Sharp decline in acute and elective hospital attendances and admissions due to COVID-19 in Malta (Q1 2020) - A population-based study

Abstract

Introduction

Social distancing measures and hospital preparations for the novel COVID-19 pandemic have been associated with a decline in elective and acute hospital encounters in March and April in several centres in different countries. Malta has one large acute general hospital, Mater Dei (MDH). This study retrospectively analysed these declines since soft lockdown commencing on the 13th March 2020 in a population-based study, the first of its kind.

Methods

Data was obtained as anonymised totals from MDH Clinical Performance Unit. Poisson regression was used to model the counts of weekly A&E attendances and hospital admissions.

Results

Outpatient attendances declined in March, stabilised in April 2020 and started to climb in May. April attendances fell to 18.8% in paediatrics and 23.4% in adults of the average of the previous January and February. A&E attendances showed the same pattern, down to 22.5% and all specialities registered a decline, paediatric > adult. Attendances dropped from circa 2600 to 588/month/100,000 population. These declines were abrupt after the second week of March. MDH admissions showed the same patterns, down from circa 1800 to 757/month/100,000 population. All declines were statistically significant.

Discussion

Many factors played a role in this unwilling experiment but the reduction in travel and physical human contact of all sorts (including school) contributed to a reduction in contagious diseases. Excess deaths of severely ill individuals who failed to go to hospital have yet to be formally quantified in Malta.

Highlights

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  The COVID-19 pandemic has disrupted health services in many ways.

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  A decline in acute hospital attendances and admissions has been noted in several specialities.

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  This is the first study to review the COVID-19 related decline in acute attendances and admissions at a national level, in a population-based study (Malta).

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  A&E attendances fell to 22.5%, general paediatric A&E declined > adult A&E.

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  Acute hospital admissions declined by a similar amount and with the same pattern.

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  Concern arises as to whether this will eventually contribute to excess deaths.