167 Changes in Patterns of Community Mortality during the SARS-CoV-2 Pandemic

Study Objectives: We aimed to analyze causes of death during the SARS-CoV-2 pandemic as a way to quantify the relationship between reduced emergency department visits during spring 2020 and community mortality rates and causes Our focus was on the eight-county area served by Southern Minnesota Regional Medical Examiner Methods: Chi-squared and Fisher’s Exact tests were applied to compare deaths between time periods All tests were two-sided and p-values less than 0 05 are considered significant We compared the causes of death from 2/9-3/16 and 3/17-4/21 for the years of 2018 and 2019 to establish a baseline for comparison to the causes of death during these same periods in 2020 These dates were determined by taking the four weeks prior to a statewide stay at home order and the first four weeks of the order Results: The causes of natural death in 2018 and 2019 did not have any significant difference When comparing the baseline with the same periods of time in 2020 there was no significant difference between the earlier time period, 2/9-3/16 (2018 = 227, 2019 = 203, 2020 = 204, p= 56), but there was a significant increase in the number of non-COVID reported deaths between 3/17-4/21/20 (2018 = 195, 2019 = 212, 2020 = 251, p = 029) There was no change in the proportion of natural versus unnatural deaths Distribution of the cause of death remained stable as far as attributed organ system There was a significant overall increase in the number of out of hospital deaths between 3/17-4/21/20 In 2018 there were 60, in 2019 there were 76 and this increased sharply to 128 in the same period during 2020 (p=< 001) Conclusion: No single natural cause of mortality is identified as having a disproportionate impact on outpatient cause of death Rather, all medical etiologies contributed to an overall increase in deaths during the early part of the SARS-CoV-2 pandemic in Southern Minnesota News media has reported concerns about decreased ED visits during this time period, and our data show that in conjunction with a significant decline in emergency department visits of approximately 50%, there has been a correlating increase in out of hospital death We do not have enough information to draw a conclusive relationship, however, it will be important to fully understand the public health implications beyond pandemic disease burden that contribute to overall mortality during public health crises to target interventions to promote appropriate use of the emergency department for urgent conditions