Drastic Decline in ER Visits Suggests Many People Avoided Critical Medical Care in March and April

A convoy of 50 ambulances drives down Lansdowne Street on their way to Fenway Park in celebration of National EMS Week on May 20, 2020 in Boston, Massachusetts.
A convoy of 50 ambulances drives down Lansdowne Street on their way to Fenway Park in celebration of National EMS Week on May 20, 2020 in Boston, Massachusetts.
Photo: Maddie Meyer (Getty Images)

A new study out Monday seems to confirm anecdotal reports from health care workers: Emergency rooms across the U.S. saw a massive decline in visits in March and April, possibly because people feared contracting covid-19 if they sought medical care.

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The study, published in JAMA Internal Medicine, was an examination of daily emergency department visits as well as hospitalizations that went through the emergency department from January to April of this year. Data from more than 20 emergency rooms in five states—Colorado, Connecticut, Massachusetts, New York, and North Carolina—was included in the study.

The authors found that there was a clear decline in daily ER visits starting in March across all five states, relative to the months before. At the same time, there was an uptick in people who visited the ER and were then admitted for hospitalization. Between states, though, there were differences.

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In New York, for instance, the studied ERs reported a 63.5% decrease in total visits through March and April, while Colorado ERs reported a 41.5% decline (the smallest decline of the five states). New York also experienced a 149% increase in hospitalizations through the ER during this period, while North Carolina experienced a 22% jump in hospitalizations (the lowest increase of the five states).

The decline in ER visits, the authors concluded, suggests that policies intended to promote social distancing between people may have been interpreted too strongly by the general public.

“This is a case where public messaging appears to have worked too well,” lead author Edward Melnick, associate professor of emergency medicine at Yale University, said in a statement released by the university. “We said, ‘stay home,’ and what people heard was: ‘Stay home at all costs to avoid COVID-19.’

The other findings by the team—that hospitalizations through the ER began increasing in March and April—do suggest that covid-19 made many people seriously sick during these early days. Importantly, the authors noted, admissions only began rising after locally reported cases of covid-19 began increasing as well. And New York’s much higher increase in hospitalizations relative to other states likely reflects the much larger outbreak the state was facing during that time (New York’s reported death toll of over 30,000 remains much greater than any other state’s so far).

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But though it’s true that some hospitals in areas hard hit by the pandemic continue to experience difficulties in securing enough resources to manage all their patients, hospitals in general do seem to have been able to cope during this time. According to Melnick, people shouldn’t be afraid to visit the ER if they feel they need emergency care, whether covid-19 rates are high in the area or not.

“Our new rallying cry is that hospitals are safe,” Melnick said. “Few hospitals outside of New York approached going over capacity during March and April 2020. That means a lot of people suffering from non-COVID illnesses and injuries may have stayed home and unnecessarily suffered or even died because they were too scared to come in.”

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Science writer at Gizmodo and pug aficionado elsewhere

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DISCUSSION

The decline in ER visits, the authors concluded, suggests that policies intended to promote social distancing between people may have been interpreted too strongly by the general public.

As someone who has worked in the ER, my first thought is “Well, a lot of people use the ER as their PCP. And quite a few shouldn’t even be going to a PCP with some of their complaints.

So I’d think part of the drop is people taking a hard look at the situation and (rightly so) realizing their issue does in no way warrant an ER visit.