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The impact of COVID-19 lockdown measures on ED visits in Lebanon - 29/07/21

Doi : 10.1016/j.ajem.2020.11.067 
Dina Mahmassani, MD a , Hani Tamim, PhD b, c , Maha Makki, MS b , Eveline Hitti, MD, MBA a,
a Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon 
b Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon 
c Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. 

Corresponding author at: Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236 Riad El Solh, Beirut 1107 2020, Lebanon.Department of Emergency MedicineAmerican University of Beirut Medical CenterP.O. Box - 11-0236 Riad El SolhBeirut1107 2020Lebanon

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Abstract

Introduction

As the COVID-19 pandemic spread globally, emergency departments (ED) around the world began to report significant drops in volumes and changes in disease patterns. During the early COVID-19 period, Lebanon followed an aggressive containment approach to halt the spread of the disease.

Objective

This study aims to examine the impact of the different national containment measures and the early COVID-19 outbreak in Lebanon on ED visit volume and disease spectrum in a single center ED in Lebanon.

Methods

This study is a secondary analysis of ED visit administrative data, comparing ED visits during the three months period prior to the first identified COVID-19 case in Lebanon with the first 3 months post-COVID-19. A time series analysis of ED visit trends in relation to the major lockdown measures was conducted. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS, version 27) and STATA version 15 (StataCorp LLC., College Station,TX). Statistical significance was set at 0.05.

Results

The daily ED visit volume significantly decreased in response to the closure of educational institutions (19.96% per day, p-value = 0.04) and the declaration of public mobilization state with border closure (97.11% per day, p-value <0.0001). ED visits decreased by 47.2% post-COVID-19. The drop was highest amongst pediatric patients (66.64%). Patients who presented post-COVID-19, compared to pre-COVID-19 were older (40.39 ± 24.96 vs 33.71 ± 24.83, p-value <0.0001), had higher hospital admission rates (28.8% vs. 22.1%, p-value <0.0001), higher critical care admission rates (5.6% vs. 3.5%, p-value <0.001), and double mortality rate (0.4% vs 0.2%, p-value = 0.006). While visits for most diseases dropped, the odds of presenting to the ED post-COVID19 were higher for bacterial infections and non-communicable disease and lower for injuries and communicable diseases.

Conclusion

ED visits dropped significantly during the COVID-19 containment period. Understanding the trends of changes in disease entities is important for ED staffing purposes during the pandemic and the varying containment efforts. While stringent lockdown measures were associated with drops in ED visits, understanding the reason behind these drops, specifically whether behavioral or related to true drops in disease prevalence, needs further exploration.

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Highlights

ED volume dropped with educational institutions closures and border closure.
There was a 47.2% drop in overall Emergency Department visits post-COVID-19.
The drop was highest amongst pediatric ED visits.
Patients had higher hospital and critical care admissions and double the mortality compared to the pre-COVID-19 period.
ED Visits for injuries and communicable diseases dropped post-COVID-19.

Le texte complet de cet article est disponible en PDF.

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Vol 46

P. 634-639 - août 2021 Retour au numéro
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