Mortality in Colorado hospitals jumped by 35% in the first 16 months of the COVID-19 pandemic, even as overall hospitalizations decreased, a new report found, further raising concerns about the impact of delayed care and the excess deaths brought on by the pandemic.

The findings, compiled and issued by the Colorado Hospital Association, further underscore what hospitals have reported for months: Far fewer non-COVID-19 patients sought treatment at Colorado facilities in the first several months of the pandemic, a phenomenon that’s now leading to sicker patients flooding the state’s hospitals. That trend was likely driven by fear among the general public about the safety of hospitals amid a the spread of a virus that, in its infancy, remained shrouded in unknowns.

Between March and May 2020, hospital admissions dropped by nearly 18%, and non-COVID admissions and ICU patients fell by more than a fifth each, the hospital association found. Hospitalizations decreased for many of the most common causes of admissions, from nervous and circulatory system problems to musculoskeletal system patients; the latter group dropped by nearly 50%.

The findings weren’t surprising, said Darlene Tad-y, the hospital association’s vice president for clinical affairs. 

“What we really recognized was that the number of patients hospitalized with COVID were patients displacing or replacing the patients with other, usual medical conditions that we are normally admitting into the hospitals,” she said this week. 

Hospital officials have previously reported declines in stroke and heart attack patients turning up at emergency rooms during those early months of the pandemic. It’s not like heart attacks and strokes stopped happening, Tad-y said, echoing what those officials have said previously.

“I think fewer people were coming to hospitals with those conditions either for fear of COVID or lack of recognition or maybe their threshold for coming to the hospital was a lot higher because of their fears,” she said. “I would expect that we didn’t see fewer gallstones or fewer people that were having heart attacks.”

As a result, ambulance crews reported that they were finding more people who died at home than before the pandemic. 

The Centers for Disease Control and Prevention reported that emergency room volume fell by 42% nationwide in the beginning of the pandemic, and urgent and primary care clinics reported similar trends. 

Unsurprisingly, the review found an increasing dominance of COVID-19 patients in November and December 2020, when the state experienced its largest surge of patients and its second-largest surge of cases, behind only the recent omicron wave. During those months, nearly 16% of hospital discharges were COVID patients, the association found, and those cases were “associated with a 17.4% decrease in non-COVID hospital discharges.”

The impacts of this delayed care, hospital officials have said, will be felt for years to come. Already hospitals are reporting higher acuity rates – meaning patients with more severe presentations – than before the pandemic. At HealthONE, Colorado’s largest health system, the severity of non-COVID patients is up 11% compared to pre-pandemic levels, a spokeswoman said last month. Banner Health’s index for tracking severity has been at its highest-ever level in recent months.

That means more patients are coming to hospitals than before COVID-19, and they’re coming in sicker.

“Never in my life have I seen this,” Richard Zane, an emergency physician with UCHealth, told the Denver Gazette last month. “And my first day was in 1993.”

The result has been an added stressor atop an already beleaguered hospital system, which faced another wave of COVID-19 patients in late 2021. At the same time, hospitals have lost as much as 20% of their workforce, largely due to burnout and exhaustion.

Overall between March and June 2021, patients experienced longer lengths of stay in the hospital: For standard beds, the increase was 5%, but it was 18% for ICU patients. The severity of illness is likely attributable in large part to COVID-19 patients, but not entirely: The report found that though “hospitalizations for COVID-19 decreased in the first half of 2021, the percentage (of patients) with an extreme severity of illness score increased to 68.4% between January and June ’21.”

Patients were staying longer, and they died at higher rates, the association said. Mortality in hospitals rose just over 35% between March 2020 and June 2021. Providers said they expect that mortality increase to persist as the impacts of delayed care continue in the months and, likely, years to come.

“Had we never had COVID, would we still be at (our previous mortality rate)?” Tad-y said. “The answer is probably yes.”