Urgent healthcare needs continued to present to hospital during lockdowns

Dr Taya Collyer is first author on a study looking at changes in
hospital attendance during the COVID-19 pandemic

While there were many anecdotal reports of reduced care-seeking behaviour during 2020 Melbourne lockdowns, analysis suggests that those with the most urgent healthcare needs continued to present to hospital. 

In a first comprehensive study of healthcare-seeking behaviour in the context of (relatively) low COVID-19 burden, team of researchers from the Academic Unit, Medicine, Peninsula Clinical School analysed data from approximately 700,000 hospital presentations to investigate the impact of restrictions to movement on hospital activity in Melbourne over two waves of community transmission (1 March to 20 September 2020).

Lead researcher Dr Taya Collyer said, “We looked specifically at heart attack, that is, myocardial infarction, stroke and injury.

“Many studies investigate changes in hospital attendance by simply comparing two timepoints, but this approach tends to produce biased results. We used new forecasting methods pioneered by researchers in Monash’s Department of Econometrics to illustrate that those aged <18 and >80 did present to hospital at historically low levels during Melbourne’s 2020 lockdowns. However, citizens appeared willing and able to present with life-threatening conditions.”

GPs switching to telemedicine did not appear to cause widespread spill-over of non-urgent presentations from primary care into the hospital emergency department. 

While the lockdowns in 2020 caused major disruption within healthcare systems, most age groups and care categories rebounded between lockdowns rather than flat-lining, and presentations for life-threatening conditions (heart attacks and strokes) were largely consistent with pre-COVID patterns.

Results of the study – the first to present a holistic picture of hospital activity during a number of discrete outbreaks of COVID-19 – identify multiple patient groups who likely require additional support during lockdown conditions. Notably, the elderly, and patients who (prior to COVID) required frequent hospitalisation were substantially less likely to present during outbreaks. These individuals have higher comorbidity than those who access care less regularly, and are more likely to suffer from chronic health conditions.  

Reference
Taya A Collyer, George Athanasopoulos, Velandai Srikanth, Ravindranath Tiruvoipati, Chris Matthews, Nicholas Mcinnes, Shyaman Menon, Jonathan Dowling, Gary Braun, Timur A Krivitsky. Impact of COVID-19 lockdowns on hospital presentations and admissions in the context of low community transmission: evidence from time series analysis in Melbourne, Australia, Helen Cooper, Nadine E Andrew http://dx.doi.org/10.1136/jech-2021-217010