Article Text

Download PDFPDF
How did the use of ED change during the first wave of the SARS-CoV-2 pandemic in the UK? An observational study
  1. Chiara Calastri1,
  2. Stephane Hess1,
  3. Brad Wilson2
  1. 1 Institute for Transport Studies and Choice Modelling Centre, University of Leeds, Leeds, UK
  2. 2 Bradford Institute for Health Research, Bradford, UK
  1. Correspondence to Dr Chiara Calastri, Institute for Transport Studies and Choice Modelling Centre, University of Leeds, Leeds LS2 9JT, UK; c.calastri{at}


Background The COVID-19 pandemic has been linked to a sharp drop in ED attendance, but the exact reasons for this are unclear. The aim of this study was to investigate differences between individuals attending the ED before and during the pandemic and the reasons for their choices.

Methods Two population-based online surveys were conducted before (2019) and during (2020) the pandemic. Participants were recruited by a survey panel to be representative of the UK population aged 18–45 years. Both surveys asked about the circumstances and reasons for the last ED attendance, with specific pandemic-related questions in the second one. Comparisons of characteristics and symptoms of individuals attending during the pandemic were compared with those attending in prior years using χ2 tests. We determined the proportion of patients who had symptoms during the pandemic but did not attend, and the reasons for that choice.

Results Young and high-income people, those with chronic illnesses and those with influenza-like symptoms were more likely to attend the ED during lockdown than before. 18% of respondents had experienced urgent symptoms during the pandemic; 60% of these individuals chose not to go to the ED. While about 30% of this group stated they believed their symptoms were not serious enough, 85% of these individuals mentioned fear of infection or worry about overburdening the system as a reason for not attending. Individuals attending during the pandemic were more likely to consider their visit unnecessary compared with those attending previously.

Conclusions The study suggests that the decision to use the ED has a discretionary component. This could potentially contribute to unnecessary visits, and raises concerns that some patients who should present at the ED do not go. More effective communication about who should visit EDs during a pandemic, and the safety of doing so, is needed.

  • COVID-19
  • emergency department
  • urgent care

Data availability statement

Data are available on reasonable request. The data are available from the authors on request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available on reasonable request. The data are available from the authors on request.

View Full Text


  • Handling editor Mary Dawood

  • Twitter @CmcLeeds

  • Contributors CC: study design, data collection, data analysis, manuscript writing, guarantor. SH: study design, data analysis, manuscript writing. BW: study design, data collection, manuscript review.

  • Funding This work was supported by the Safety Innovation Challenge promoted by the NIHR Yorkshire and Humber Patient Safety Translational Research Centre.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.