More Data & Questions about Spring 2020 Covid in New York City Hospitals
Five observations toward better understanding what the heck happened.
A couple weeks ago, I posted data showing that New York City’s hospital emergency departments were not at a breaking point in spring 2020. Quite the opposite: Systemwide, there was a 50% drop — from which EDs still haven’t recovered.
Additional data from the City’s health department
NYC Emergency Departments weren’t overrun by people with covid-19. Only 3% of the people who came to New York City emergency during the spring 2020 March - May wave were clinically diagnosed1 with the virus. At no point did the percentage of visits to NYC hospital EDs with a covid diagnosis never exceeded 10%.
Covid-diagnosed visits were highest during winter 2022’s omicron wave, when total daily ED visits briefly reached pre-pandemic respiratory-virus season levels, before again dropping below normal. We don’t know how many of these people had symptoms associated with the disease. We do know that the 2017-2018 flu season created busier emergency rooms for NYC than covid ever has. INSERT HISTORICAL ED CHART
The NYC Emergency Room respiratory visit spike may have been panic-driven. Respiratory visits for the 2019-2020 peaked in January, and were on the way down, before New York Governor Cuomo’s lockdown directive on March 10, 2020.
At that point, Calls to Emergency Medical Services soared, as did the number of people going to emergency rooms with respiratory symptoms. The dramatic rise & fall suggests fear, not actual “spread” triggered the sudden surge.
Were all of these people who reported respiratory symptoms diagnosed with covid? No. At spring 2020’s peak, the ratio of respiratory visits to covid diagnosis was 30%, another data point that suggests at least some visits were people freaking out, psychogenic illness, or symptoms
Respiratory visits and visits for influenza-like illness (ILI) are not mutually exclusive, but adding ILI to respiratory gives us a “maximum” number of people heading to the hospital because they thought they had covid.2 This makes the ratio who were diagnosed with covid even smaller. Is it possible a good number of weren't being tested in March & April 2020? Sure. But a "diagnosis" doesn't require testing, and we can be sure that some portion of the patients who were tested for SARS-CoV-2 in the ED weren't people who had respiratory symtoms or ILI.
Do we know how people came to the hospital with covid-like illness and were admitted, regardless of whether they went to the ED or were diagnosed there?
Ask NYDOH is clinically-diagnosed ED visit is separate from respiratory visit
Per NYC Dept of Health, a clinically-diagnosed covid ED visit is “a visit with an ICD-10 discharge diagnosis code of U07.1 or a SNOMED code of 840539006.” A clinical diagnosis does not have to include a laboratory-confirmed test for SARS-CoV-2, but a positive test irrespective of symptoms would receive diagnosis.
NYC DOH staff: “ED visits are generally categorized into one syndrome only. If an ED visit contains chief complaint terms or diagnosis codes from multiple syndrome categories, we use the following hierarchy: respiratory > diarrhea > asthma > vomiting. The exception is ILI, where patients can be in both ILI and other syndrome categories. This is because we use the standard CDC definition for ILI: fever+(sore throat or cough). Respiratory could include people with ILI, or the other way around, but the two numbers can’t be added together to represent different visits.”
Great post, the visual difference between the first and second graphs you posted could be a litmus test for statistical illiteracy. Not once did the NYT show graph 1, it was always graph 2.
Fabulous work. What a man-made-disaster this was, wow.