Masking for COVID-19 Is Associated with Decreased Emergency Department Utilization for Non-COVID Viral Illnesses and Respiratory Conditions in Maryland

Abstract

Background : Masking, which is known to decrease the transmission of respiratory viruses, was not widely practiced in the United States until the COVID-19 pandemic. This provides a natural experiment to determine whether the percentage of community masking was associated with decreases in emergency department (ED) visits due to non-COVID viral illnesses (NCVI) and related respiratory conditions. Methods: Observational study of ED encounters in a 11-hospital system in BLINDED during 2019-2020. Year-on-year ratios for all complaints were calculated to account for ‘lockdowns’ and the global drop in ED visits due to the pandemic. Encounters for specific complaints were identified using the International Classification of Diseases, version 10. Encounters with a positive COVID test were excluded. Linear regression was used to determine the association of publicly available masking data with ED visits for NCVI and exacerbations of asthma and chronic obstructive pulmonary disease (COPD), after adjusting for patient age, sex, and medical history. Results: There were 285,967 and 252,598 ED visits across the hospital system in 2019 and 2020, respectively. There was a trend towards an association between the year-on-year ratio for all ED visits and the BLINDED stay-at-home order (parameter estimate=-0.0804, p=0.10). A 10% percent increase in the prevalence of community masking was associated with a 17.0%, 8.8%, and 9.4% decrease in ED visits for non-COVID viral illness and exacerbations of asthma exacerbations and COPD, respectively (p<0.001 for all). Conclusions: These findings may be valuable for future public health responses, particularly in future pandemics with respiratory transmission or in severe influenza seasons.

Assessment of the impact of the COVID-19 pandemic on health services use

“…Coherent with our and others' results, emergency department visits declined during the pandemic [ 28 , 29 ], which may be explained by a combination of factors including avoidance due to COVID-19 infection fears and reductions in both motor vehicle accident and other-related trauma [ 30 ], which are a major reason for emergency department visits [ 28 , 30 ]. However, it should also be noted that another contributing factor to emergency department visit declines may be the unusually low influenza rates during 2020–2021, likely due to masking, social distancing, and increased uptake of flu vaccines as a result of the COVID-19 pandemic [ [31] , [32] , [33] ].…”

Return to School and COVID-19 Vaccination for Pediatric Solid Organ Transplant Recipients in the United States: Expert Opinion for 2021-2022

“…Even in areas with very high levels of community transmission, there has been minimal evidence of student-to-student transmission when strict procedures are in place to limit the spread of infection [ 25–27 ]. In fact, the effect of prevention measures extended beyond SARS-CoV-2 and had a profound impact on decreasing other seasonal respiratory viruses [ 28 , 29 ].…”

Decreased incidence of febrile neutropenia in Michigan following masking and social distancing orders for the COVID-19 pandemic: A population based cohort study

“…The public health response to COVID-19 in the state of Michigan provided a unique opportunity to analyze the impact of social distancing and masking on the incidence of FN. Masking and social distancing designed to prevent the spread of COVID-19 have resulted in the decline of other non-covid viral illnesses[ 10 , 11 ]. Our study is the first to document an association between this phenomenon and a decline in the incidence of FN, both overall and in patients with an ICD-10-CM diagnosis consistent with hematologic malignancy.…”