Should we fear "flu fear" itself? Effects of H1N1 influenza fear on ED use

Am J Emerg Med. 2012 Feb;30(2):275-82. doi: 10.1016/j.ajem.2010.11.027. Epub 2011 Jan 3.


Background: Surges in patient volumes compromise emergency departments' (EDs') ability to deliver care, as shown by the recent H1N1 influenza (flu) epidemic. Media reports are important in informing the public about health threats, but the effects of media-induced anxiety on ED volumes are unclear.

Objective: The aim of this study is to examine the effect of widespread public concern about flu on ED use.

Methods: We reviewed ED data from an integrated health system operating 18 hospital EDs. We compared ED visits during three 1-week periods: (a) a period of heightened public concern regarding flu before the disease was present ("Fear Week"), (b) a subsequent period of active disease ("Flu Week"), and (c) a week before widespread concern ("Control Week"). Fear Week was identified from an analysis of statewide Google electronic searches for "swine flu" and from media announcements about flu. Flu Week was identified from statewide epidemiological data.

Results: Data were reviewed from 22 608 visits during the study periods. Fear Week (n = 7712) and Flu Week (n = 7687) were compared to Control Week (n = 7209). Fear Week showed a 7.0% increase in visits (95% confidence interval, 6-8). Pediatric visits increased by 19.7%, whereas adult visits increased by 1%. Flu Week showed an increase over Control Week of 6.6% (95% confidence interval, 6-7). Pediatric visits increased by 10.6%, whereas adult visits increased by 4.8%.

Conclusion: At a time of heightened public concern regarding flu but little disease prevalence, EDs experienced substantial increases in patient volumes. These increases were significant and comparable to the increases experienced during the subsequent epidemic of actual disease.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data*
  • Epidemics
  • Fear / psychology
  • Hospitalization / statistics & numerical data
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Infant
  • Influenza A Virus, H1N1 Subtype*
  • Influenza, Human / epidemiology
  • Influenza, Human / psychology*
  • Retrospective Studies
  • United States / epidemiology