COVID-19 effects on intimate partner violence, sexual assault, and child abuse in the emergency department

Background and Objectives: Over 20 million people in the United States have contracted the SARS-CoV- 2 virus during the COVID-19 pandemic. Key measures in preventing spread of the virus are social distancing and stay-at- home mandates. As described during prior natural disasters, these measures along with other stressors have the potential to increase incidences of intimate partner violence (IPV), sexual assault, and child abuse. Emergency Medicine as a specialty is uniquely poised to identify trends in violence and guide future disaster planning for at-risk populations. Method(s): We performed a retrospective review of Emergency Department (ED) visits, Sexual Assault Nurse Examiner (SANE) consults, and Domestic Violence Healthcare Project (DVHP) advocacy team consults at a Level 1 trauma center in Charlotte, NC. ICD-10 codes specific to IPV, sexual assault, and child abuse were queried from 3/1/2020 through 10/31/2020. The same query was repeated for identical dates in 2019. Similarly, the number of consults performed by SANE and DVHP was collected comparing 2020 to 2019. All ED visits and consultations were compared to total ED visits for the reviewed time period, and chi-square tests were used to analyze study endpoints. Result(s): We found proportional increases in the percentage of ED visits for IPV and child abuse during the study timeframe by 39.9% (p = 0.03) and 38.0% (p = 0.03) respectively. The total number of consults for DVHP and SANE services decreased, however, a higher percentage of ED patients required DVHP and SANE services. Of note, only the proportional increases in DVHP consults in the first three months were statistically significant, increasing by 25.1% (p = 0.03). Conclusion(s): Despite decreased ED volumes throughout the pandemic, the percentage of visits and subsequent resource utilization related to IPV, child abuse, and sexual assault increased following the initiation of stay-at- home orders, though only IPV and child abuse saw consistent, statistically significant changes. These numbers are likely higher than reported as victims often do not seek care after episodes of violence and abuse, especially during a pandemic when people are avoiding the ED. Further research is needed to evaluate hospital, prehospital, and community resources required during disasters such as the COVID-19 pandemic.