December 9, 2021 — Responses to the COVID-19 pandemic have included public health restrictions, such as instructions to stay home as much as possible. Even so, Canadians have been advised to go to emergency departments if they need urgent care. From March 2020 to June 2021, there were approximately 9,300 fewer emergency department visits per day across Canada on average, compared with the pre-pandemic period (January to December 2019). Analysis of CIHI data highlights the effect of COVID-19 on who went to the emergency department for care and the type of care provided.
Increasing COVID-19 infections in the community impacted emergency department visits
During the first and second waves of the pandemic, the number of emergency department visits dropped as COVID-19 cases rose in the community. Visits then rebounded toward pre-pandemic levels during Wave 3. The biggest drop in emergency department visits occurred during Wave 1, with almost 25,000 fewer visits — or about half the usual number — on 1 day in mid-April 2020. This was likely due to the way people interpreted public health restrictions and their fear of contracting COVID-19 while in hospital.
Note: For this analysis, the term “wave” refers to significant surges of community cases of COVID-19 infections in Canada overall, although we recognize that the timing and size of the waves may vary by jurisdiction.
By summer 2020, as COVID-19 cases in the community decreased and public health restrictions eased, emergency department visits rebounded but remained lower than is typical for that time of year (88% of August 2019 volumes). At their lowest point during the second wave, emergency department visits dropped by almost 15,000 on 1 day (in December 2020). By June 2021, visits were about 9% lower on average than pre-pandemic levels (compared with June 2019).
Change in emergency department visits during the pandemic, March 2020 to June 2021
Compared with 2019, emergency department (ED) visits dropped sharply by about 50% in April 2020 as the first wave of the COVID-19 pandemic took hold in Canada. As the number of COVID-19 community cases slowly declined in late spring and throughout the summer, ED visits recovered to 88% of pre-pandemic levels by August 2020. The second wave led to another drop in ED visits at the end of December, to 64% of the previous year’s volume. Starting in January 2021, ED visits began trending steadily upward, with a small decrease in April 2021 coinciding with the peak of the third wave. By the end of June 2021, ED visits had reached 91% of pre-pandemic levels.
Notes
Full regional coverage is available for Quebec, Ontario, Alberta and Yukon. Partial regional coverage is available for Prince Edward Island, Nova Scotia, Manitoba, Saskatchewan and British Columbia.
Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data.
Sources
National Ambulatory Care Reporting System, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for Health Information.
Public Health Agency of Canada. COVID-19 daily epidemiology update. Accessed September 24, 2021.
Between March 2020 and June 2021, emergency department visits (for all urgency levels combined) were 22% below pre-pandemic levels. Less urgent and non-urgent visits decreased the most, by about 28%. With fewer people coming in to seek care, people waited less time to see a physician. To explore emergency department Wait Time indicators at the hospital and regional levels for 2020–2021, please visit Your Health System: In Depth, CIHI’s interactive web tool.
It is possible that some people may have found alternatives to emergency department care (e.g., family physicians, virtual care providers). Others may not have sought care at all.
Emergency department visits for children and youth declined the most
Children and youth had the largest decrease in emergency department visits. Visits for children age 0 to 4 decreased by an average of about 50% per month compared with the pre-pandemic period, and visits for children and youth age 5 to 19 decreased by an average of 38% per month.
Change in emergency department visits during the pandemic, by age group, March 2020 to June 2021
| Month | Percentage change in ED visits, age 0 to 4 | Percentage change in ED visits, age 5 to 19 | Percentage change in ED visits, age 20 to 64 | Percentage change in ED visits, age 65 to 84 | Percentage change in ED visits, age 85+ | Monthly COVID-19 community cases |
|---|---|---|---|---|---|---|
| March 2020 | -34% | -36% | -19% | -26% | -29% | 8,533 |
| April 2020 | -72% | -69% | -41% | -42% | -46% | 44,688 |
| May 2020 | -59% | 56% | -25% | -26% | -31% | 37,711 |
| June 2020 | -48% | -39% | -15% | -15% | -20% | 13,257 |
| July 2020 | -38% | -22% | -11% | -12% | -17% | 12,108 |
| August 2020 | -31% | -19% | -9% | -10% | -14% | 12,636 |
| September 2020 | -33% | -25% | -12% | -11% | -14% | 29,810 |
| October 2020 | -45% | -33% | -17% | -17% | -20% | 76,686 |
| November 2020 | -52% | -39% | -18% | -17% | -19% | 142,695 |
| December 2020 | -68% | -52% | -23% | -21% | -23% | 203,288 |
| January 2021 | -64% | -44% | -22% | 19% | -24% | 198,426 |
| February 2021 | -57% | -40% | -19% | -12% | -17% | 87,841 |
| March 2021 | -50% | -32% | -16% | -10% | -17% | 114,416 |
| April 2021 | -47% | -38% | -13% | -14% | -21% | 237,308 |
| May 2021 | -37% | -34% | -8% | -12% | -16% | 162,155 |
| June 2021 | -23% | -23% | -6% | -5% | -7% | 33,711 |
Notes
Full regional coverage is available for Quebec, Ontario, Alberta and Yukon. Partial regional coverage is available for Prince Edward Island, Nova Scotia, Manitoba, Saskatchewan and British Columbia.
Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data.
Sources
National Ambulatory Care Reporting System, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for Health Information.
Public Health Agency of Canada. COVID-19 daily epidemiology update. Accessed September 24, 2021.
In addition to children and youth (or their caregivers) changing the way they accessed health care, other public health measures — such as school closures, cancellations of sports activities and stay-at-home orders — may have had an impact on emergency department visits. For example, visits for accidental falls in children age 0 to 19 declined by 27% during the pandemic period, and alcohol-related harms in youth age 10 to 19 were down 36%. Illnesses typically associated with the school environment, such as colds and influenza, also declined. A similar drop was seen in family physician visits for people age 0 to 17.
We are at a point in the year where respiratory viruses start becoming common in young children. The public health measures that helped prevent the spread of COVID-19 last year also helped reduce or prevent the spread of other respiratory illnesses. This is clear with CIHI’s data, which shows a dramatic decrease in visits to emergency departments for the youngest age group. Now that many of the measures have been relaxed across the country, combined with the evidence that Canada basically didn’t have a flu or RSV (respiratory syncytial virus) season last year, we expect to see a spike in the number of emergency department visits for these illnesses, as has been seen in other countries.— Dr. Jeremy Friedman, Associate Paediatrician-in-Chief, Hospital for Sick Children
Fewer emergency department visits for non–COVID-19 respiratory conditions
In a typical year, respiratory conditions are the second most common reason for an urgent visit to the emergency department. Consistent with the experience in other countries,Reference1 public health measures such as physical distancing and wearing masks reduced community transmission of many seasonal respiratory viruses in Canada. This contributed to fewer emergency department visits for conditions such as bronchiolitis (in young children), influenza, pneumonia, asthma and chronic obstructive pulmonary disease (COPD).
During the pandemic period, emergency department visits for respiratory conditions — excluding confirmed cases of COVID-19 — dropped by 45% from pre-pandemic levels to an average of about 42,000 visits per month. To explore data for COVID-19 patients, please see CIHI’s COVID-19 hospitalization and emergency department statistics.
In addition, hospitals implemented strategies to reduce crowding in waiting rooms, which may have resulted in fewer patients being seen. These strategies included
- Triaging people before they entered the emergency department, either virtually or at the door
- Redirecting those who could be treated elsewhere
- Providing virtual emergency department visits
What we don’t know from this information
- What impact did virtual care have on people’s access to care and use of the emergency department?
- What were the health consequences for those who did not go or who delayed going to the emergency department?
- What impact did COVID-19 assessment centres have on emergency department visits?
Featured resource
Data tables
These data tables contain information on emergency department (ED) visits from 2 periods: pre-pandemic and pandemic, to help understand the impact of COVID-19 on EDs in Canada.
Reference
- 1.
- Back to Reference 1 in text
- Olsen SJ, Winn AK, Budd AP, et al. Changes in influenza and other respiratory virus activity during the COVID-19 pandemic — United States, 2020–2021. Morbidity and Mortality Weekly Report. July 23, 2021.