Non-COVID-19 patients in times of pandemic: Emergency department visits, hospitalizations and cause-specific mortality in Northern Italy

Abstract

The COVID-19 pandemic forced healthcare services organization to adjust to mutating healthcare needs. Not exhaustive data are available on the consequences of this on non-COVID-19 patients. The aim of this study was to assess the impact of the pandemic on non-COVID-19 patients living in a one-million inhabitants’ area in Northern Italy (Bologna Metropolitan Area-BMA), analyzing time trends of Emergency Department (ED) visits, hospitalizations and mortality. We conducted a retrospective observational study using data extracted from BMA healthcare informative systems. Weekly trends of ED visits, hospitalizations, in- and out-of-hospital, all-cause and cause-specific mortality between December 1st, 2019 to May 31st, 2020, were compared with those of the same period of the previous year. Non-COVID-19 ED visits and hospitalizations showed a stable trend until the first Italian case of COVID-19 has been recorded, on February 19th, 2020, when they dropped simultaneously. The reduction of ED visits was observed in all age groups and across all severity and diagnosis groups. In the lockdown period a significant increase was found in overall out-of-hospital mortality (43.2%) and cause-specific out-of-hospital mortality related to neoplasms (76.7%), endocrine, nutritional and metabolic (79.5%) as well as cardiovascular (32.7%) diseases. The pandemic caused a sudden drop of ED visits and hospitalizations of non-COVID-19 patients during the lockdown period, and a concurrent increase in out-of-hospital mortality mainly driven by deaths for neoplasms, cardiovascular and endocrine diseases. As recurrencies of the COVID-19 pandemic are underway, the scenario described in this study might be useful to understand both the population reaction and the healthcare system response at the early phases of the pandemic in terms of reduced demand of care and systems capability in intercepting it.

Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis

“…Gender and age were almost equally distributed between the 2 years. ED visits consistently dropped in March (− 52%) and April (− 52%) 2020 during the first pandemic wave as already described in other Italian settings [6][7][8]. During summer, the reduction of SARS-CoV-2 contagion and COVID-19 related-hospitalization rates were associated with a gradual increase in ED presentations.…”

“…During the COVID-19 pandemic, a consistent decrease in ED visits has been recorded worldwide. Italy has been the first western country to register a reduction in individuals seeking medical attention in EDs, although studies describing this phenomenon are mostly limited to the first pandemic wave [6][7][8].…”

Trends of follow-up clinic visits and admissions three-months before and during COVID-19 pandemic at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: an interrupted time series analysis

“…In a study conducted in TASH before the COVID 19 pandemic, overcrowding was one problem identified hindering the provision of quality care and care within a reasonable time [ 25 ], which might have an implication on implementation of social distancing, which is one of the preventive measures during COVID 19 pandemic [ 20 , 26 ]. Studies conducted during the early stages of COVID in Ethiopia also revealed the problem of inadequate personal protective equipment in major hospitals of Addis Ababa, including TASH [ 38 ]. The overcrowding and the limited availability of personal protective equipment at TASH justifiably increase the fear of acquiring COVID 19 in this setting, which could decline follow-up visits.…”

“…Although the admission rate did not significantly decline compared to outpatient follow-up, we will not undermine the decline in a hospital that used to be full with patients waiting to be admitted at any time of the year. In addition, the emergency admission significantly decreased in the study period, which raised the concern of increased morbidity and mortality due to delay or lack of care [ 38 ].…”

Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

“…In countries around the world, SARS CoV-2 dramatically disrupted healthcare systems that often failed to find a balance between maintaining safe routine healthcare for patients with non-COVID-19 disorders and the sudden need for resources to take in the increasing number of patients with COVID-19 [ 4 ]. This competition for resources led to additional COVID-19-related damages, due to complications resulting from uncontrolled disease with increased levels of disability and mortality in non-COVID-19 populations [ 5 ]. Health systems have had little time to prepare and to rapidly reorganize services to meet the acute needs of patients with COVID-19, whilst also maintaining routine and emergency care for people requiring new or ongoing support, and at the same time managing physical distancing and reducing face-to-face appointments and attendance at healthcare establishments.…”