Update

COVID-19 Pandemic–Associated Changes in Emergency Department Visits

United States, December 2020-January 2021

Jennifer Adjemian, PhD; Kathleen P. Hartnett, PhD; Aaron Kite-Powell, MS; Jourdan DeVies, MS; Roseric Azondekon, PhD; Lakshmi Radhakrishnan, MPH; Katharina L. van Santen, MSPH; Loren Rodgers, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2021;70(15):552-556. 

In This Article

Discussion

After a decline in ED visits in the United States associated with the COVID-19 pandemic during March–April 2020,[1] ED visits steadily increased through July 2020, and then stabilized through the fall. During December 2020–January 2021, visits declined again to a level 25% lower than that during December 2019–January 2020. These declines were highest in children aged ≤10 years, who had 65% fewer ED visits during December 2020–January 2021 than during December 2019–January 2020. Although ED visits increased among adults during December 2020–January 2021, they were 17% below those during the prepandemic period. There was a decline in ED visits among children for conditions such as influenza, acute bronchitis, and pneumonia, which could reflect reduced transmission of other pathogens; therefore the decreased visits might represent appropriate use of ED care or that children might be disproportionately affected by changes in care-seeking behaviors because of the COVID-19 pandemic. The reasons for ED visits have changed during the pandemic period compared with those during the prepandemic period. More visits were associated with severe respiratory and cardiovascular conditions during the pandemic period; more adults and children have also been seeking emergency care for mental or behavioral health and socioeconomic and psychosocial concerns. However, weekly numbers for visits for some categories of mental or behavioral health diagnoses (e.g., feeding and eating disorders) remain relatively low, particularly among pediatric patients.

Decreases in the numbers of ED visits among children might disproportionately affect families that lack reliable access to primary care and might instead use EDs for treatment,[3] possibly preventing them from obtaining needed care. In addition, the wide regional variations in numbers of ED visits might indicate differences in public health messaging and risk perceptions regarding COVID-19, stay-at-home policies, transmission patterns, access to testing and primary care, as well as other factors. Possible barriers to necessary medical care should be addressed with targeted public health messaging and clinical guidance to ensure that treatment for critical conditions is not delayed. Although the numbers of ED visits associated with socioeconomic factors and mental or behavioral health conditions are low, the increased proportion of these visits by both adults and children suggests that health care providers should maintain heightened vigilance in screening for factors that might warrant further treatment, guidance, or intervention during the COVID-19 pandemic.[4,5]

The findings in this report are subject to at least four limitations. First, diagnostic categories rely on the use of specific codes, which might be missing or used inconsistently across hospitals.[6] Second, NSSP coverage is not uniform across or within states; some hospitals report statewide and others do not report statewide or have no data available for some counties. However, given that NSSP data represent 71% of U.S. EDs, trends identified at the national level likely represent actual patterns in persons seeking care during the COVID-19 pandemic. Third, this analysis did not analyze NSSP data by age, sex, race, and ethnicity within each region; future studies that evaluate this information can help guide interventions to address the increased prevalence of socioeconomic factors and mental or behavioral health conditions associated with ED visits. Finally, ED visits and trends are likely the result of many factors that can be challenging to fully understand with limited patient data available; additional studies are needed to help guide public health communication strategies on ED use.

These findings provide updates for clinical and public health stakeholders on the changing profile of ED visits associated with the COVID-19 pandemic. CDC is available to provide support to sites interested in participating in NSSP to monitor for critical trends in ED visits. As the nation continues to manage the impact of the ongoing pandemic, public understanding of the importance of seeking guidance and emergency care for acute and mental or behavioral health conditions is necessary. Wider access to health messages, triage help lines, and virtual visits that help all persons, especially caregivers of children and adolescents, can help determine when seeking immediate care might be warranted and might also result in fewer patients seeking ED care.[7]

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