(Reuters) – Emergency department visits fell 42% across the United States during the early days of the coronavirus pandemic compared to the same period last year, according to a study by the U.S. Centers for Disease Control and Prevention (CDC).

The steepest declines in emergency department visits, from the start of 2020 through May 30, were seen in children younger than 14 and women, and in the northeast region that includes New York and New Jersey, the epicenter of the U.S. outbreak.

The proportion of infectious disease-related visits, including for general symptoms, pneumonia not caused by tuberculosis and for respiratory failure, was four times higher during the early pandemic period.

But the number of visits for chest pain, heart attacks and other medical issues not related to the virus fell sharply, suggesting people were delaying care for conditions that might be fatal if left untreated, researchers said in the CDC’s Morbidity and Mortality Weekly report.

Previous reports in May highlighted a rise in deaths here from causes other than COVID-19 in New York City, and a drop in child vaccination rates here as people avoided hospitals for fear exposure to the coronavirus.

The findings suggest COVID-19 has altered use of the emergency department, and that people who lack access to primary care and telemedicine might be disproportionately affected, the researchers said.

They recommend healthcare systems continue addressing concerns of infection risk in hospital emergency departments and expand the use of virtual visits during the pandemic.