Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis

Abstract

Objectives Following the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and the subsequent global spread of the 2019 novel coronavirus disease (COVID-19), health systems and the populations who use them have faced unprecedented challenges. We aimed to measure the impact of COVID-19 on the uptake of hospital-based care at a national level. Design The study period (weeks ending 5 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization and the initiation of the UK lockdown. We undertook an interrupted time-series analysis to evaluate the impact of these events on hospital services at a national level and across demographics, clinical specialties and National Health Service Health Boards. Setting Scotland, UK. Participants Patients receiving hospital care from National Health Service Scotland. Main outcome measures Accident and emergency (A&E) attendances, and emergency and planned hospital admissions measured using the relative change of weekly counts in 2020 to the averaged counts for equivalent weeks in 2018 and 2019. Results Before the pandemic announcement, the uptake of hospital care was largely consistent with historical levels. This was followed by sharp drops in all outcomes until UK lockdown, where activity began to steadily increase. This time-period saw an average reduction of −40.7% (95% confidence interval [CI]: −47.7 to −33.7) in A&E attendances, −25.8% (95% CI: −31.1 to −20.4) in emergency hospital admissions and −60.9% (95% CI: −66.1 to −55.7) in planned hospital admissions, in comparison to the 2018–2019 averages. All subgroup trends were broadly consistent within outcomes, but with notable variations across age groups, specialties and geography. Conclusions COVID-19 has had a profoundly disruptive impact on hospital-based care across National Health Service Scotland. This has likely led to an adverse effect on non-COVID-19-related illnesses, increasing the possibility of potentially avoidable morbidity and mortality. Further research is required to elucidate these impacts.

Comparison of presentations to the emergency department during the COVID-19 pandemic (COPED-C)

“…The disruptive impact of COVID-19 on hospital-based and emergency care has been the subject of some studies to date. 12 , 13…”

Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance?

“…• Possible increased use of azithromycin and teicoplanin (because of the initial absence of clear guidelines for the treatment of COVID-19 patients) [4,6,8] • Difficulties in accessing advice from experts before prescribing antimicrobial agents [4] • Antimicrobial stewardship efforts may be undermined because of high workloads and shifting priorities related to COVID-19 [37,38] • Possible aggravation of existing shortages of certain narrowspectrum antimicrobial agents [39,40] • Bacterial co-infection (estimated on presentation) in only 3.5% (95% CI: 1-7%) of COVID-19 patients [33] • Bacterial/fungal infection in only 8% of hospitalised COVID-19 patients vs 11% in non-COVID-19 patients [34]; the percentage for COVID-19 patients may be underestimated because many may have received empiric antimicrobial therapy [41] • Only 1.3% of COVID-19 patients in ICUs, and apparently no patients in other units, developed a healthcare-associated superinfection with antimicrobial-resistant bacteria [19] • Postponed planned surgical interventions result in fewer antibiotic courses for surgical prophylaxis [42] • Fewer emergency and planned hospital admissions [43,44], including chronically ill patients (e.g. oncology patients, diabetic patients, transplant patients), resulting in fewer antibiotic prescriptions Infection prevention and control in hospitals…”

“…for processing rapid tests for MDROs, because resources are focused on SARS-CoV-2 diagnosis [4] • Isolation of COVID-19 patients with enhanced standard precautions, e.g. increased hand hygiene and use of PPE, plus universal chlorhexidine bathing protocols for patients in ICUs [5] • Increased disinfection of the environment [4,5] • COVID-19 patients are often cohorted in one single unit and cared for by the same group of HCWs [5] • Fewer emergency and planned hospital admissions [43,44], including chronically ill patients (e.g. oncology patients, diabetic patients, transplant patients), resulting in lower colonisation pressure by fewer carriers of MDROs…”

Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales

“…8 Messaging to avoid overwhelming the National Health Service (NHS) and fear of contracting SARS-CoV-2 in hospitals had an impact on patients’ willingness to seek emergency care. 9 However, restrictions in movement 10 and social contact with the resulting reduction in outdoor air pollution and exposure, and transmission of other respiratory viruses could have led to a true reduction in asthma exacerbations during the lockdown.…”