With emergency visits down 42%, US hospitals reeling from COVID-19

Hospital emergency department
Hospital emergency department

Open Grid Scheduler / Flickr cc

In April, 42% less people visited emergency departments (EDs) across the United States than in April last year, according to data published today in Morbidity and Mortality Weekly Report.

This significant drop-off, which took place while most states had stay-at-home orders, translates to millions of dollars lost by US hospitals still fighting the COVID-19 pandemic, and Americans becoming at risk for worsening outcomes for non-COVID emergencies.

The data were collected from the National Syndromic Surveillance Program' electronic health data in real time. Visits dropped from a mean of 2.1 million per week (Mar 31 to Apr 27, 2019) to 1.2 million per week (Mar 29 to Apr 25, 2020).

The biggest drop-off in patients was among children 14 years old and younger, women and girls, and people in the Northeast (presumably due to large COVID-19 outbreaks in New York and New Jersey). In the pre-pandemic 2019 data, 12% of emergency department visits were for children; that figure dropped to 6% in the pandemic period.

Although the fewest visits were seen in mid-April, the most recent complete week (May 24 through 30) remained 26% below the corresponding week in 2019, the authors said. And though telemedicine has emerged as an important tool during the pandemic, the authors warn it's not always appropriate—or accessible—for patients.

"Health messages that reinforce the importance of immediately seeking care for symptoms of serious conditions, such as myocardial infarction, are needed," the authors said, cautioning that while telemedicine is useful, avoiding the emergency room in times of distress is dangerous.

"Persons who use the ED as a safety net because they lack access to primary care and telemedicine might be disproportionately affected if they avoid seeking care because of concerns about the infection risk in the ED," they write.

Major delays in healthcare

Today the Washington Post released its own analysis of hospital use based on cellphone data. The Post also shows a significant drop in those seeking in-person healthcare, with many counties across the country showing a 50% drop-off or more compared with last year. The report says nearly 100 million people have delayed healthcare over the past 3 months.

The reduction in visits was seen in hospitals battling COVID-19 as well as in communities without many cases. Much of the reduction in visits was due to elective surgeries being canceled, which translated into millions of dollars of lost revenue.

According to the monthly government jobs report, 1.4 million US healthcare workers lost their jobs in April as hospitals began to eliminate services to prepare for a crush of COVID cases.

Call for emergency funds for hospitals

In an effort to both help hospitals fight COVID-19 and confront furloughs and decreased patient numbers, the president of the American Hospital Association (AHA) yesterday penned a letter to Health and Human Services Secretary Alex Azar, asking for three sums of money:

  • $10 billion to fund "hot spot" COVID-19 hospitals to help offset the significant costs incurred in testing, diagnosing, and treating patients
  • $10 billion to hospitals serving large numbers of Medicaid and uninsured patients
  • $30 billion in additional funds to all hospitals, including rural and urban short-term acute-care facilities

"Many hospitals are in dire circumstances as they face the biggest financial crisis in history," writes AHA President Richard J. Pollack, MD. "While our members continue to do everything they can to address COVID-19 cases, quickly making substantial additional funds available would help them continue to put the health and safety of patients and personnel first, and in many cases, may actually ensure they are able to keep their doors open."

New York sees drop in hospitalizations

To date, US officials have tracked 1,841,629 COVID-19 cases and 106,696 fatalities, according to an online dashboard maintained by Johns Hopkins University.

In a positive development, New York Governor Andrew Cuomo said hospitalizations for COVDI-19 in his state are at an all-time low since mid-March, with just 154 new hospitalizations on Jun 1.

New York has been the epicenter of the US outbreak, with 374,085 cases and 24,079 fatalities. On Jun 1, New York City launched its contact tracing program, which aimed to track 600 newly identified COVID-19 cases.

According to CBS News, the city has hired 1,700 people as contact tracers. Cuomo said the city needs 2,500 tracers before it can start phase 1 of the city's four-phase reopening plan.

Confusion over testing

Most of Virginia is set move into phase 2 of that state's reopening plan on Jun 5, with restaurants allowed to run at 50% and gyms open at 30% capacity, the Richmond Times-Dispatch reported today. Social gathering limits will also be raised from 10 to 50 people. Northern Virginia and Richmond, however, will remain in phase 1 for at least another week,

As businesses across the country reopen, many are struggling with how and when to test employees for COVID-19, Politico reports. Though the White House and the Centers for Disease Control and Prevention (CDC) said businesses can make employee testing a condition for reopening, there are no clear guidelines about how often to conduct the tests.

Adding to the confusion is a flood of more than 200 antibody tests—only 15 of which are approved by the Food and Drug Administration (FDA)—that have entered the US market in recent weeks.

Antibody tests were widely touted as the key to reopening the economy after a 6- to 12-week shutdown in most states, but inaccurate test results and high prices make the tests of limited use.

In May the CDC warned that because of the low prevalence of COVID-19 cases in most parts of the country, serology tests could be wrong as much as half the time. Experts say the FDA needs to tighten regulations on the testing marketplace.

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