Stranger Months: How SARS-CoV-2, Fear of Contagion, and Lockdown Measures Impacted Attendance and Clinical Activity During February and March 2020 at an Urban Emergency Department in Milan
Stefano Franchini, Marzia Spessot, Giovanni Landoni, Cecilia Piani, Chiara Cappelletti, Federica Mariani, S Mauri, Maria Vittoria Taglietti, Manuela Fortunato, Federico Furlan, B. Guglielmi, Eleonora Setti, Davide Di Napoli, Giovanni Borghi, Federico Pascucci, George Ujlaki-Formenti, Riccardo Sannicandro, Matteo Moro, Sergio Colombo, Lorenzo Dagna, Antonella Castagna, Moreno Tresoldi, Patrizia Rovere‐Querini, Alberto Ambrosio, Fabio Ciceri, Alberto Zangrillo, Michele Carlucci, Roberto Faccincani
Abstract
OBJECTIVES: An unprecedented wave of patients with acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) hit emergency departments (EDs) in Lombardy, starting in the second half of February 2020. This study describes the direct and indirect impacts of the SARS-CoV-2 outbreak on an urban major-hospital ED. METHODS: Data regarding all patients diagnosed with COVID-19 presenting from February 1 to March 31, 2020, were prospectively collected, while data regarding non-COVID patients presenting within the same period in 2019 were retrospectively retrieved. RESULTS: ED attendance dropped by 37% in 2020. Two-thirds of this reduction occurred early after the identification of the first autochthonous COVID-19 case in Lombardy, before lockdown measures were enforced. Hospital admissions of non-COVID patients fell by 26%. During the peak of COVID-19 attendance, the ED faced an extraordinary increase in: patients needing oxygen (+239%) or noninvasive ventilation (+725%), transfers to the intensive care unit (+57%), and in-hospital mortality (+309%), compared with the same period in 2019. CONCLUSIONS: The COVID-19 outbreak determined an unprecedented upsurge in respiratory failure cases and mortality. Fear of contagion triggered a spontaneous, marked reduction of ED attendance, and, presumably, some as yet unknown quantity of missed or delayed diagnoses for conditions other than COVID-19.