After hospital volumes plummeted due to COVID-19, full rebound not likely soon

Dive Brief:

  • Hospitalizations for several medical conditions at a major New York City-area hospital system plunged after the COVID-19 pandemic began, a new research letter published in JAMA Internal Medicine by researchers at New York University and the University of Michigan medical schools finds. And even amid a recent rebound, admissions still remain well below pre-pandemic levels. Similar conclusions were made by researchers at Stanford University Medical Center and Weill Cornell Medical College examining their respective healthcare institutions.
  • While the NYU/Michigan researchers suggest patients may be avoiding the hospital or may have lost their health insurance as a result of the economic fallout from the pandemic, they also cited two other reasons: Many healthcare services may be overused, and patients — particularly those with chronic conditions — might be taking better care of themselves.
  • Yet there is another disturbing trend that is coming into focus: According to the Stanford/Weill Cornell researchers, significantly more patients with serious medical conditions are dying at home, possibly as the result of deferring crucial care.

Dive Insight:

Most hospitals in the U.S. promptly canceled elective procedures after COVID-19 was declared a pandemic back in March. Those restrictions have since eased. But while elective procedures have rebounded close to pre-pandemic levels, other forms of hospital admissions have lagged. The research by the two teams put a number of the decline.

The NYU/Michigan researchers focused on the NYU Langone hospital system. They studied non-COVID-19 inpatient admissions between March 1 and May 9 for the years 2018, 2019 and 2020. They discovered admissions dropped 31.9% this year compared to 2019. They were down 43% this year when compared to 2018 data.

Patients admitted for myocardial infarctions dropped by 75%; nearly 65% for heart failure and more than 50% for septicemia, among other conditions. Admissions for most conditions showed rebounds later in the study period as COVID-19 restrictions eased up, but they still remained well below pre-pandemic levels. Pregnancy-related admissions were actually lower by the late period of the study.

“Notably, while hospitalizations for acute events began recovering in the late COVID-19 period, many of those related to chronic diseases generally did not,” the NYU/Michigan researchers noted. “The implications of the decreases in hospitalizations for chronic disease are concerning for the possibility that sick patients are not obtaining necessary hospital care; alternatively, this trend could suggest prior overuse of hospitalization or improved self-management.”

Some data suggest that elective procedures are rebounding — at least as long as COVID-19 cases are not spiking. Meanwhile, a recent Kaufman Hall survey suggested hospital volumes wouldn’t fully rebound until 2022.

Findings were fairly similar when the Stanford and New York Presbyterian/Weill Cornell Medical Center data was analyzed. The daily volumes for myocardial infarctions declined 39% at New York Presbyterian and 26% at Stanford; ischemic stroke volumes declined 49% at New York Presbyterian and 16% at Stanford; and non-traumatic subarachnoid hemorrhages declined 33% and 21%, respectively.

However, the researchers in that instance suggest that the decline in hospitalizations may have a darker conclusion.

“Recent data suggest that deaths resulting from COVID-19 account for only half of the excess number of at-home deaths during the pandemic,” they observed, citing data from the British Medical Journal. “The combination of fewer patients presenting with medical emergencies and an increased number of non–COVID-19–related at-home deaths is concerning. Fear of exposure to patients with COVID-19 may lead individuals to defer care for acute conditions.”