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Report from the front
Emergency department use during COVID-19 as described by syndromic surveillance
  1. Helen E Hughes1,2,
  2. Thomas C Hughes3,
  3. Roger Morbey1,
  4. Kirsty Challen4,
  5. Isabel Oliver5,
  6. Gillian E Smith1,
  7. Alex J Elliot1
  1. 1 Real-time Syndromic Surveillance Team, Public Health England, Birmingham, UK
  2. 2 University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
  3. 3 John Radcliffe Hospital, Oxford, UK
  4. 4 Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, UK
  5. 5 Field Service, National Infection Service, Public Health England, Bristol, UK
  1. Correspondence to Helen E Hughes, Real-time Syndromic Surveillance Team, Public Health England, Birmingham B3 2PW, UK; helen.hughes{at}phe.gov.uk

Abstract

On 12 March 2020 the UK entered the ‘delay phase’ of the COVID-19 pandemic response. The Public Health England Emergency Department Syndromic Surveillance System (EDSSS) carries out daily (near real-time) public health surveillance of emergency department (ED) attendances across England. This retrospective observational analysis of EDSSS data aimed to describe changes in ED attendances during March–April 2020, and identify the attendance types with the largest impact. Type 1 ED attendances were selected from 109 EDs that reported data to EDSSS for the period 1 January 2019 to 26 April 2020. The daily numbers of attendances were plotted by age group and acuity of presentation. The 2020 ’COVID-19’ period (12 March 2020 to 26 April 2020) attendances were compared with the equivalent 2019 ’pre-COVID-19’ period (14 March 2019 to 28 April 2019): in total; by hour and day of the week; age group(<1, 1-4, 15-14, 15-44, 45-64 and 65+ years); gender; acuity; and for selected syndromic indicators(acute respiratory infection, gastroenteritis, myocardial ischaemia). Daily ED attendances up to 11 March 2020 showed regular trends, highest on a Monday and reduced in children during school holidays. From 12 March 2020 ED attendances decreased across all age groups, all acuity levels, on all days and times. Across age groups the greatest percentage reductions were seen in school age children (5–14 years). By acuity, the greatest reduction occurred in the less severe presentations. Syndromic indicators showed that the greatest reductions were in non-respiratory indicators, which fell by 44–67% during 2020 COVID-19, while acute respiratory infection was reduced by −4.4% (95% CI −9.5% to 0.6%). ED attendances in England have been particularly affected during the COVID-19 pandemic due to changes in healthcare seeking behaviour. EDSSS has enabled real-time daily monitoring of these changes, which are made publicly available to facilitate action. The EDSSS provides valuable surveillance of ED attendances in England. The flexibility of EDSSS allowed rapid development of new indicators (including COVID-19-like) and reporting methods.

  • emergency department utilisation
  • infectious diseases
  • viral
  • epidemiology
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/emermed-2020-209980

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    Footnotes

    • Handling editor Ed Benjamin Graham Barnard

    • Contributors HEH: Study design, data preparation, data analysis, drafting the manuscript, critical revision and final approval of the manuscript. TCH: Study design, critical revision and final approval of the manuscript. RM: Study design, data analysis, critical revision and final approval of the manuscript. KC: Study design, critical revision and final approval of the manuscript. IO: Study design, critical revision and final approval of the manuscript. GS: Study design, critical revision and final approval of the manuscript. AJE: Study design, drafting the manuscript, critical revision and final approval of the manuscript.

    • Funding HEH and AJE receive support from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections. GS, RM and AJE receive support from the NIHR HPRU in Emergency Preparedness and Response. IO receives support from the NIHR HPRU in Behavioural Science and Evaluation.

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR, Public Health England or the Department of Health and Social Care.

    • Competing interests TCH is a director of L2S2 Ltd.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. Restrictions apply to the availability of the data that support the findings of this study. Surveillance outputs and limited data are routinely available at https://www.gov.uk/government/collections/syndromic-surveillance-systems-and-analyses and can be used acknowledging the source.