I'm friends with an ER nurse and she was saying that the ER was almost completely empty during the first few weeks of COVID-19 because everyone was staying home out of fear.

Probably because there's no way he could possibly know what "business as usual" was for any company where he wasn't employed. He has no idea what each company's financial situation is and is merely spouting cynicism.

I definitely don't think they saw the number of ambulance rides go down.

Is this something you monitor? Is there even a way to do that with a private ambulance company?

Considering the number of medical providers, doctors' offices, and hospitals that had business plummet to catastrophic levels, I think you're imagining things.

I work in healthcare, and just off the top of my head can think of several medical clinics and pharmacies that shut down because of pandemic-induced financial difficulties.

People who would otherwise have gone to the ER, even if not strictly necessary, were hesitating, "do I really need to go, perhaps not".

And then on the other side, you had people who really _should_ go not wanting to, due to fear.

Both ambulance services in my county were shutting down ambulances and furloughing employees heavily.

-- a paramedic

I wouldn't be surprised to learn that emergencies are a small portion of what ambulances are used for, but I don't have access to that data.

But let’s assume your premise; it’s likely their costs went up dramatically between Personal protective equipment, hazard pay, quarantine procedures for exposed employees etc.

Ambulance services are capital intensive (ie large Debt payments) and low margin. A 20% drop in revenue would bankrupt the company.

Covid hasn't been prevalent enough to increase ER visits in most of the country (until now) and other people have been avoiding going to the ER unless on deaths door. Not to mention the lack of driving has probably plummeted car accident rates. I remember reading that organ donors are in short supply.