More on Acute Care

Emergency department visits are down 42% across U.S. due to COVID-19

Younger patients are driving this decline, as the biggest dip was seen among children younger than 14.

Jeff Lagasse, Associate Editor

Hospital emergency departments are seeing steep declines in the numbers of patients they're treating, and April was an especially rough month. In fact, from April to 2019 to April 2020 there was a 42% decline in emergency department visits, according to data published in the Morbidity and Mortality Weekly Report from the U.S. Centers for Disease Control and Prevention.

That's had a direct impact on hospital finances as facilities have lost millions in ED revenue at a time when many are still treating high numbers of COVID-19 patients.


Those who use the ED as a safety net because they lack access to primary care and telemedicine might be disproportionately affected if they avoid seeking care because of concerns about the infection risk in the ED, the data suggests.

Mid-April saw the largest dip overall, but low ED numbers persisted into May, with 26% lower utilization found in the last full week of that month.

Younger patients are driving the decline, since the biggest dip was seen among children younger than 14. Where once they accounted for 12% of ED visits, they now account for 6%. Females have stayed at home in higher numbers than males, and a sharp decline in ED utilization was found in the Northeast, likely due to the high numbers of confirmed positive coronavirus cases in areas such as New York and New Jersey.

Among children, the largest declines were in visits for influenza (a 97% decrease), otitis media (85%), other specified upper respiratory conditions (84%), nausea and vomiting (84%), asthma (84%), viral infection (79%), respiratory signs and symptoms (78%), abdominal pain and other digestive or abdomen symptoms (78%), and fever (72%).

Among all ages, the diagnostic categories with the largest changes (abdominal pain and other digestive or abdomen signs and symptoms, musculoskeletal pain, and essential hypertension) were the same in males and females, but declines in those categories were larger in females than males. Females also had large declines in visits for urinary tract infections.

The authors advise health systems to continue adherence to Centers for Disease Control and Prevention infection control recommendations, such as immediately screening every person for fever and symptoms of COVID-19, and maintaining separate, well-ventilated triage areas for patients with and without coronavirus symptoms.


These challenges have placed a financial burden on hospitals that can't be overstated. In fact, a Kaufman Hall report looking at April hospital financial performance showed that steep volume and revenue declines drove margin performance so low that it broke records.

Despite $50 billion in funding allocated through the CARES Act, operating EBITDA margins fell to -19%. They fell 174%, or 2,791 basis points, compared to the same period last year, and 118% compared to March. This shows a steady and dramatic decline, as EBITDA margins were as high as 6.5% in April.

Twitter: @JELagasse

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