The COVID-19 pandemic dramatically altered the delivery of outpatient care in 2020. Beginning in March, health care practices began deferring elective visits, modifying their practices to safely accommodate in-person visits, and increasing the use of telemedicine.

Since the start of the pandemic, reports tracking weekly outpatient visit volume. In April the number of visits to ambulatory care providers had declined by nearly 60 percent. By May, visits had rebounded, though they were still below the pre-pandemic baseline. In August modest drops in visits in some of the COVID-19 hot-spot states. By October, office visit volumes had essentially returned to baseline, and telemedicine use showed signs of declining.

However, there were several notable changes in November and December, including a modest shift back to telemedicine and a substantial drop in visits among children. In November 2020, weekly visits to rheumatologists and adult primary care physicians, among other provider specialties, exceeded the pre-pandemic baseline. But weekly visits to certain other specialists,  in particular, pediatricians, were substantially below their baseline.

As in-person visits dropped during the early phase of the pandemic, telemedicine visits rose rapidly. Since the peak in mid-April, telemedicine use steadily fell into October before increasing yet again in November and December, rising from 6 percent of visits to just over 8 percent of visits.

There was a substantial cumulative reduction in visits across all specialties over the course of the pandemic in 2020. One critical question is whether visit volumes will rise above the baseline level as we gain increasing control over the pandemic and people receive care that had been deferred. The number of weekly visits in 2020 was 5 percent to 6 percent below this typical pattern, suggesting a cumulative decline in visits.

Despite the surge in COVID-19 cases at the end of 2020, outpatient visits per week were stable over the first three months of 2021 and unchanged from the baseline week of March 1. While numbers of visits overall returned to pre-pandemic levels, trends varied by age group. Among children ages, 3 to 17, weekly visit volumes in 2020 fell after October and ended the year substantially lower than what would be expected in a typical year (the blue line). In contrast, visit volumes for older adults remained more stable.

Over the last week of March of 2021, the Philippines yet again witnessed an unprecedented rise in COVID-19 cases. Coming on the heels of the holiday season, this COVID-19 surge affected the people in Metro Manila, and was back to being in Enhance Community Quarantine once more, exacerbating several challenges already facing care providers: treating patients exposed to the virus or infected by it; managing patients with non-COVID-19-related illnesses; keeping providers and staff healthy, and ensuring the financial viability of their practices.