Analysis of Emergency Department Visits and Hospital Activity during Influenza Season, COVID-19 Epidemic, and Lockdown Periods in View of Managing a Future Disaster Risk: A Multicenter Observational Study

Enrique Casalino, Christophe Choquet, Donia Bouzid, Olivier Peyrony, Sonja Curac, Eric Revue, Jean-Paul Fontaine, Patrick Plaisance, Anthony Chauvin, Daniel Aiham Ghazali, Enrique Casalino, Christophe Choquet, Donia Bouzid, Olivier Peyrony, Sonja Curac, Eric Revue, Jean-Paul Fontaine, Patrick Plaisance, Anthony Chauvin, Daniel Aiham Ghazali

Abstract

ED-visits and through-ED admissions to medical/surgical wards (MSW) and intensive care unit (ICU) during influenza, COVID-19 and lockdown periods were evaluated in a four-hospital prospective observational study from November 2018 to March 2020. ED visit characteristics and main diagnostic categories were assessed. Analysis of 368,262 ED-visits highlighted a significantly increasing trend in ED-visits during influenza followed by a significantly decreasing trend after lockdown. For MSW-admissions, a pattern of growth during influenza was followed by a fall that began during COVID-19 pandemic and intensified during the lockdown. For ICU-admissions, a significant rise during the COVID-19 pandemic was followed by diminution during the lockdown period. During lockdown, significantly diminishing trends were shown for all diagnostic categories (between -40.8% and -73.6%), except influenza-like illness/COVID cases (+31.6%), Pulmonary embolism/deep vein thrombosis (+33.5%) and frequent users (+188.0%). The present study confirms an increase in demand during the influenza epidemic and during the initial phase of the COVID-19 epidemic, but a drop in activity during the lockdown, mainly related to non-COVID conditions. Syndromic surveillance of ILI cases in ED is a tool for monitoring influenza and COVID-19, and it can predict ED activity and the need for MSW and ICU beds.

Keywords: COVID-19; emergency department activity; hospital admissions; lockdown; seasonal influenza; time series analysis.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart. Legend: ED, Emergency department; ICU, intensive care unit; MSW, medical/surgical wards.
Figure 2
Figure 2
(a) ED visits during the entire study period, from 25 November 2018 to 25 November 2019 (pre-epidemic period) and from 26 November 2019 to 26 March 2020 (study period including influenza- and COVID-19-epidemic and lockdown periods); (b) ED visits subgroups during Influenza, Covid-19, and lockdown periods (from 26 November 2019 to 26 March 2020); (c) MSW admissions during epidemic period (from 26 November 2019 to 26 March 2020); (d) ICU admissions during epidemic period(from 26 November 2019 to 26 March 2020). Caption: Admissions are given as a function of Infuenza like related cases; non-COVID related cases; COVID-19 related cases; ED, emergency department; ICU, intensive care unit; MSW, medical/surgical wards.

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