Attendances at A&E departments across England dropped by half following the introduction of the first UK lockdown in March 2020, with Black and Asian people even less likely to attend than white populations.
Analysis of 41 English major A&E departments by the Strategy Unit, the Nuffield Trust and the Health Foundation, found that attendances were affected by factors including age, ethnicity and health condition. Between 11 March to 7 April 2020 – covering the main lockdown period –there was an average 51% drop in attendance in all the A&Es surveyed, but some groups had significantly larger initial reductions.
The biggest drop-offs were among patients of Chinese (74.5%); Bangladeshi (75.3%), Indian (64.9%), Pakistani (71.8%), and Black African ethnicities (63.5%).
Steven Wyatt, Head of Strategic Analytics at the Strategy Unit, who led the study, said: “The fact that people from the Black and Asian communities were less likely to attend hospital is worrying. People are weighing up the risk of catching COVID if they attend A&E against the risk of leaving health problems untreated if they do not. We need to make sure that people have the information and support they need to make the right call.”
The number of children (those under 19 years) also dropped significantly, with a 69.1% reduction from pre-lockdown attendances. Mr Wyatt said: “Lower attendance by children might be because the lockdown limited opportunities for outdoor play, sport, and the transmissions of childhood infections; or because in general parents make the decision to bring them in, and the pandemic may have affected that decision-making process.”
The authors found that the drops in attendance by older people, although still substantial, were smaller than the average 51% figure. Attendances in people aged 65-74 years fell by 42.6% and in those over 75 by 40.1%.
The authors also looked at method of arrival and type of diagnostic group during the lockdown period. There was a fall of 60.3% of those coming to hospital by themselves, and those with contusions or abrasions (66.9%), muscle and tendon injuries (65.6%), and other diagnosis that wasn’t classified (72.7%). Other conditions such as cardiac, gastrointestinal, poisoning, and cerebro-vascular related illnesses showed a less severe drop off. Gender and deprivation factors didn’t affect attendances.
Co-author Elizabeth Fisher, Senior Fellow at the Nuffield Trust, said: “People seeking urgent care at A&Es were less likely to use walk-in services during the first wave. That may be down to them resorting to self-care, delaying visits to A&E for fear of contracting the virus, accessing other forms of care, or choosing to call an ambulance over using public transport. What is clear is that the ambulance service has remained under immense pressure during this pandemic, with no signs of let up any time soon.”
The authors analysed visits to A&E between January 2019 and June 2020. They found that attendance rates began to increase again 2-3 weeks after the lockdown was announced and continued to increase steadily up to the end of June 2020, when the study data ended.
By late summer, attendance rates at A&Es increased back up to 90% of the usual rate, but subsequently reduced again in the second and third lockdowns back down to about 75% of the usual rate, according to national A&E Attendances and Emergency Admissions data.
Ruth McConkey, programme manager at the Health Foundation and one of the report authors, said: ‘The way people used emergency services changed dramatically during the pandemic, with people from some black and minority ethnic groups using it far less than previously. What is not clear is the extent to which people’s health may have been harmed as a result and is something that needs further investigation. Illness and death due to COVID-19 has hit black and minority ethnic communities particularly hard. It is vital that existing inequalities are not widened further as we continue to grapple with the ongoing impact of the virus.’
Dr Farzana Hussain, a GP at the Project Surgery, Newham, and current GP of the Year, said: “This fits with my experience working as a GP in a deprived part of London. The pandemic has highlighted many of the pre-existing inequalities in our society, but it’s still shocking to see how this affects even basic access to emergency care. We have to support all of our communities, and having this analysis shows where more attention and more action is needed”.