The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. The views and opinions expressed in this article are solely those of the authors and do not necessarily reflect those of the institutions to which they are affiliated. The corresponding author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; and no important aspects of the study have been omitted.
The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats and media (whether known now or created in the future), to i) publish, reproduce, distribute, display and store the Contribution, ii) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or, abstracts of the Contribution, iii) create any other derivative work(s) based on the Contribution, iv) to exploit all subsidiary rights in the Contribution, v) the inclusion of electronic links from the Contribution to third party material where-ever it may be located; and, vi) licence any third party to do any or all of the above.
All authors have completed the ICMJE uniform disclosure form at
www.icmje.org/coi_disclosure.pdf and declare centre funding from MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA). Funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
To tackle the COVID-19 epidemic, the UK Government instituted fundamental changes to the provision of health and social services.[1, 2] As a result, the NHS undertook an unprecedented re-arrangement of their resources, with specific measures including the postponing of non-urgent elective procedures and video-triaging patients for referral to hospital services. Moreover, on March 12, the UK Government issued the first of a series of non-pharmaceutical interventions, including advice for the public to self-isolate if experiencing COVID-19 symptoms, advice for social distancing, the closure of schools and universities and the ban of public events. These measures were rapidly followed by a national lockdown on March 24 and legislation indicating people to stay at home and avoid social interaction with others outside their households, unless an emergency arises.[1, 3]
Perhaps largely as a result of the widespread implementation of such non-pharmaceutical interventions in England, a steady reduction in the daily number of COVID-19 cases and deaths has been observed from early April onwards.[4, 5] However, publicly available data show that the number of attendances to emergency departments (ED) (i.e. consultant-led, 24-hour services including resuscitation units) has decreased by approximately 50% across all England regions (see Figure S1, for the authors’ own analysis). Moreover, concerns have emerged that ED attendances remain low, despite the reduction in in COVID-19 cases and deaths.
Evidence from other countries indicates that the number of out-of-hospital cardiac arrests have increased alongside a decrease in ED attendances during the COVID-19 pandemic.[7, 8] These data also suggest that the number of non-COVID-19 attendances to emergency services did not increase as expected as COVID-19 cases and deaths decrease. In the United Kingdom, a recent analysis of the Scottish healthcare system has revealed similar trends, with ED attendances also decreasing during the COVID-19 response and also remaining below expected levels compared to historic trends.
To date, no published study in England has analysed the trends in non-COVID-19 attendances to ED departments during the pandemic. Such data are crucial to understand the changes in ED attendances associated with reconfiguring emergency care resources in the country. Furthermore, beyond national-level situation reports,[5, 6] analyses of potential sociodemographic and epidemiological factors associated with reduced ED attendances are urgently needed to inform a public health response to revert these trends and ensure continued high-quality standards of care for non-COVID-19 patients in England, as well as ensuring ED services do not revert to the overcrowding seen prior to the pandemic.
In this study, we use pseudonymised administrative patient-level records from Imperial College Healthcare NHS Trust (ICHNT) to: a) analyse local trends and factors associated with ED attendances and emergency admissions pre- and post-implementation of lockdown policies in March 12, 2020 in England; and b) analyse regional (all London ED services) and national situation reports to understand the magnitude and directionality of how our local trends compare against these.