If a patient experienced chest pain, a broken bone, or a worsening allergic reaction a year ago, it is unlikely that they would object to a trip to the emergency department (ED). But when EDs across the nation became inundated with coronavirus disease 2019 (COVID-19) patients, what was once an automatic decision became fraught with hesitation and risk-benefit analysis. Visits to the ED dropped at the onset of the pandemic as patients wondered if the risk of contracting COVID-19 outweighed the care they would receive at the ED.1

Research published in Infection Control & Hospital Epidemiology indicates that the risk of acquiring COVID-19 in an ED is low.2 The study authors state that patients experiencing symptoms that require a visit to the ED should not hesitate to go to the hospital, and providers should reassure patients that visiting an ED is not associated with an increased risk for COVID-19 acquisition. To determine this, researchers identified 102 patients who tested positive for severe acute respiratory coronavirus 2 (SARS-CoV-2) by a polymerase chain reaction (PCR) test between 7 to 21 days after going to the ED.  When feasible, each case was then paired with 2 control cases who visited the same ED within 6 days as the case patient and had a negative SARS-CoV-2 PCR test 7 to 21 days later. Researchers excluded patients who tested positive during their ED visit as well as patients who presented to the ED with a fever, cough, chills, or shortness of breath.

To assess the degree of exposure to COVID-19 in the ED for both cases and controls, researchers calculated the number of COVID-19 patients in the ED in the 24 hours prior to each patient’s arrival as well as the number of minutes each patient spent in an ED along with COVID-19 patients. The study authors also assessed the percentage of positive tests in each patient’s home zip code in the 14 days prior to their ED visit to measure community prevalence.

Neither visiting an ED at the same time nor in the 24 hours following a COVID-19 patient was associated with an increased risk for acquiring COVID-19, according to the multivariate model. Compared with controls, positive cases were more likely to occur in younger patients (mean age 46.4 years vs 52.2 years, P= .026), Hispanic patients (39.2% vs 18.4%, P= .0003), those with an Emergency Severity Index (ESI) of 4 to 5 (31.7% vs 18.9%, P= .006), and those who live in a zip code with a COVID-19 test positivity rate higher than 14% (47.1% vs 33.3%, P= .024).


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Researchers noted that Hispanic patients are disproportionately affected by COVID-19 indicating a greater need for addressing the spread of SARS-CoV-2 in Hispanic populations. The study authors speculate that strict adherence to social distancing and personal protective equipment (PPE) rules are responsible for the lack of COVID-19 risk inside EDs but acknowledged that each hospital participating in the study had different protocols. Researchers did not assess which strategies were most effective for limiting the spread of the virus.

“In a retrospective case–control study from 39 US EDs, we found that ED colocation with COVID-19 patients was not associated with acquisition of COVID-19. Our findings may provide reassurance that patients who receive care in EDs are not likely at increased risk of contracting COVID-19,” researchers concluded.

Reference

1. Wong L, Hawkins J, Langness S, Murrell K, Iris P, Sammann A. Where are all the patients? Addressing COVID-19 fear to encourage sick patients to seek emergency care. Published online May 14, 2020. NEJM Catalyst 2020. doi: 10.1056/CAT.20.0193.

2. Ridgway JP, Robicsek AA. Risk of coronavirus disease 2019 (COVID-19) acquisition among emergency department patients: a retrospective case control study. Published online September 23, 2020. Infect Control Hosp Epidemiol. doi:10.1017/ice.2020.1224