The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel

Ziona Haklai; Yael Applbaum; Vicki Myers; Mor Saban; Ethel-Sherry Gordon; Osnat Luxenburg; Rachel Wilf-Miron

doi:10.1016/j.ajem.2022.01.005

The effect of the COVID-19 pandemic on non-COVID respiratory ED visits in Israel

Am J Emerg Med. 2022 Mar:53:215-221. doi: 10.1016/j.ajem.2022.01.005. Epub 2022 Jan 11.

Authors

Ziona Haklai¹, Yael Applbaum¹, Vicki Myers², Mor Saban³, Ethel-Sherry Gordon¹, Osnat Luxenburg⁴, Rachel Wilf-Miron⁵

Affiliations

¹ Division of Health Information, Ministry of Health, Jerusalem, Israel.
² Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. Electronic address: vickimg@gertner.health.gov.il.
³ Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
⁴ Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel.
⁵ Gertner Insititute of Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel; School of Public Health, Tel Aviv University, Tel Aviv, Israel.

Abstract

Background: The COVID 19 pandemic has had a crucial effect on the patterns of disease and treatment in the healthcare system. This study examines the effect of the COVID-19 pandemic on respiratory ED visits and admissions broken down by age group and respiratory diagnostic category.

Methods: Data on non-COVID related ED visits and hospitalizations from the ED were obtained in a retrospective analysis for 29 acute care hospitals, covering 98% of ED beds in Israel, and analyzed by 5 age groups: under one-year-old, 1-17, 18-44, 45-74 and 75 and over. Diagnoses were classified into three categories: Upper respiratory tract infections (URTI), pneumonia, and COPD or asthma. Data were collected for the whole of 2020, and compared for each month to the average number of cases in the three pre-COVID years (2017-2019).

Results: In 2020 compared to 2017-2019, there was a decrease of 34% in non-COVID ED visits due to URTI, 40% for pneumonia and a 35% decrease for COPD and asthma. Reductions occurred in most age groups, but were most marked among infants under a year, during and following lockdowns, with an 80% reduction. Patients over 75 years old displayed a marked drop in URTI visits. Pediatric asthma visits fell during lockdowns, but spiked when restrictions were lifted, accompanied by a higher proportion admitted. The percent of admissions from the ED visits remained mostly stable for pneumonia; the percent of young adults admitted with URTI decreased significantly from March to October.

Conclusions: Changing patterns of ED use were probably due to a combination of a reduced rate of viral diseases, availability of additional virtual services, and avoidance of exposure to the ED environment. Improved hygiene measures during peaks of respiratory infections could be implemented in future to reduce respiratory morbidity; and continued provision of remote health services may reduce overuse of ED services for mild cases.

Keywords: Admissions; Asthma; COVID-19; Emergency department (ED) visits; Pneumonia; Respiratory disorders; URTI.

MeSH terms

Adolescent
Adult
Aged
COVID-19 / prevention & control*
COVID-19 / transmission
Child
Child, Preschool
Emergency Service, Hospital / organization & administration
Emergency Service, Hospital / statistics & numerical data*
Female
Humans
Infant
Israel / epidemiology
Male
Middle Aged
Patient Acceptance of Health Care / statistics & numerical data*
Respiratory Insufficiency / diagnosis*
Respiratory Insufficiency / epidemiology
Retrospective Studies