1. The COVID-19 pandemic may have limited access to emergency department (ED) care, with increased ED encounters for sexual assault seen leading up to the pandemic and a decrease after lockdown was implemented 

Evidence Rating Level: 2 (Good)

Various stressors such as financial stress, family stress, increased caregiver burden and fear of COVID-19 infection are all factors that were affected by the COVID-19 pandemic and are associated with the risk of gender-based violence and sexual assault. Additionally, physical distance protocols during the pandemic may have led to the isolation of someone with an abusive partner as well as led to a reduction in access to support systems including formal services such as health care and informal support from family and friends. This study aimed to compare rates of emergency department (ED) encounters in Ontario for sexual assault during the pandemic. Two months prior to the pandemic, ED encounters for sexual assault increased among both female and male individuals (8.4 vs 6.9 cases per 100 000; RD, 1.51 [95% CI, 1.06 to 1.96]; aRR, 1.22 [95% CI, 1.09 to 1.38] and 1.2 vs 1.0 cases per 100 000; RD, 0.19 [95% CI, 0.05 to 0.36]; aRR, 1.19 [95% CI, 0.87 to 1.64] respectively. Following the implementation of lockdown and during the first two months of the pandemic. The rates then decreased for both female and male individuals (4.2 vs 8.3 cases per 100 000; RD, −4.07 [95% CI, −4.48 to −3.67]; aRR, 0.51 [95% CI, 0.44 to 0.58] and 0.5 vs 1.2 cases per 100 000; RD, −0.72 [95% CI, −0.86 to −0.57]; aRR, 0.39 [95% CI, 0.26 to 0.58] respectively). For the rest of the study period, oscillations were seen in ED encounter rates, with rates similar to those prior to the pandemic when there were loosened COVID-19 restrictions. This pattern was seen across sex, age group, community size and income group. This study was limited as it only used data from emergency department settings, which tend to indicate the most extreme cases and is unable to estimate the prevalence of sexual assault in the general population. However, this study does suggest that the implementation of COVID-19 measures may have limited access to care for those experiencing sexual assault. Future studies are needed to identify ways in which to balance pandemic protocols while including antiviolence considerations, and to also identify other factors and stressors that may impact rates of sexual violence. 

Click to read the study in JAMA Network Open

Image: PD

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