Provision of Acute Care Services During the COVID-19 Pandemic in Finland

The first case of COVID-19 was reported in Finland in January 2020. Thereafter, the number of COVID-19 cases increased rapidly, and the Finnish Government declared a state of Emergency on 16 March 2020, leading to several social restrictions. New peaks in the number of COVID-19 cases were seen during the years 2020 and 2021. During the later waves of the pandemic, regional restrictions were implemented instead of a national lockdown. The number of ED admissions during the pandemic decreased in Finland when compared to previous years. Moreover, a decrease in surgical volumes and major surgical operations was also seen. The main aim of this dissertation was to evaluate the effect of the COVID-19 pandemic on emergency departments and emergency surgical operations, acute care services, in Finland during the first and second waves of the pandemic.

The study was conducted at three large Finnish hospitals: Tampere University Hospital (tertiary level unit), Mikkeli Central Hospital (secondary level unit) and Central Finland Hospital (secondary level unit). Information on the number of emergency department visits and emergency surgeries in adult patients (aged 18 or older) was collected from the patient information systems of the participating hospitals using the International Classification of Diseases 10th Revision (ICD-10) and NOMESCO Classification of Surgical Procedures (NCSP) procedure codes (Finnish version). The data cover the years 2017-2020. In study V, we also included the year 2021.

After the declaration of the national lockdown in spring 2020, the incidence of ED visits due to abdominal pain, back pain and traumatic brain injury decreased. The incidence of abdominal pain visits was lowest in March (IRR 0.83, CI: 0.76 to 0.90) when the lockdown was first declared. Similar findings were seen in the incidence of back pain visits, the lowest being in March (IRR 0.67, CI: 0.57 to 0.78). In traumatic brain injuries, the first decrease in the incidence of ED visits was seen in March (IRR 0.86, CI: 0.73 to 1.02), and the incidence was lowest in April (IRR 0.83, CI: 0.68 to 1.01). When the lockdown ended, the incidence rebounded to its previous level. A second decrease was seen during the second wave of the pandemic in November and December 2020. During the first wave of the pandemic, the incidence of acute abdominal surgeries remained at the same level as in previous years, but a decrease was seen in December 2020 (IRR 0.84, CI: 0.71-1.00). When comparing the incidence of urgent spine surgeries, the incidence remained at the same level during 2020 as in previous years. However, a decrease in incidence of trauma craniotomies and craniectomies was seen during the first wave of the pandemic in April (IRR 1.90, CI: 0.54 to 6.75). During the second wave of the pandemic, the incidence remained at the same level when compared to the reference years.

The incidence of ICU admissions for all reasons decreased during the lockdown period in 2020 when compared to previous years. In February, the IRR of all-cause ICU admissions was 1.02 (CI: 0.89 to 1.18) and then decreased during the lockdown period to 0.78 (CI: 0.67 to 0.90) in March. After the lockdown, the incidence rebounded to its previous level and remained there until the end of that year. During 2021, the incidence of all-cause ICU admissions was at the same level as in previous years. The number of COVID-positive patients in ICUs remained low during the pandemic. In 2020, 110 COVID-positive patients were treated in ICUs (2.5% of all ICU admissions) and 141 patients (2.9% of all ICU admissions) in 2021.

In conclusion, we found that the incidence of ED visits and ICU admissions decreased when the COVID-19 pandemic and national lockdown began in Finland in 2020. A second decrease in ED visits was also seen during the second wave of the pandemic at the end of that year. When comparing the incidence of emergency surgeries, a decrease was seen in trauma craniotomies and craniectomies, while acute abdominal surgeries and urgent spine surgeries remained at the same level as in previous years.