117(6): 1692-1701, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1672926

ABSTRACT

AIMS: To examine how weekly rates of emergency department (ED) visits for drug overdoses changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the pre-pandemic, peak, and re-opening periods of the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN: Population-based retrospective cohort study conducted between September 30, 2018 and September 26, 2020. SETTING: Ontario, Canada. PARTICIPANTS: A total of 38 617 IRHH, 15 022 369 housed individuals, and 186 858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MEASUREMENTS: ED visits for drug overdoses of accidental and undetermined intent. FINDINGS: Average rates of ED visits for drug overdoses between January and September 2020 were higher among IRHH compared with housed individuals (rate ratio [RR], 148.0; 95% CI, 142.7-153.5) and matched housed individuals (RR, 22.3; 95% CI, 20.7-24.0). ED visits for drug overdoses decreased across all groups by ~20% during the peak period (March 17 to June 16, 2020) compared with corresponding weeks in 2019. During the re-opening period (June 17 to September 26, 2020), rates of ED visits for drug overdoses were significantly higher among IRHH (RR, 1.56; 95% CI, 1.44-1.69), matched housed individuals (RR, 1.25; 95% CI, 1.08-1.46), and housed individuals relative to equivalent weeks in 2019 (RR, 1.07; 95% CI, 1.02-1.11). The relative increase in drug overdose ED visits among IRHH was larger compared with both matched housed individuals (P = 0.01 for interaction between group and year) and housed individuals (P < 0.001) during this period. CONCLUSIONS: Recently homeless individuals in Ontario, Canada experienced disproportionate increases in ED visits for drug overdoses during the re-opening period of the COVID-19 pandemic compared with housed people.


Subject(s)
COVID-19 , Drug Overdose , Homeless Persons , COVID-19/epidemiology , Drug Overdose/epidemiology , Emergency Service, Hospital , Humans , Ontario/epidemiology , Pandemics , Retrospective Studies
7.
Cureus ; 14(1): e20958, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1626450

ABSTRACT

Introduction Coronavirus disease 2019 (COVID-19) pandemic has influenced various aspects of health care and its outcomes. Several studies conducted on different age groups from different countries have reported a decrease in the frequency of hospital visits during the pandemic. Aim This study aimed to assess the self-reported effect of the COVID-19 pandemic on hospital visits and healthcare outcomes in the pediatric age group. We further aimed to assess the participants' beliefs on the reasons for decreased frequency of hospital visits during the pandemic. Methods This was a quantitative analytical cross-sectional study. Data from the parents of children less than 14 years living in the Kingdom of Saudi Arabia (KSA) was collected using a self-administered structured questionnaire. The questionnaire included sociodemographic characteristics of the participants, self-reported frequency of hospital visits, and potential consequences on pediatric care outcomes during the pandemic. A total of 1,548 initial respondents filled the questionnaire, out of which only 1,311 had children aged less than 14 years. SPSS version 25 (IBM, New York, USA) was used for statistical analysis. Results We found that of the 1,311 eligible respondents, majority (75.1%) were mothers of the children while only 24.9% were fathers, and 34.4% of the respondents had two children less than 14 years. Majority (76.7%) of the respondents were from the central region and felt that the pandemic has reduced their frequency of hospital visits. Furthermore, majority (78.6%) of the respondents believed that the decreased hospital (emergency or clinic) visits did not have any negative effect on the health and care of their children. Moreover, 56.4% of the participants responded that lack of the need to visit the hospital during the pandemic was the reason for their decreased hospital visits frequency, and 51.6% were afraid of being infected by the virus. There was a significant association between decreased hospital visits and missing an appointment for vaccination, delayed diagnosis, deterioration of participants' children's condition, and running out of treatment and inability to refill. Conclusion This study was conducted to assess the impact of the COVID-19 pandemic on hospital visits and pediatric care outcomes in the KSA. We hypothesized that the pandemic has led to a reduction in pediatric hospital visits which might influence pediatric care outcomes. We found that there was a decrease in the frequency of hospital visits. This decrease was attributed to the lack of the need to go to the hospital or to the fear of being infected by the virus. A significant association was found between the participants' beliefs of the pandemic effect on hospital visits and its effect on the pediatric care outcomes.

8.
Int J Emerg Med ; 14(1): 64, 2021 Nov 04.
Article in English | MEDLINE | ID: covidwho-1503924

ABSTRACT

We aimed to describe the epidemiology of all pediatric emergency department visits (focusing on mental health-related visits versus total visits) at the University Children's Hospital of Nice (France) from 1 January to 31 December 2020 (year of the COVID-19 pandemic) and to compare it with the earlier 3-year period. The increase in mental health-related visits (44.2%) that we observed, while total visits decreased (30.0%), suggests an impact of the pandemic on children's and adolescents' mental health.

9.
J Infect Public Health ; 15(1): 132-137, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1466625

ABSTRACT

BACKGROUND: On March 2, 2020, Saudi Arabia identified the first positive COVID-19 case. Since then, several aspects of the COVID-19 impact on Emergency Departments (EDs) use have been reported. The objective of this study is to describe the pattern and characteristics of Emergency Department visits during the COVID-19 pandemic period, compared with the same period in the previous year, including the patients' demographic information, acuity level, length of stay, and admission rate. METHODS: Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia. The health records of all the patients who presented at the Emergency Department from January 2019 to September 2020 were retrospectively reviewed. The variations in the patient and the visit characteristics were described for the periods before and during COVID-19. RESULTS: The records of 209,954 patients who presented at the Emergency Department were retrieved. In contrast to 2019, the number of visits during the pandemic period reduced by 23%. A dramatic decrease was observed after the announcement of the first COVID-19 diagnosed case in Saudi Arabia, and subsequently the numbers gradually increased. The patients who presented at the Emergency Department during the pandemic period were slightly older (mean age, 43.1 versus 44.0 years), more likely to be older, more urgent and had a higher admission rate compared to the pre-pandemic period. There was a slight increase in visits during the daytime curfew hours and a decrease during the nighttime. CONCLUSION: We report a considerable decrease in the number of Emergency Department visits. The reduction was higher in non-urgent and less urgent cases. Patients presenting at the Emergency Department during the curfew times were more likely to stay longer in the Emergency Department and more likely to be admitted, compared with the pre-pandemic period.


Subject(s)
COVID-19 , Adult , Emergency Service, Hospital , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers
10.
Clin Infect Dis ; 73(Suppl 1): S110-S117, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1364763

ABSTRACT

BACKGROUND: Respiratory tract infections are common, often seasonal, and caused by multiple pathogens. We assessed whether seasonal respiratory illness patterns changed during the COVID-19 pandemic. METHODS: We categorized emergency department (ED) visits reported to the National Syndromic Surveillance Program according to chief complaints and diagnosis codes, excluding visits with diagnosed SARS-CoV-2 infections. For each week during 1 March 2020 through 26 December 2020 ("pandemic period"), we compared the proportion of ED visits in each respiratory category with the proportion of visits in that category during the corresponding weeks of 2017-2019 ("pre-pandemic period"). We analyzed positivity of respiratory viral tests from 2 independent clinical laboratories. RESULTS: During March 2020, cough, shortness of breath, and influenza-like illness accounted for twice as many ED visits compared with the pre-pandemic period. During the last 4 months of 2020, all respiratory conditions, except shortness of breath, accounted for a smaller proportion of ED visits than during the pre-pandemic period. Percent positivity for influenza virus, respiratory syncytial virus, human parainfluenza virus, adenoviruses, and human metapneumovirus was lower in 2020 than 2019. Although test volume decreased, percent positivity was higher for rhinovirus/enterovirus during the final weeks of 2020 compared with 2019, with ED visits similar to the pre-pandemic period. CONCLUSIONS: Broad reductions in respiratory test positivity and respiratory ED visits (excluding COVID-19) occurred during 2020. Interventions for mitigating spread of SARS-CoV-2 likely also reduced transmission of other pathogens. Timely surveillance is needed to understand community health threats, particularly when current trends deviate from seasonal norms.


Subject(s)
COVID-19 , Virus Diseases , Emergency Service, Hospital , Humans , Pandemics , SARS-CoV-2 , Seasons , United States/epidemiology , Virus Diseases/epidemiology
11.
Front Psychiatry ; 12: 603318, 2021.
Article in English | MEDLINE | ID: covidwho-1346422

ABSTRACT

Background: During the spread of coronavirus disease (COVID-19), mandatory quarantines increased social isolation and anxiety, with inevitable consequences on mental health and health seeking behavior. We wished to estimate those trends. Methods: We examined all psychiatric visits to the emergency department (ED) during March, April 2020, compared to identical months in 2018, 2019. We evaluated both number and nature of referrals. Results: Throughout the years, psychiatric referrals comprised about 5% of the total number of ED visits. In March-April 2020, 30% decreases were observed in overall ED visits and in psychiatric referrals in the ED. Compared to 2018-2019, in 2020, the proportions of these diagnoses were higher: anxiety disorders (14.5 vs. 5.4%, p < 0.001), personality disorders (6.7 vs. 3.2%, p = 0.001), psychosis (9.5 vs. 6.7%, p = 0.049), post-traumatic stress disorder (3.2 vs. 1.5%, p = 0.023). Compared to 2018-2019, in 2020, proportions were lower for adjustment disorder (5.8 vs. 8.9%, p = 0.036) and for consultation regarding observation (11.7 vs. 31.6%, p < 0.001). Differences were not observed between 2018-2019 and 2020 in the proportions of other diagnoses including suicide and self-harm disorders. Referrals concerning suicide and self-harm in a rural hospital and community clinic were 30% lower in the COVID-19 lockdown than in the same months in 2018, 2019. Conclusion: Psychiatric ED visits decreased by the same proportion as overall visits to the ED, apparently driven by fears of COVID-19. Referrals relating suicidality and self-harm shown nominal decrease, but their proportioned share remained constant. Increased anxiety and delayed care may eventually lead to increased mental health needs.

12.
Am J Emerg Med ; 38(9): 1732-1736, 2020 09.
Article in English | MEDLINE | ID: covidwho-549275

ABSTRACT

BACKGROUND: COVID-19 pandemic effects are still being elucidated. Stay-at-home orders and social distancing compounded with COVID-19 concerns have caused significant disruptions in daily life. One notable effect of these variables may be a change in the number of emergency department (ED) visits. This study aims to investigate the effects of COVID-19 on ED visits, and possible reasons for changes. METHODS: Retrospective analysis using CDC data for ED visits and percentage of visits for COVID-19-Like Illness (CLI) and Influenza-Like Illness (ILI). Google Trends was used to assess COVID-19 public awareness. Motor vehicle collision (MVC) data was collected from cities, which reported current data. A descriptive statistical analysis and two-sample t-test was performed on ED visit data to assess for significance and a descriptive analysis was conducted to assess COVID-19's impact on MVCs. RESULTS: The mean number of ED visits per week for the last four weeks of available data during the pandemic was significantly less than the four weeks prior to COVID-19 pandemic (p = 0.008). The ED visit decrease per week varied by region, with Region 1 having the greatest decrease (45%). MVCs decreased substantially across all cities studied, with New York City and Baton Rouge experiencing the greatest decrease (66%) during the pandemic. CONCLUSION: A number of factors have likely contributed to the substantial decrease in ED visits observed in this study. In light of these findings, it is important to raise patient awareness regarding acute conditions that are deadlier than COVID-19 and require immediate medical intervention to ensure recovery.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Emergency Service, Hospital/statistics & numerical data , Pandemics , Patient Safety/standards , Pneumonia, Viral/epidemiology , Adult , COVID-19 , Coronavirus Infections/transmission , Female , Humans , Male , Pneumonia, Viral/transmission , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
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