Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions - United States, January-May 2020

Abstract

On March 13, 2020, the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, states enacted stay-at-home orders to slow the spread of SARS-CoV-2, the virus that causes COVID-19, and reduce the burden on the U.S. health care system. CDC* and the Centers for Medicare & Medicaid Services (CMS)† recommended that health care systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in health care settings. By May 2020, national syndromic surveillance data found that emergency department (ED) visits had declined 42% during the early months of the pandemic (1). This report describes trends in ED visits for three acute life-threatening health conditions (myocardial infarction [MI, also known as heart attack], stroke, and hyperglycemic crisis), immediately before and after declaration of the COVID-19 pandemic as a national emergency. These conditions represent acute events that always necessitate immediate emergency care, even during a public health emergency such as the COVID-19 pandemic. In the 10 weeks following the emergency declaration (March 15-May 23, 2020), ED visits declined 23% for MI, 20% for stroke, and 10% for hyperglycemic crisis, compared with the preceding 10-week period (January 5-March 14, 2020). EDs play a critical role in diagnosing and treating life-threatening conditions that might result in serious disability or death. Persons experiencing signs or symptoms of serious illness, such as severe chest pain, sudden or partial loss of motor function, altered mental state, signs of extreme hyperglycemia, or other life-threatening issues, should seek immediate emergency care, regardless of the pandemic. Clear, frequent, highly visible communication from public health and health care professionals is needed to reinforce the importance of timely care for medical emergencies and to assure the public that EDs are implementing infection prevention and control guidelines that help ensure the safety of their patients and health care personnel.

Conflict of interest statement

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Figures

FIGURE 1

Number of emergency department (ED) visits for myocardial infarction, stroke, and hyperglycemic crisis — National Syndromic Surveillance Program, United States, week 1, 2019–week 21, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * Includes diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. † Week 1, 2019 (week ending January 5, 2019) to week 21, 2020 (week ending May 23, 2020).

FIGURE 2

Absolute decreases in number of emergency department (ED) visits for myocardial infarction, stroke, and hyperglycemic crisis between COVID-19 prepandemic and early pandemic periods, by sex and age group — National Syndromic Surveillance Program, United States, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * Prepandemic (weeks 2–11) corresponds to January 5–March 14, 2020. † Early pandemic (weeks 12–21) corresponds to March 15–May 23, 2020. § There was a slight absolute increase in ED visits for stroke among males aged 0–17 years and for hyperglycemic crisis among females aged 75–84 years.