During many winter seasons, pediatric hospitals are bursting at the seams. RSV, Human Metapneumovirus, and other respiratory viruses like non-SARS CoV-2 Coronavirus cause significant disease burden sending pediatric specialists scrambling to find space to admit children with bronchiolitis who need supplemental oxygen and other forms of respiratory support. Patients with the same viruses will “double bunk” in single rooms to receive life-saving care.
2020 has been very different. COVID-19 was announced to have arrived in Utah March 6, 2020. March 13 2020 Utah schools announced that beginning March 16 online home learning would begin and Saturday March 14 the first case community spread of COVID-19 was confirmed. March 16 the Utah Department of Health issued a public health emergency limiting some services and businesses and Intermountain Healthcare and University of Utah Health announced elective and non-emergent surgeries and many non-urgent ambulatory services would be canceled. March 27 the Governor issued a “Stay Safe, Stay Home” directive. Social distancing during these months, via economic and public gathering restriction, was the only public directive. Mask wearing in Utah did not become widely encouraged until July 2020.
As a result of these social distancing measures, we have witnessed a dramatic decrease in infectious diseases. The following data are from germwatch.org and contain data of common infectious disease prevalence in Utah, as identified by testing performed at and sent to Intermountain Healthcare labs, clinics, and hospitals.
We have seen a drop in Emergency Department census that is unprecedented. We attribute this change to the decrease in circulating viruses, commonly spread bacterial pathogens and different healthcare consumer choices. In over 15 years, we have not seen ED volumes in the low ranges we are consistently seeing them now.
Even as many economic restrictions have lifted in recent months, ED census remains lower than previous. At this point, we are uncertain which of the following influencers are playing roles, if all, or others?
- Health care consumer choices (avoiding health care)
- Social distancing reducing disease transmission
- Mask wearing reducing disease transmission as social distancing/economic restriction has begun to lift
Emergency departments are a clinical service entirely dependent upon what is referred or self-referred to them. Yet they are a critical part of the healthcare system for unexpected, emergent care and as a venue for coordinating complex care.
We are seeing an apparent, but slow, increase in ED census over the past 3 months. Much slower than the stock market rebound 😉
July 2020 Daily Census Range: 57-92 July 2019 Daily Census Range: 79-120
Our hospital and others around the country have been bursting at the seams with seasonally variable infectious diseases like RSV and influenza. We now know that social distancing behaviors that decrease disease transmission can have a significantly decrease disease transmission. Data from the Southern hemisphere indicate that influenza season may be better than previous years, perhaps because of societal behavioral changes.
-Eric Glissmeyer, MD
Associate Professor, Department of Pediatrics, University of Utah
Division of Pediatric Emergency Medicine, University of Utah
Medical Director, Care Transformation Information Services, Intermountain Healthcare