Waiting for the Second (Non)-Covid-19 Wave: Variations in Volume of Emergency Surgeries and of Emergency Department Accesses in a Third Level Hospital in Milan, Lombardy, During the Outbreak

Introduction: During the recent outbreak of COVID-19 (Corona VIrus Diseases 2019), Lombardy was the Italian region most affected, with 87,000 patients and 15,876 deaths (until May 26). Since February 22, well before the Government declared the state of emergency, a huge reduction of emergency surgeries was seen in Lombardy Hospitals, with a generalized drop of attendances in the Emergency Departments (EDs). Study Objective: The aim of this study is to report the experience of the ED of a third-level hospital in downtown Milan, Lombardy (IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico), and try to explain the causes of the observed phenomena. Methods: A retrospective, observational study was performed assessing the volume of emergency surgeries and of the attendances in the ED during the course of the pandemic, i.e. immediately before, during and after progressive community lockdown in response to the COVID-19 pandemic, comparing the same time periods in 2019. Results: Compared to the previous year, in 2020 a significant overall drop of emergency surgeries (60%, p<0.002) and of ED attendances (66%, p≅0) was observed. The drop was significant for medical ( 40%), surgical (74%), specialist fast track (92%), and psychiatric (60%) complaints, for domestic violence accesses (59%) and for patients who left the ED without being seen (LWBS) (76%). Conversely, deaths raised by 196%. Conclusion: During the COVID-19 outbreak the volume of urgent surgeries and the volume of patients accessing ED dropped. At the moment, it is not known if mortality of people who did not seek care increased during the pandemic. Further studies are needed to try to understand if such reductions during the COVID-19 pandemic will result in a rebound of patients left untreated, or in unwanted consequences on population health.