Where Have All the Hospital Patients Gone?

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And those who were hospitalized were not necessarily Covid-19 holdouts, so fearful of contagion that they came only when they were at death’s door. Analyzing hospital mortality rates, Dr. Birkmeyer and his colleagues found that apart from a small bump during the early weeks of the pandemic, hospitalized patients without Covid-19 were not dying more than they were before.

Moreover, as the pandemic wore on, fears of getting infected at the hospital may have begun to dissipate. By June, patients were going back to their doctors’ offices, with some specialists like dermatologists experiencing more demand for in-person visits than previously. “If dermatology visits are higher than pre-Covid levels,” said Jonathan Skinner, senior author of the study and a professor of economics at Dartmouth College, “I can’t imagine people not showing up at a hospital if they are having a stroke.”

The most likely explanation for persistent lower hospitalization rates “may simply be that fewer patients are getting sick in the first place,” Dr. Birkmeyer posited. Statewide stay-at-home orders aimed at curbing the coronavirus resulted in a dramatic drop in human activity and a concomitant improvement in air quality across the country. Poor air quality is linked not only to respiratory diseases like asthma and emphysema but also to other illnesses like strokes and heart attacks. Recent reports from around the world have noted decreases in hospitalizations for heart attacks and non-Covid viral respiratory illnesses like influenza during regional lockdowns and quarantines.

Research over the years has also shown that during recessions and periods of higher unemployment, people may at least temporarily adopt healthier behaviors. Individuals may smoke and drink less, get more exercise, improve their diet, lose weight and have less stress related to work or commuting.

Recent public health efforts to promote wearing masks and frequent hand-washing have also probably lowered the transmission rate of other viruses and bacteria that can be responsible for colds, pneumonias and the life-threatening infections or exacerbations of asthma and emphysema. “People keep saying, ‘Hey, I don’t remember the last time I had a cold,’” Mr. Skinner noted. “It’s because no one is hugging or shaking hands, and everyone is washing their hands.”

The published study followed hospitalization trends only through July, but the researchers have continued to gather data which shows that depressed hospital admission rates are persisting into the fall. While both Dr. Birkmeyer and Mr. Skinner concede that more work needs to be done, their study makes clear that the pandemic has had significant public health and public policy implications beyond those directly related to Covid-19.

“All of the things we are doing to reduce Covid shouldn’t necessarily disappear once we have a vaccine,” Mr. Skinner reflected.

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