Healthcare systems across the U.S. saw visits to their emergency departments plummet by as much as over 60% at the start of the COVID-19 pandemic.

Researchers at Yale and Mayo Clinic observed that stay-at-home orders issued back in March persuaded the public to avoid hospitals, suggesting that those with non-COVID conditions stayed at home despite needing hospital care and as a result, suffered unnecessarily or even died. They assert that public officials must be clearer in their messages that people with serious injuries or illnesses visit EDs, even during a pandemic.

"Providers and hospital leaders should emphasize to the public that in an emergency seconds and minutes matter," Dr. Edward Melnick, associate professor of emergency medicine at Yale, told HCB News. "If you are having an emergency, you should go to an emergency department. Very few hospitals have been stretched beyond capacity. Hospitals are safe and taking extra precautions to limit transmission of COVID-19 in the hospital."

The team evaluated data from 24 emergency departments across five healthcare systems, including four EDs in Colorado, and five of each in Connecticut, Massachusetts, New York and North Carolina. EDs varied in size and location. Settings spanned across rural, urban and suburban areas, and included regions with a high COVID-19 caseload and ones with lower case counts. Annual baseline volume across all EDs ranged from 12,500 to 115,000 visits.

Compared to January and February, ED visits fell in all five states starting the week of March 11 and continued trending downward into mid-April. Colorado saw the lowest decline at 41.5% and New York experienced the highest at 63.5%. Massachusetts had a decrease of 57.4%, followed by Connecticut at 48.9% and North Carolina at 46.5%.

Despite the reduction in visits, hospital admissions via EDs remained stable across health systems, only to spike when a local increase in COVID-19 cases occurred. North Carolina saw a 22% rise, while New York had an increase of 149%.

The lowest amount of visits to the ED were recorded during the week of April 8, after which visits in all five states began to rise according to data from April, May and June. Emergency hospital admissions also stabilized and began to decrease around the same time. Admissions for both types of visits, however, have not returned to pre-COVID-19 levels, even when the rate of new COVID-19 cases sharply decreased.

Researchers also are unable to determine for sure if people with serious symptoms, illnesses and injuries went untreated due to the pandemic, but suggest that the greater availability of telehealth options may be keeping ED visits below regular rates.

The group is continuing to observe ED visits in more states and is examining pre-hospital data such as 911 phone calls and deaths in the field to determine why people are avoiding the ED and what has happened to them as a result.

“It is definitely our concern that we would see a repeat of these patterns in areas with spiking COVID-19 cases," said Melnick. "However, the public perceptions have changed since March and April, so we plan to study more recent changes as well. The differences between admit rates pre-COVID and at the end of June are interesting, but we can only speculate as to why they may be different (i.e., public getting the message to stay home for minor issues but go to ED for higher-acuity conditions, less emergent conditions being successfully triaged by telehealth, fewer non-emergent conditions due to staying home).”

The study is titled, 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.

The findings were published in JAMA Internal Medicine.