# Epidemiology of Emergency Department Visits Before, During, and After the COVID-19 Pandemic: Experience From a Referral Center in Southeastern Brazil

## TL;DR

This study examines how emergency department visits changed in Brazil before, during, and after the COVID-19 pandemic, showing lasting declines and varying recovery patterns.

## Contribution

The study provides new insights into ED utilization trends in Brazil, a region where EDs often handle non-urgent cases, revealing long-term impacts of the pandemic.

## Key findings

- Total ED visits dropped by 39.5% from 2019 to 2020, with slower recovery to 77.8% of pre-pandemic levels by 2024.
- Children's visits fell more sharply than adults', and recovery was incomplete across most specialties.
- Neurology and some surgical specialties showed growth, while psychiatry and ophthalmology had incomplete recovery.

## Abstract

Background

The COVID-19 pandemic and its related restrictions were associated with changes in emergency department (ED) utilization, with reductions reported in many regions worldwide. In Brazil, where EDs often serve non-urgent cases, the long-term impact remains unclear. Therefore, this study evaluated ED utilization trends across pre-pandemic, pandemic, and post-pandemic periods in a large tertiary hospital.

Methods

This retrospective observational study analyzed all ED visits recorded at the University of Campinas Clinics Hospital, a tertiary care referral hospital in southeastern Brazil, from January 2018 to December 2024. Data from the electronic medical record system were categorized into pre-pandemic, pandemic, and post-pandemic periods. Temporal trends in total, adult, and pediatric ED visits, as well as by medical specialty, were evaluated using joinpoint regression (Joinpoint Regression Program, version 4.9.0.1).

Results

Between Jan/18-Feb/20 (pre-pandemic), Mar/20-May/23 (pandemic), and Jun/23-Dec/24 (post-pandemic), 388,733 ED visits were recorded, including 329,111 adults and 59,622 pediatrics. Total visits declined by 39.5% from 2019 (69,519 visits) to 2020 (41,991), with reductions of 34.8% among adults (56,813 to 37,013) and 60.8% among children (12,706 to 4,978). Joinpoint analysis for total visits identified a sharp negative trend at the onset of the pandemic (p = 0.03), followed by a gradual recovery that did not reach pre-pandemic levels by 2024 (77.8% of baseline; pre-pandemic mean = 70,701; visits in 2024 = 54,987). Temporal patterns varied by specialty: neurology and some surgical specialties showed growth, while internal medicine, psychiatry, and ophthalmology exhibited distinct fluctuations and incomplete recovery.

Conclusion

The COVID-19 pandemic caused a marked and prolonged disruption in ED services utilization. Although visit volumes gradually recovered, they remained below pre-pandemic levels, with variable patterns across age groups and specialties. These findings highlight lasting shifts in healthcare-seeking behavior and the need for adaptive planning for future health crises.