Study finds silver lining in horror of pandemic: dramatic drop in non-COVID hospitalizations

Emergency room
Posted at 1:33 PM, Nov 19, 2020
and last updated 2020-11-19 13:33:25-05

More than 250,000 people have died from COVID-19 in the United States and infections are on the rise again.

But now a study by a major physician group, Sound Physicians, and the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth’s Geisel School of Medicine, found what its authors called a “silver lining” in the pandemic. They estimate there have been 700,000 fewer hospitalizations for non-COVID cases from March through July.

“At first we thought that fewer hospitalizations were a result of patients just being afraid to come to the Emergency Department at a hospital for fear of contagion,” Dr. John Birkmeyer, one of the study’s authors and the chief clinical officer of Sound Physicians, told PIX11.

But as the COVID situation started improving in many places in America, the researchers found something odd.

“As time passed and patients began getting their surgical procedures, started getting back to outpatient doctors visits, it was interesting that there were still far fewer patients getting admitted to the hospital," Dr. Dr. Birkmeyer said. "Perhaps the largest reason is that fewer patients are getting sick in the first place.”

Tacoma, Washington based Sound Physicians is comprised of hospital-based doctors across America. Their study focused on about one million of their hospital admissions at 201 hospitals in 36 states.

Sound Physicians is not in any New York City hospitals but does have a presence in Patchogue and Hackensack. The authors of the study believe their results can be extrapolated to New York.

The numbers in the study’s findings are eye opening based on a seasonally adjusted comparison to the same pre-COVID-19 periods in 2019.

During the largest admissions drop-off in April, hospital admissions fell by 42.8 percent, admissions for strokes fell by 24.7 percent, heart attack (acute myocardial infarction) admissions fell by 42.2 percent, pneumonia by 53.6 percent and chronic obstructive pulmonary disease/asthma by 68.6 percent.

But look at the numbers as people started going back to hospitals in an admissions rebound in June and July: Stroke admissions were still down by 16.9 percent, heart attack admissions were down by 22.2 percent and pneumonia admissions were still down by more than 44 percent.

And those involving asthma and other chronic breathing problems were down more than 40 percent!

“We just believe that fewer people are having heart attacks and strokes in the first place.” he said. “It’s really astounding to me that… pneumonia can be down by over 40 percent"

Birkmeyer believes these results show the impact of the COVID prevention measures people are taking in addition to better air quality with far fewer people traveling.

”Less travel, better air quality, social distancing and masks may be keeping us from getting sick in other ways," Dr. Birkmeyer said.

The numbers suggest some people may be learning a lesson about the costs of their behavior, according to another of the study’s authors, health economist Jonathan Skinner. Skinner is a professor in the Department of Community and Family Medicine at Dartmouth’s Geisel School of Medicine.

“If we learn from this disaster – the pandemic – then perhaps in the future we will live differently," Skinner said. "We won’t be shaking hands and hugging so much.”

But there is some disturbing data in the study. Overall declines in hospital admissions among majority-Black, majority-Hispanic and poorer neighborhoods have remained significantly lower during the June/July rebound. But besides potential health improvements, the study’s authors believe this also suggests these people have less access to care.

“We’re concerned that there are patients who should be coming to the hospital but still are not,” said Skinner.

“Even now,” said Dr. Birkmeyer, “Patients without health insurance and those residing in disadvantaged areas have worse health outcomes in large part because they have reduced access both to physicians and hospitals.”

The change in our behavior could mean some problems for hospitals. Fewer admissions mean more empty beds and possibly less revenue. Health economist Skinner believes the hospitals that may feel the pinch are those already financially unstable.

“The New York Presbyterians with lots of commercial payers are not going to be the ones that will have to close their doors," Skinner said. "The concern is that safety net hospitals, hospitals that now are just holding on and providing a real central source of healthcare for their poorer patients – they may be the ones that are hurt the most."

Nor does Skinner foresee any cost savings just because fewer people are using hospitals.

“I think that you wouldn’t make a lot of money if you ever bet on health care costs going down," Skinner said.

The researchers are planning a follow-up to see how long the effects they found may last.

“Social distancing and hand washing could have a much bigger public benefit than any of us would have appreciated before the study,” Dr. Birkmeyer told PIX11. “My suspicion…is that it will be a long time before patients go back to handshaking and hugging and social interactions that are the same as they were before the pandemic.”