Emergency department use during COVID-19 as described by syndromic surveillance

Abstract

On 12 March 2020 the UK entered the ‘delay phase’ of the COVID-19 pandemic response. The Public Health England Emergency Department Syndromic Surveillance System (EDSSS) carries out daily (near real-time) public health surveillance of emergency department (ED) attendances across England. This retrospective observational analysis of EDSSS data aimed to describe changes in ED attendances during March–April 2020, and identify the attendance types with the largest impact. Type 1 ED attendances were selected from 109 EDs that reported data to EDSSS for the period 1 January 2019 to 26 April 2020. The daily numbers of attendances were plotted by age group and acuity of presentation. The 2020 ’COVID-19’ period (12 March 2020 to 26 April 2020) attendances were compared with the equivalent 2019 ’pre-COVID-19’ period (14 March 2019 to 28 April 2019): in total; by hour and day of the week; age group(<1, 1-4, 15-14, 15-44, 45-64 and 65+ years); gender; acuity; and for selected syndromic indicators(acute respiratory infection, gastroenteritis, myocardial ischaemia). Daily ED attendances up to 11 March 2020 showed regular trends, highest on a Monday and reduced in children during school holidays. From 12 March 2020 ED attendances decreased across all age groups, all acuity levels, on all days and times. Across age groups the greatest percentage reductions were seen in school age children (5–14 years). By acuity, the greatest reduction occurred in the less severe presentations. Syndromic indicators showed that the greatest reductions were in non-respiratory indicators, which fell by 44–67% during 2020 COVID-19, while acute respiratory infection was reduced by −4.4% (95% CI −9.5% to 0.6%). ED attendances in England have been particularly affected during the COVID-19 pandemic due to changes in healthcare seeking behaviour. EDSSS has enabled real-time daily monitoring of these changes, which are made publicly available to facilitate action. The EDSSS provides valuable surveillance of ED attendances in England. The flexibility of EDSSS allowed rapid development of new indicators (including COVID-19-like) and reporting methods.

The impact of the COVID-19 pandemic on gastrointestinal infection trends in England, February – July 2020

“…As COVID-19 cases increased and further restrictions were implemented, health-seeking behaviour changed dramatically in England, with health service attendances decreasing from week 12 across all syndromic indictors [1,[18][19][20][21][22]. Similar decreases were observed internationally, with speculation that reduced healthcare usage was due to public avoidance, with some evidence that those with milder symptoms were least likely to seek care [3][4][5][6][7]23]. However, behavioural surveys conducted during late lockdown and lockdown easing found 70-80% of participants had continued to seek care, if needed [24][25].…”

The authors respond: the impact of COVID-19 on ED utilization, case mix and functions

“…We applaud Lai et al in this Letter to the Editor for exploring changes in acute care utilization in Taiwan related to COVID-19. Their result, that ED visits fell by between 21.3% and 36.3% compared to prior years during the Lunar New Year Holiday in 2020, and that they fell by even larger margins for influenza-like-illnesses, is comparable to findings from the United States [ 1 , 2 ], the UK [ 3 ], and Japan [ 4 ]. In Taiwan, COVID-19 control measures likely contributed to a change in the baseline population incidence of pathologies with infectious etiology.…”

Paediatric ED utilisation in the early phase of the COVID-19 pandemic

“…There have concomitant decreases in ED visits for adults during the pandemic and concern that adult patients with serious illnesses are delaying care. 9 Over time volumes are likely to return to normal. However, it is unclear how long this pandemic will last, and there is potential for surges to recur in a cyclical fashion.…”