Clinical value of the emergency department in screening and diagnosis of COVID-19 in China

Impact of non-pharmaceutical interventions for the COVID-19 pandemic on emergency department patient trends in Japan: a retrospective analysis

Aim

The coronavirus disease (COVID‐19) pandemic massively impacted emergency department (ED) visits. The unavailability of specific therapies or vaccines has made non‐pharmaceutical interventions (NPIs) an alternative strategy for COVID‐19. We assessed the impact of NPIs (nationwide school closures and state of emergency) on ED visits during the COVID‐19 pandemic in Japan.

Methods

This retrospective study compared the trends in ED visits from 1 January to 25 May, 2020 (during the pandemic) with the average during 2015–2019 (before the pandemic). The primary end‐point was the change in the number of ED visits during the COVID‐19 pandemic with those from before the pandemic, with the NPI application stratified across four periods in 2020: Period 0 (1–15 January), no COVID‐19 cases detected in Japan; Period I (16 January–1 March), initial COVID‐19 outbreak; Period II (2 March–15 April), nationwide school closures; Period III (16 April–25 May), state of emergency.

Results

Compared with before the pandemic, the number of walk‐in ED visits significantly decreased by 23.1%, 12.4%, and 24.0% (4,047 versus 3,111; 3,211 versus 2,813; and 3,384 versus 2,573; P < 0.001 for all) in Periods I, II, and III, respectively. The number of ambulance ED visits during the pandemic significantly increased by 8.3% in Period I (1,814 versus 1,964, P = 0.002), whereas there was no significant change in Periods II and III with 2.7% and −3.1% (1,547 versus 1,589 and 1,389 versus 1,346; P = 0.335 and P = 0.284, respectively).

Conclusions

The application of an NPI during the COVID‐19 pandemic could have significantly reduced patient attendance in the ED.

Immune dysfunction following COVID-19, especially in severe patients

The coronavirus disease 2019 (COVID-19) has been spreading worldwide. Severe cases quickly progressed with unfavorable outcomes. We aim to investigate the clinical features of COVID-19 and identify the risk factors associated with its progression. Data of confirmed SARS-CoV-2-infected patients and healthy participants were collected. Thirty-seven healthy people and 79 confirmed patients, which include 48 severe patients and 31 mild patients, were recruited. COVID-19 patients presented with dysregulated immune response (decreased T, B, and NK cells and increased inflammatory cytokines). Also, they were found to have increased levels of white blood cell, neutrophil count, and D-dimer in severe cases. Moreover, lymphocyte, CD4⁺ T cell, CD8⁺ T cell, NK cell, and B cell counts were lower in the severe group. Multivariate logistic regression analysis showed that CD4⁺ cell count, neutrophil-to-lymphocyte ratio (NLR) and D-dimer were risk factors for severe cases. Both CT score and clinical pulmonary infection score (CPIS) were associated with disease severity. The receiver operating characteristic (ROC) curve analysis has shown that all these parameters and scores had quite a high predictive value. Immune dysfunction plays critical roles in disease progression. Early and constant surveillance of complete blood cell count, T lymphocyte subsets, coagulation function, CT scan and CPIS was recommended for early screening of severe cases.