The influence of coronavirus disease 2019 on emergency department visits in Nanjing, China: A multicentre cross-sectional study

Sun, Hao; Liu, Keqin; Li, Meng; Tang, Shaowen; Monte, Andrew A.; Wang, Jun; Nie, Shinan; Rui, Qinglin; Liu, Wenge; Qin, Haidong; Tan, Xiao; Ni, Haibin; Yang, Wenxin; Zhu, Congjian; Yang, Runhua; Yu, Tianhao; Wang, Shengwei; Jiang, Hao; Chen, Xiaofeng; Zhang, Wei; Zhu, Yi; Zhao, Huatou; Yang, Shiyu; Yin, Kejin; Shao, Danbing; Xiao, Liang; Chen, Zhengwei; Yuan, Weizhong; Hu, Dongdong; Wan, Xiaoyong; Wu, Lanfu; Zhang, Jinsong

INTRODUCTION: Influenza has been linked to the crowding in emergency departments (ED) across the world. The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on China EDs has been quite different from those during past influenza outbreaks. Our objective was to determine if COVID-19 changed ED visit disease severity during the pandemic. METHODS: This was a retrospective cross sectional study conducted in Nanjing, China. We captured ED visit data from 28 hospitals. We then compared visit numbers from October 2019 to February 2020 for a month-to-month analysis and every February from 2017 to 2020 for a year-to-year analysis. Inter-group chi-square test and time series trend tests were performed to compare visit numbers. The primary outcome was the proportion of severe disease visits in the EDs. RESULTS: Through February 29 (th) 2020, there were 93 laboratory-confirmed COVID-19 patients in Nanjing, of which 40 cases (43.01%) were first seen in the ED. The total number of ED visits in Nanjing in February 2020, were dramatically decreased (n = 99,949) in compared to January 2020 (n = 313,125) and February 2019 (n = 262,503). Except for poisoning, the severe diseases in EDs all decreased in absolute number, but increased in proportion both in year-to-year and month-to-month analyses. This increase in proportional ED disease severity was greater in higher-level referral hospitals when compared year by year. CONCLUSION: The COVID-19 outbreak has been associated with decreases in ED visits in Nanjing, China, but increases in the proportion of severe ED visits.