• Hao Sun, Keqin Liu, Meng Li, Shaowen Tang, Andrew A Monte, Jun Wang, Shinan Nie, Qinglin Rui, Wenge Liu, Haidong Qin, Xiao Tan, Haibin Ni, Wenxin Yang, Congjian Zhu, Runhua Yang, Tianhao Yu, Shengwei Wang, Hao Jiang, Xiaofeng Chen, Wei Zhang, Yi Zhu, Huatou Zhao, Shiyu Yang, Kejin Yin, Danbing Shao, Liang Xiao, Zhengwei Chen, Weizhong Yuan, Dongdong Hu, Xiaoyong Wan, Lanfu Wu, and Jinsong Zhang.
• Department of Emergency, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guang Zhou Road, Nanjing, Jiangsu, 210029, People's Republic of China.
• Am J Emerg Med. 2020 Oct 1; 38 (10): 2101-2109.

IntroductionInfluenza has been linked to the crowding in emergency departments (ED) across the world. The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on China EDs has been quite different from those during past influenza outbreaks. Our objective was to determine if COVID-19 changed ED visit disease severity during the pandemic.MethodsThis was a retrospective cross sectional study conducted in Nanjing, China. We captured ED visit data from 28 hospitals. We then compared visit numbers from October 2019 to February 2020 for a month-to-month analysis and every February from 2017 to 2020 for a year-to-year analysis. Inter-group chi-square test and time series trend tests were performed to compare visit numbers. The primary outcome was the proportion of severe disease visits in the EDs.ResultsThrough February 29 th 2020, there were 93 laboratory-confirmed COVID-19 patients in Nanjing, of which 40 cases (43.01%) were first seen in the ED. The total number of ED visits in Nanjing in February 2020, were dramatically decreased (n = 99,949) in compared to January 2020 (n = 313,125) and February 2019 (n = 262,503). Except for poisoning, the severe diseases in EDs all decreased in absolute number, but increased in proportion both in year-to-year and month-to-month analyses. This increase in proportional ED disease severity was greater in higher-level referral hospitals when compared year by year.ConclusionThe COVID-19 outbreak has been associated with decreases in ED visits in Nanjing, China, but increases in the proportion of severe ED visits.Copyright © 2020 Elsevier Inc. All rights reserved.

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