On March 13, 2020, the United States declared a national emergency over COVID-19. States issued stay-at-home orders, and CDC and the Centers for Medicare & Medicaid Services advised health systems to prioritize urgent visits and delay elective care. By May, national data showed that emergency department (ED) visits overall had fallen 42% in the pandemic’s early months.
Some emergencies, though, always need immediate care. A CDC team looked at three of them — heart attack (myocardial infarction), stroke and hyperglycemic crisis, the dangerous high blood sugar of diabetes — to see what happened to ED visits for them. The report was posted as an MMWR Early Release on June 22, 2020.
The data
The analysis used CDC’s National Syndromic Surveillance Program, which collects electronic records from EDs in 47 states and the District of Columbia — about 73% of the nation’s ED visits — limited to 1,670 EDs with consistently complete discharge diagnoses. The three conditions were identified by diagnosis code, and visits in the 10 weeks after the declaration (March 15–May 23, 2020) were compared with the 10 weeks before (January 5–March 14).
What happened
| Condition | Change in ED visits |
|---|---|
| Heart attack | −23% |
| Stroke | −20% |
| Hyperglycemic crisis | −10% |
Visits for heart attack and stroke had been stable through early 2020. They dropped sharply from the week beginning March 1, bottomed out in late March, and then crept back up without returning to their earlier level. Hyperglycemic crisis followed a similar but milder pattern. The declines were similar for men and women.
Weekly ED visits for the three conditions, 2019 to May 2020, with the emergency declaration marked. Image from CDC’s page.
The relative drop for heart attack and stroke was similar across ages, while the drop for hyperglycemic crisis tended to be larger in younger people, especially women. In numbers of visits, the biggest falls were:
- heart attack: people aged 65–74 (2,114 fewer visits among men, 1,459 among women);
- stroke: men aged 65–74 (1,406 fewer) and women aged 75–84 (1,642 fewer);
- hyperglycemic crisis: adults aged 18–44 (419 fewer among men, 775 among women).
Decrease in ED visits by age group and sex. Image from CDC’s page.
Why it matters
A short-term fall this large in how often heart attacks and strokes actually happen is biologically implausible, especially among older adults, and unlikely for hyperglycemic crisis. The more likely explanation is that people could not get care, or delayed or avoided it — out of fear of catching COVID-19, because of messages to stay home and avoid nonurgent care, or for other reasons. The authors suggest the missed visits may partly explain the excess deaths during the pandemic that were not attributed to COVID-19.
Other studies found the same: a 38% drop in heart-attack activations at nine large U.S. cardiac catheterization labs in March 2020; 43%–50% fewer admissions for heart attack and other acute cardiovascular conditions in large hospital systems in California, Massachusetts and New York City; and 39% fewer patients evaluated for stroke across about 850 U.S. hospitals. Hyperglycemic crisis may have fallen less because people with diabetes often recognize it through home glucose monitoring rather than symptoms alone.
These are common and deadly conditions. Heart disease is the leading cause of death in the United States and stroke the fifth; someone has a heart attack every 40 seconds, and about 795,000 people have a stroke each year. Diabetes affects 34 million Americans, and uncontrolled high blood sugar can lead to diabetic ketoacidosis or a hyperosmolar hyperglycemic state — preventable but life-threatening. The sooner emergency care begins, the better the chance of survival.
The message
Anyone with severe chest pain, sudden or partial loss of movement, altered mental state, signs of extremely high blood sugar, or another life-threatening problem should call 9-1-1 — pandemic or not. Public health and health care professionals need to communicate clearly that timely emergency care matters, and that EDs follow infection-control practices to keep patients and staff safe.
Limitations
- Coverage varies within and between states, and reporting hospitals change over time.
- Diagnosis coding practices may differ, though coding for these common, serious conditions is likely consistent.
- The system does not record deaths, so it is unknown whether some patients sought care elsewhere or died at home.
- Late reporting may make the final weeks look slightly lower.
- Seasonal effects may exist, but comparing adjacent periods limited other changes.
Sources
Based on Lange SJ, Ritchey MD, Goodman AB, et al., "Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions — United States, January–May 2020," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
许可协议： CC0 1.0（公有领域） · 改编自 www.cdc.gov
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