Impact of the first COVID-19 shelter-in-place order in the United States on emergency department utilization, Marin County, California

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1. 

   ScreenIT

   Mar 1, 2021

   SciScore for 10.1101/2020.07.01.20144691: (What is this?)

   Please note, not all rigor criteria are appropriate for all manuscripts.

   Table 1: Rigor

   Institutional Review Board Statement	not detected.
   Randomization	not detected.
   Blinding	not detected.
   Power Analysis	not detected.
   Sex as a biological variable	not detected.

   Table 2: Resources

   No key resources detected.

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   Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

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   Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

   However, the limitations include the inability to verify symptoms based on clinical chart review, due to limited data available from ED records. Because the data came from three different EDs, the coding of chief complaints may …

   SciScore for 10.1101/2020.07.01.20144691: (What is this?)

   Please note, not all rigor criteria are appropriate for all manuscripts.

   Table 1: Rigor

   Institutional Review Board Statement	not detected.
   Randomization	not detected.
   Blinding	not detected.
   Power Analysis	not detected.
   Sex as a biological variable	not detected.

   Table 2: Resources

   No key resources detected.

   ---

   Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

   ---

   Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

   However, the limitations include the inability to verify symptoms based on clinical chart review, due to limited data available from ED records. Because the data came from three different EDs, the coding of chief complaints may have varied. Diverging trends in healthcare utilization have emerged during the early COVID-19 pandemic period. Our results suggest that SIP orders and other circumstances of the COVID-19 pandemic were associated with reduced ED utilization. This reduction may be due to public fear or other unintended consequences of reduced human mobility (e.g. fewer traffic accidents), and reduced transmission of other communicable diseases due to reduced physical contact. Future directions include a time series analysis to better understand the statistical impacts of SIP orders in Marin, further stratification of syndromes to separate causes of non-respiratory visits, and investigation of linking ED visit data with other data sources such as emergency medical services database, death records, and the human mobility index. In conclusion, COVID-19 mitigation efforts including large-scale SIP orders can significantly impact healthcare systems. Specifically, ED utilization appears to be closely associated with these orders and appear very responsive to temporal trends in disease dynamics. This information may be used to support clinical-decision making and guide strategic public health messages if future non-pharmacological interventions are required.

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   Results from TrialIdentifier: No clinical trial numbers were referenced.

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   Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

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   Results from JetFighter: We did not find any issues relating to colormaps.

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   Results from rtransparent:

   • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
   • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
   • No protocol registration statement was detected.

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2. 

   Version published to 10.1101/2020.07.01.20144691v1 on medRxiv

   Jul 3, 2020