How did the use of ED change during the first wave of the SARS-CoV-2 pandemic in the UK? An observational study.

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 χ 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.