Impact of the SARS-CoV-2 pandemic and associated lockdown measures on attendances at EDs in English hospitals

A retrospective database study looking looking at 14,224,908 attendances at consultant-led ED departments operated by 41 NHS trusts in England between January 2019 and June 2020.

Journal article

Published: 28/01/2021

An analysis published in in The Lancet Regional Health – Europe led by the Strategy Unit and co-authored by Nuffield Trust's Elizabeth Fisher.

The research's main findings were that:

  • Overall attendances at ED fell by 51%;
  • The biggest drop-offs were among patients of Bangladeshi (75.3%), Chinese (74.5%), Pakistani (71.8%), Indian (64.9%), and Black African ethnicities (63.5%);
  • Attendances for those under 19 years also dropped significantly, with a 69.1% reduction from pre-lockdown attendances. Falls in attendances for older people were less marked. For people aged 65-74 years the figure was 42.6%; for those over 75 it was 40.1%;
  • 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,
  • Gender and deprivation factors didn’t affect attendances.

Journal article information


The SARS-CoV-2 outbreak and associated lockdown measures have challenged healthcare. We examine how attendances to ED in England were impacted.


Interrupted time series regression (January 2019 to June 2020) of data from EDs in 41 English NHS Trusts was used to estimate the initial decrease in attendances and the rate of increase following an interruption from 11 March – 7 April 2020, which included the 23 March lockdown in England.


The SARS-CoV-2 interruption led to an initial 51.1% reduction (95% CI 46.3–55.9%) in ED attendances followed by a linear increase in attendances of 3.0% per week (95% CI 2.5–3.5%).  Significantly larger initial reductions were seen in those aged 0–19 years (69.1%), Indian (64.9%), Pakistani (71.8%), Bangladeshi (75.3%), African (63.5%) and Chinese people (74.5%), self-conveying attendees (60.3%) and those presenting with contusions or abrasions (66.9%), muscle and tendon injuries (65.6%), and those with a diagnosis that was not classifiable (72.7%).  Significantly smaller initial reductions were seen in those aged 65–74 years (42.6%), 75+ years (40.1%), those conveyed by ambulance (31.9%), and those presenting with the following conditions: central nervous system (44.9%), haematological (44.0%), cardiac (43.7%), gastrointestinal (43.4%), gynaecological (43.2%), psychiatric (40.4%), poisoning (39.7%), cerebro-vascular (39.0%), endocrinological (36.1%), other vascular (34.6%), and maxillo-facial (19.7%). No significant differences in the initial reduction of activity were seen in subgroups defined by sex, deprivation, urbanicity or acuity.


The SARS-CoV-2 outbreak and lockdown substantially reduced ED activity. The reduction varied by age groups, ethnicity, arrival mode and diagnostic group but not by sex, deprivation, urbanicity or acuity.


No funding to declare.