Reduced Emergency Department Utilization During the Early Phase of the COVID-19 Pandemic: Viral Fear or Lockdown Effect?

Barten, Dennis G.; Latten, Gideon; Osch, Frits van

doi:10.1017/dmp.2020.303

Cited by 86 publications

(104 citation statements)

References 9 publications

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“…Interestingly, an Italian study showed that patients with a suspected breast lesion and those with diagnosed breast cancer frequently refused surgery because of the risk of developing symptoms of COVID-19 [ 26 ]. Furthermore, one retrospective analysis of data from three Dutch hospitals showed that the lockdown in the Netherlands was preceded by decreased emergency department utilization [ 27 ], suggesting that fear may play a significant role in decreasing rates of healthcare utilization. In addition, semi-structured interviews conducted in the United States revealed that patients frequently see hospitals as infectious reservoirs [ 28 ] and may therefore be reluctant to go to hospital or to make an appointment with a primary care physician.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Cancer Diagnoses in General and Specialized Practices in Germany

Jacob

Loosen

Kalder

et al. 2021

Cancers

111

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The aim of this retrospective study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on cancer diagnosis in general and specialized practices in Germany. This study included a total of 102,009 patients aged ≥18 years newly diagnosed with cancer in 1660 practices in Germany from January to May 2019 and from January to May 2020. Practices included general, gynecology, ear, nose, and throat (ENT), dermatology, and urology practices. New cancer diagnoses included all types of cancer and corresponded to cancers not previously documented in the database for a given patient. The number of new cancer diagnoses per general practice decreased significantly between March and May 2020 compared with the same period in 2019 (March: −12.0%, April: −27.6%, and May: −23.4%). A similar trend was observed in specialized practices, and this trend was more pronounced in April 2020 (dermatology: −44.4%, gynecology: −32.0%, and ENT: −28.2%). In addition, there was a significant decrease in almost all sex and age groups in April and May 2020 compared with the same period in 2019. Finally, the decrease in the number of new cancer diagnoses was particularly pronounced among cancers of the skin and the respiratory and intrathoracic organs. Together, these data show that the COVID-19 pandemic had a significant negative impact on cancer diagnosis in Germany, highlighting the need for public health measures improving the management of cancer in this country during this ongoing pandemic.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Cancer Diagnoses in General and Specialized Practices in Germany

Jacob

Loosen

Kalder

et al. 2021

Cancers

111

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“…16 Although RD repairs and procedures for retinal tears decreased during the COVID-19 pandemic, it is uncertain whether this decrease is fully explained by patients who avoided evaluation and treatment from a fear of COVID-19 infection. 17 Multiple specialties, including emergency medicine, neurosurgery, pediatric orthopedics, and cardiology, have experienced decreases in clinical volumes, with attribution to fear of the virus as well as other specialty-dependent explanations. 7,[18][19][20][21] One of these studies examining approximately 15 000 cases of myocardial infarction demonstrated a decreased rate in myocardial infarction hospitalization within the first 5 weeks of the pandemic, followed by an increase in hospitalization with worse mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Urgent or Emergent Vitreoretinal Surgical Procedures in the United States During the COVID-19 Pandemic

et al. 2021

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(AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. OBJECTIVE To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. MAIN OUTCOMES AND MEASURES Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. RESULTS A total of 526 536 CPT codes were ascertained: 483 313 injections, 19 257 lasers or cryotherapy, 14 949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, −259 to −69 injections; P = .002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, −6.8 to −3.3 procedures; P < .001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, −2.7 to −1.4 repairs; P < .001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, −3.3 to −1.8 other vitrectomies; P < .001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. CONCLUSIONS AND RELEVANCE Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what ex...

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“…In addition, the fear of viral transmission in hospital settings may explain the significant decrease in emergency admissions, as patients avoid coming into the hospital. [6] As reported by Riley and colleagues, the COVID-19 pandemic led to a significant decrease in the number of surgical complaints, with a 61% decrease in the number of urgent vascular episodes. [7] A shift in vascular disease severity may also account for this reduction in emergent procedures.…”

Section: Discussionmentioning

confidence: 84%

Lessons Learned from the Impact of the COVID-19 Pandemic in a Vascular Surgery Department and Preparation for Future Outbreaks

Duarte

Melo

Lopes

et al. 2021

Annals of Vascular Surgery

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Objectives: This study aims to report the changes and adaptations of a vascular tertiary center during a global pandemic and the impact on its activity and patients. Methods: We conducted a retrospective cohort study within the Vascular Surgery ward in Centro Hospitalar Universitário Lisboa Nor te, Por tugal. All data from surgical, inpatient and outpatient activity were collected from February to June 2020 and compared to the same 5-month period in 2018 and 2019. We ran a descriptive analysis of all data and performed statistical tests for the variation of procedures and admissions between February and June 2018 and the same time period in 2020. Results: During the outbreak, our staff had to be readapted. Six nurses were transferred to COVID-19 units (out of a total of 33 nurses) while 1 of the 7 residents was transferred to an intensive care unit and 1 senior surgeon was put on prophylactic leave. In the outpatient clinic, there was an increase in the number of telemedicine consultations with a greater focus on first-time referrals and urgent cases. There was a significant increase in the total number of elective admissions whereas there were significantly less admissions from an emergency setting ( + 57% and −54%, respectively, P < 0.001). The vascular surgery team performed a total number of 584 procedures between February and June 2020 ( −17.8% compared to 2018 and 2019), with a significant increase in the number of endovascular procedures ( P < 0.001) and in the use of local and regional anesthesia ( P < 0.001), especially in the Angio Suite ( + 600%, P < 0.001). Comparing with 2018 and 2019, the surgical team performed less outpatient procedures in early 2020. We reported a significant increase in the total number of procedures for patients with a chronic limb-threatening ischemia (CLTI) diagnosis ( + 21%, P < 0.001). We did not report significant changes in the proportion of other vascular conditions. Regarding mortality, we observed a 16% decrease in the intraoperative mortality ( P 0.67).

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Reduced Emergency Department Utilization During the Early Phase of the COVID-19 Pandemic: Viral Fear or Lockdown Effect?

Cited by 86 publications

References 9 publications

Impact of the COVID-19 Pandemic on Cancer Diagnoses in General and Specialized Practices in Germany

Impact of the COVID-19 Pandemic on Cancer Diagnoses in General and Specialized Practices in Germany

Frequency of Urgent or Emergent Vitreoretinal Surgical Procedures in the United States During the COVID-19 Pandemic

Lessons Learned from the Impact of the COVID-19 Pandemic in a Vascular Surgery Department and Preparation for Future Outbreaks

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