Abstract
Objective:
Since the emergence of the COVID-19 pandemic, several reports have shown markedly reduced Emergency Department utilization. We aimed to examine the trends in Emergency Department visits during the early phase of the COVID-19 pandemic in a tertiary care center in Pakistan.

Methods:
A retrospective, observational analysis of Emergency Department visits was performed at Shifa International hospital over the 3-month study period (March to May 2020) in the early phase of the COVID-19 pandemic. The same 3-month period in 2019 was used as a reference. Total visits, as well as priority level at arrival, diagnosis, and disposition at discharge along with age and gender, were recorded and compared, and the changes in Emergency Department visits were assessed descriptively.

Results:
During the study period, the total Emergency Department volume was 40% lower than that of 2019. Percentage of hospitalizations increased to 32.7 % (of all Emergency Department visits) in 2020: a 4.1% rise (p-value <0.05). An overall increased mortality rate in the Emergency Department was noted in the year 2020: 1.1% compared to 0.6% in 2019 (p-value <0.05).

Conclusions:
The total number of patients presenting to the emergency was markedly reduced during the early phase of the local spread of COVID-19. Public health authorities should provide reassurance to patients suffering from life-threatening ailments that they will not be neglected, and they must emphasize and reinforce the importance of seeking timely medical attention for serious and acute conditions during the current COVID-19 pandemic, or any pandemic in the future, to avoid adverse outcome resulting from delay in seeking urgent care.

Key words: COVID-19, SARS-CoV-2, Emergency Department utilization, emergency preparedness, Attendance