{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T12:59:34Z","timestamp":1765976374598,"version":"3.40.5"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T00:00:00Z","timestamp":1595808000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Disaster med. public health prep."],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec id=\"S1935789320002657_as1\"><jats:title>Objectives:<\/jats:title><jats:p>An unprecedented wave of patients with acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) hit emergency departments (EDs) in Lombardy, starting in the second half of February 2020. This study describes the direct and indirect impacts of the SARS-CoV-2 outbreak on an urban major-hospital ED.<\/jats:p><\/jats:sec><jats:sec id=\"S1935789320002657_as2\"><jats:title>Methods:<\/jats:title><jats:p>Data regarding all patients diagnosed with COVID-19 presenting from February 1 to March 31, 2020, were prospectively collected, while data regarding non-COVID patients presenting within the same period in 2019 were retrospectively retrieved.<\/jats:p><\/jats:sec><jats:sec id=\"S1935789320002657_as3\"><jats:title>Results:<\/jats:title><jats:p>ED attendance dropped by 37% in 2020. Two-thirds of this reduction occurred early after the identification of the first autochthonous COVID-19 case in Lombardy, before lockdown measures were enforced. Hospital admissions of non-COVID patients fell by 26%. During the peak of COVID-19 attendance, the ED faced an extraordinary increase in: patients needing oxygen (+239%) or noninvasive ventilation (+725%), transfers to the intensive care unit (+57%), and in-hospital mortality (+309%), compared with the same period in 2019.<\/jats:p><\/jats:sec><jats:sec id=\"S1935789320002657_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>The COVID-19 outbreak determined an unprecedented upsurge in respiratory failure cases and mortality. Fear of contagion triggered a spontaneous, marked reduction of ED attendance, and, presumably, some as yet unknown quantity of missed or delayed diagnoses for conditions other than COVID-19.<\/jats:p><\/jats:sec>","DOI":"10.1017\/dmp.2020.265","type":"journal-article","created":{"date-parts":[[2020,7,27]],"date-time":"2020-07-27T07:44:44Z","timestamp":1595835884000},"page":"e33-e42","source":"Crossref","is-referenced-by-count":27,"title":["Stranger Months: How SARS-CoV-2, Fear of Contagion, and Lockdown Measures Impacted Attendance and Clinical Activity During February and March 2020 at an Urban Emergency Department in Milan"],"prefix":"10.1017","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1807-8696","authenticated-orcid":false,"given":"Stefano","family":"Franchini","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marzia","family":"Spessot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Landoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Piani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Cappelletti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Mariani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Mauri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria 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to surge to face the SARS-CoV-2 outbreak: lessons learned from Lombardy, Italy","author":"Faccincani","year":"2020","journal-title":"Disaster Med Public Health Prep."},{"key":"S1935789320002657_ref10","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-2026.2003.00495.x"},{"volume-title":"Disease Control Priorities: Improving Health and Reducing Poverty","year":"2017","author":"Madhav","key":"S1935789320002657_ref3"},{"key":"S1935789320002657_ref4","unstructured":"4. Decreto del Presidente del Consiglio dei Ministri della Repubblica Italiana. 8 marzo 2020. Ulteriori disposizioni attuative del decreto-legge 23 febbraio 2020, n. 6, recante misure urgenti in materia di contenimento e gestione dell\u2019emergenza epidemiologica da COVID-19. 2020. https:\/\/www.gazzettaufficiale.it\/eli\/id\/2020\/03\/08\/20A01522\/sg. Accessed April 22, 2020."},{"key":"S1935789320002657_ref13","article-title":"Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis","author":"Ciceri","year":"2020","journal-title":"Crit Care Resusc."},{"key":"S1935789320002657_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30627-9"},{"key":"S1935789320002657_ref2","unstructured":"2. Presidenza del Consiglio dei Ministri - Dipartimento della Protezione Civile. COVID-19 Italia - Monitoraggio situazione. Schede riepilogative. Regioni. 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