Intended for healthcare professionals


Covid-19: A&E visits in England fall by 25% in week after lockdown

BMJ 2020; 369 doi: (Published 06 April 2020) Cite this as: BMJ 2020;369:m1401

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  1. Jacqui Thornton
  1. London, UK

Attendances at emergency departments in England have fallen significantly since the covid-19 lockdown, sparking concern that some people may be harmed by not accessing treatment.

The Royal College of Emergency Medicine said that the public should not be frightened of going to emergency departments after figures showed that they saw 89 584 attendances in the week after the lockdown (March 23-29), down 25% on the 120 356 seen the previous week.

Compared with the last week in February (24 February to 1 March), when attendances were 177 370, visits to emergency departments after the lockdown were down 49%, statistics from the Emergency Department Syndromic Surveillance System: England (EDSSS) showed.1

Only pneumonia cases increased in the week the lockdown began. In every other indicator, including cardiac, myocardial ischaemia, and gastrointestinal conditions, the figures went down.

Vice president of the college Ian Higginson, a practising emergency physician, said that this was a well recognised but unexplained universal phenomenon that has also been observed in Australia, Canada, and Europe.

“We don’t know whether there is less disease, whether it’s being managed differently, or whether people are at home with diseases that should be treated,” he said.

The drop occurred immediately after the prime minister Boris Johnson announced a lockdown on 23 March. In the same week in 2019 (week 13) there were 136 669 total attendances.2

Last week’s emergency figures were even lower than Christmas week 2019, when there were 125 768 attendances.3

There may be less disease because of the reduced contact between people and less trauma because of lower vehicle use. However, the college is concerned that there may be more domestic violence because of alcohol use at home and couples being trapped together in close confinement. Calls to the UK-wide National Domestic Abuse Helpline increased by 25% last week compared with the last week in February, according to a report on the BBC.

That still leaves many conditions such as heart attack, strokes, angina, exacerbations of chronic obstructive pulmonary disease, and asthma, which are being seen in much smaller numbers.

Higginson said that patients may be finding other ways of getting treated without going to hospital. For example, they may be being dealt with remotely by their GPs using video consultations and people with pre-existing conditions such as cancer, liver disease, or postoperative complications may be being treated directly by their specialist team.

There are likely to be others who choose to wait and see rather than calling an ambulance because they were worried about catching the virus. “There’s undoubtedly an element of people where there’s a degree of discretion to attend,” said Higginson.

He said there was concern that some people should be getting treated, such as those with small heart attacks or strokes, and healthcare professionals would see the consequences of that down the line.

But he said a public health message to go to the emergency department as normal would not be helpful as they were extremely busy. “Patients should not be frightened about going to the emergency department if they need urgent or emergency care because emergency departments are still open,” he said.

The number of attendances has been declining for a month since the news of the impact of covid-19 on Wuhan and Italy intensified. The UK had its first death on 5 March (week 10) when weekly attendances were 174 428.4

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