The impact of COVID-19 control measures on the utilization of emergency department during lunar new year in Taiwan

To the Editor:

In US, Venkatesh et al. found a significant decline in ED visiting during COVID-19 pandemic, compared to pre-pandemic period and suggested that the pandemic might have impeded patients from seeking essential care [1]. In contrast to US, Taiwan had only 941 confirmed case of COVID-19 and 9 deaths till February 19, 2021 [2], the excellent result was accomplished without imposing any lockdown, but as a result of multiple aggressive infection control and prevention measures, particularly for universal mask wearing and hand hygiene [3]. The pandemic itself almost did not impede the accessibility of medical services in Taiwan, however, we were curious about the impact of COVID-19 control measures on the ED utilization in Taiwan. We conducted this study to investigate trends in ED visits overall, and for influenza-like illness and acute diarrhea particularly.

In Taiwan, nearly all outpatient services, both in hospitals and local clinics, were stopped during Lunar New Year – a 6-day-long holiday, leaving the ED as the only providers fulfilling all kinds of discomforts of the public. This surge usually caused a significant burden on ED. In this study, we compared the national ED visits during Lunar New Year from 2017 to 2021. The data were obtained from an open database established by Taiwan CDC [4]. The percentage of change was calculated as the difference between 2021 and other four years divided by the ED visits in the comparator year.

First, the overall ED visits were 122,542 during this period in 2021, which was much lower than those in the same period from 2017 to 2020 (the average was 174,653)(Fig. 1A). The percentage of decline ranged from 21.3% to 36.3%. Second, the ED visits for influenza-like illness was 9816 during this period in 2021, which was much lower than those in the same period from 2017 to 2020 (the average was 34,347)(Fig. 1B). The percentage of decline ranged from 61.2% to 75.3%. Third, the ED visits for acute diarrhea illness was 10,447 during this period in 2021, which was also lower than those in the same period in the prior four years (the average was 13,785)(Fig. 1C). The percentage of decline ranged from 12.1% to 37.9%.

Fig. 1.

Emergency department visits for (A) overall population, (B) influenza-like illness and (C) acute diarrhea illness during Lunar New Year from 2017 to 2021.

In this study, we found the ED visits, especially for influenza-like illness during Lunar New Year was lower in 2021 than those in previous 4 years. The main possible cause would be the declining respiratory tract infections, including influenza under the COVID-19 control measures [5]. Mask wearing may be the most effective intervention in mitigating COVID-19 and also bring the collateral benefit of preventing the spread or outbreak of other respiratory tract infections. In conclusion, although the causes of decreasing ED visits during COVID-19 pandemic are multifactorial, our finding suggests that the collateral benefit of COVID-19 control measures in Taiwan, resulting in the reduced incidence of influenza-like illness and hence lowering the ED utilization, especially during the Lunar New Year period.