Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear.

The novel coronavirus, Severe acute respiratory syndrome -CoronaVirus - 2 (SARS-CoV-2), and the resulting infection, COVID-19, is posing an enormous threat and huge workload to emergency departments (EDs) worldwide. The COVID-19 pandemic is a major health emergency that is impacting the behaviour of entire populations in response to a direct threat to both individuals and communities.

Italy saw an exponential growth in COVID-19 cases from the day the first patient was identified in the north of Italy until the 9th of March, when the Italian government imposed the national lockdown. This measure represented a necessary and inevitable action to reduce the spread of infection; however, it also created an environment of strong emotions in the community, especially fear.

Recent studies have shown a significant reduction in ED visits related to different disciplines over the first weeks of the pandemic. , The consensus is that patients were avoiding going to hospitals because they feared getting infected with COVID-19. This may highlight the overuse of EDs by non-emergency and low complex cases that could be managed by general practitioners; however, there may also be a worrisome tendency to postpone consultations with specialists, even when necessary.

We compared ED visits in two major referral hospitals in the north of Italy from the 21st February to 16th April with COVID-19 daily mortality data from the Italian Civil Protection Department (Fig. 1 ). It emerges that the two curves almost mirror one another, with a meeting point on the 16th of March and the lowest peak of ED visits corresponding with the highest peak in the COVID-19 daily mortality trend. ED visits have recently shown a timid turnaround, reaching 150 visits/day on 16th April, which suggests the two curves will meet again in the coming next weeks.

Fig. 1

Non-COVID-19 emergency department admissions vs COVID-19 daily deaths. HSM = Policlinico San Martino Hospital (Genoa, Italy); OSCDC = IRCCS Sacro Cuore Don Calabria Hospital (Negrar di Valpolicella, Italy).

The slow upward trend of non-COVID-19 visits to EDs presents a milder slope than the reduction in COVID-19 mortality, indicating how the behaviour of a population in a negative emotional state may require a longer time to change and, mostly, that the fear of what we can get might be greater than the fear of what we have.

Conflicts of interest

None.

Fundings

None.