How to Prepare Emergency Department for the Next Pandemic? Analysis of Emergency Visits Based on COVID-19 Incidence: A One-Year Multicenter Retrospective Cross-Sectional Study.

Objective: In 2020, the emergence of Covid-19, rapidly evolves into a global pandemic. The government has put in place measures and recommendations to limit the spread of the virus. Some studies have focused on the effects of lockdown and social distancing on the Emergency Department (ED) attendance. Our hypothesis is that the number of visits vary with the incidence. Methods: We designed a multicentric, observational, retrospective study between May 13, 2020, and May 3, 2021. All patients over 18 years old from 8 ED were included, excluding inter-hospital transfers. Demographic variables, reasons for use, discharge diagnosis and destination were extracted from electronic files. A visit was considered covid-like (CL) if one of the reasons for use was fever, cough or dyspnea. Reasons for use and discharge diagnosis were grouped by specialty for subgroup analysis. We compared the number of entries according to the Covid incidence rate using Spearman’s correlation coefficient adjusted to the governmental measures. Results: 237,888 ED visits of patients of 49 years with 49.3% of men were enrolled. The correlation between ED visits and the Covid-19 incidence rate adjusted for governmental measures is 0.22 (p=0.131). The correlation between visits and the incidence rate was 0.24 (p=0.454) during lockdown, 0.157 (p=0.467) during unlockdown, and 0.832 (p<0.0001) during the curfew. The correlation between attendance and the Covid-19 incidence rate was 0.83 (p<0.0001) for CL reasons compared to 0.02 (p=0.880) for non-Covid-like (NCL) reasons. Only respiratory and miscellaneous reasons, where CL reasons are classified (dyspnea, cough and fever), have a significant to moderate correlation (respectively r=0,86, p<0,0001 and r=0,53, p<0,0001). Only diagnoses of infectious and respiratory pathologies have a moderate to significant correlation in relation to the incidence rate of Covid-19 (respectively r=0,68, p<0,0001 and r=0,91, p<0,0001) with an increase in hospitalizations in ward units (r=0,69, p<0,0001). There is any correlation between Covid-19 incidence rate and intensive care units’ admission. Conclusion: Our study does not highlight a link between the incidence of Covid-19 and global ED visits or for NCL use. The incidence rate does not seem to be a good indicator for predicting ED visits.