Impact of the COVID-19 pandemic on emergency department: Early findings from a hospital in Madrid

Abstract

Introduction SARS-CoV-2, coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in Spain on 31 January 2020. On 14 March 2020, a state of emergency was declared in Spain in a bid to control the spread of the COVID-19 pandemic in the country. The aim of our study is to analyse the impact on emergency medicine attendance after the national lockdown, as well as the clinical presentation and the management of patients with suspected COVID-19 in the Paediatric Emergency Department. Patients and methods This retrospective observational study included children and adolescents under the age of 18, attended in our Paediatric Emergency Department during the period March 14 to April 17, 2020. Results A total of 1,666 patients were attended during the study period, 65.4% less than in the same period of 2019. Just over half (51.2%) were males, and mean age was 5.4 years. In triage, 39.9% were high priority levels, 6.5% more than 2019. Most frequent reasons for consultation at the Paediatric Emergency Department were fever (26.5%), respiratory symptoms (16.1%), and trauma (15.2%). A total of 218 patients (13%) received a diagnosis of possible COVID-19, with SARS-CoV-2 infection confirmed in 18.4%, and 23.8% (52/218) were hospitalised. At discharge, 44% (96/218) were diagnosed with lower, and 33.9% (74/218) with upper respiratory infection. Conclusions During the SARS-CoV-2 outbreak, the demand for urgent paediatric care decreased, with the proportion of cases with high priority triage levels increasing. Most of the patients with suspected or microbiological confirmation of COVID-19 had mild respiratory symptoms.

Impact of COVID‐19 pandemic on the medical activities of the Directorate of Health and Hygiene, Vatican City State

“…Occupational medicine was followed by dermatology, general surgery and ophthalmology, for which in-office appointments were mostly rescheduled. These findings are in line with reports from healthcare systems of other countries, where COVID-19 pandemic seriously impacted specialty consultations, leading to concerns regarding the impact of these changes on non-COVID chronic or acute conditions and screening procedures with potential consequences on patients' life [16][17][18][19]. Diversely, the number of legal medicine, angiology and psychiatry consultations increased in 2020.…”

“…Starting from June 2020, the Directorate of Health and Hygiene returned near to average pre-COVID-19 volumes for medical procedures even if the pandemic condition imposed a new agenda with increased time between appointments to allow disinfection procedures. When comparing with other countries, our results look promising; in fact, recent studies have shown that, after the lockdown of the initial period, a stable decrease in medical procedures could be found due to delays in restoring pre-COVID schedules and to patients' fear of contracting the infection at the hospital [16][17][18].…”

The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

“…Declines in the number of ED visits due to the COVID-19 pandemic were widely reported and ranged from 30 to 89% [ 6 , 34 ]. In Italy and the USA, a bigger decline in ED visits of children with non-acute illness or low triage codes was reported, causing a larger proportion of ED visits with higher acuity in most countries [ 14 , 17 , 20 , 28 , 35 ], although one Irish study reported no change after lockdown [ 36 ]. The absolute admission count during lockdowns decreased by 19–73% in all studies, except one [ 17 ].…”

“…Other countries reported a decrease in respiratory infections between 52 and 98% as well, and this reduction was generally larger than for other diagnosis groups [ 8 , 33 , 36 , 37 , 41 , 42 ], except for two studies in Spain, a country with a harsh lockdown [ 13 ]. Here, the reduction in the number of ED visits because of respiratory symptoms was identical to the overall reduction in visits [ 16 , 35 ]. In addition to reduced ED visits, our data also showed a decrease in infection-related hospitalizations, which was also observed in Denmark [ 43 ].…”

Expectations of Patients Seen in the Emergency Department for SARS-CoV-2 During the Pandemic

“…In this sense, the reasons for a visit to our PED in the initial phases of the pandemic were similar to those associated normally with visits at the same time of the year, as may be seen in other studies. 6,7 Concerns about delay in PED admission owing to fear of contracting infection in the health care setting, and a number of cases with unfavorable outcome due to this delay have been described. [6][7][8][9][10] It is likely that viewing the hospital as an unsafe location with the possibility of disease transmission may be a factor in this delay.…”