COVID-19 Pandemic: The Impact of Lockdown Measures on Emergency Department Presentations to a Tertiary Care Hospital in Singapore

Introduction: COVID-19 has affected healthcare systems worldwide. We aim to analyse the impact of the pandemic and ‘lockdown’ measures on the services of a tertiary hospital emergency department (ED) in Singapore. Methods: A retrospective observational study was conducted at the Singapore General Hospital ED, examining visit characteristics, demographics and diagnoses during ‘lockdown’ (7 April to 1 June 2020) comparing it with the same calendar period in 2019.  Results: The median number of daily ED visits reduced significantly from 342 (IQR 322-358) to 256 (IQR 246-290) during ‘lockdown’. However, the number of ‘fever’ cases increased by 37 (95% CI 113-132) visits a day, contributing a much higher proportion of total visits during ‘lockdown’ (22% vs 2·7%; p <0·001). ED visits per day for ‘clean’ cases fell by 123 (95% CI 113-132). The proportion of inpatient admissions and length of inpatient stay increased (53% vs 48% and 4 [IQR 2-7] vs 3 [IQR 2-6] days respectively; p <0·001). There were significantly smaller proportions of cases of diarrhea, gastroenteritis, food poisoning, and alcohol intoxication, with no significant change for life-threatening conditions such as acute coronary syndromes and stroke. Conclusion: COVID-19 pandemic and ‘lockdown’ measures have led to decreased ED attendances. Potential reasons include fear of nosocomial infections, but also positive externalities from ‘lockdown’ measures. Surge in ‘fever’ cases and reduction in efficiency is expected. Timely and adequate public messaging, imposition of regulations, ensuring surge capacity and robust resource management are important aspects in managing these changes in characteristics of ED attendances during a pandemic. Funding Information: There was no funding source required for this study. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: SingHealth Centralized Institutional Review Board approved this study and waived the requirement for participants to provide consent (CIRB Ref: 2020/2684).