Delayed access to care and late presentations in children during the COVID‐19 pandemic New Zealand‐wide lockdown: A New Zealand Paediatric Surveillance Unit study

Abstract

Aim Describe paediatricians' experience of adverse health outcomes for children during the New Zealand‐wide level 4 lockdown in response to the COVID‐19 pandemic. Methods Weekly national survey of paediatricians with an open‐ended questionnaire. Results During the 6‐week study survey period, the New Zealand Paediatric Surveillance Unit received 33 reports about 55 instances where paediatricians believed care may have been compromised, about half (56%) relating to infants aged from birth to 6 weeks. Compromised care was for acute presentations in 75%, acute complications of a chronic illness in 14%, with 11% for chronic conditions. Paediatricians reported the outcome as moderately severe (short‐term morbidity, increased length of stay, higher level of care) in 38 cases (69%) and in a further 4 (7%) as severe (potential to be life‐threatening or result in permanent disability). Conclusion Despite clear messaging, hospital avoidance and reduced access to primary and secondary care were associated with significant potential harm for children in New Zealand during a strict lockdown, with newborn infants disproportionately affected. During the implementation of interventions to eliminate community transmission of COVID‐19, New Zealand paediatricians note the importance of face‐to‐face post‐natal visits for newborns and primary care services for children with acute illness, to avoid preventable harm.

Reduced presentations with fractures or orthopaedic infections to a major children's hospital during a national COVID‐19 elimination strategy

“…Firstly, parents may have been reluctant to bring children with cellulitis into hospital, due to anxiety regarding catching COVID-19. 13 Some children with cellulitis may have been seen in primary care, virtually or face to face. Nationally, only one child was reported to the New Zealand Paediatric Surveillance Unit as having an adverse outcome due to delayed diagnosis of a skin infection, suggesting that cellulitis was successfully managed during this time, whether through CED or primary care.…”

“…Nationally, only one child was reported to the New Zealand Paediatric Surveillance Unit as having an adverse outcome due to delayed diagnosis of a skin infection, suggesting that cellulitis was successfully managed during this time, whether through CED or primary care. 13 Secondly, one of the Government's main messages was to stay home. Level 4 required 2 m physical distancing, and stopped children playing at school and in playgrounds, and with children from other 'bubbles', likely reducing their risk of cuts and scratches, and reducing bacterial transmission.…”

“…Several reasons for reduced infections are proposed. Firstly, parents may have been reluctant to bring children with cellulitis into hospital, due to anxiety regarding catching COVID‐19 13 . Some children with cellulitis may have been seen in primary care, virtually or face to face.…”

“…Some children with cellulitis may have been seen in primary care, virtually or face to face. Nationally, only one child was reported to the New Zealand Paediatric Surveillance Unit as having an adverse outcome due to delayed diagnosis of a skin infection, suggesting that cellulitis was successfully managed during this time, whether through CED or primary care 13 . Secondly, one of the Government's main messages was to stay home.…”

Disentangling crucial factors of the pandemic in Brazil: Effect of lockdown restrictions on mental health

“…Many problems that are attributed to the pandemic cannot be easily distinguished from those that are caused by the lockdown itself and vice versa. With regard to heath, mortality rate and economic variables, other studies investigated these issues using cross‐sectional designs (Duncanson et al, 2021 ), nationwide data (Bendavid et al, 2021 ), integrative reviews (Joffe, 2021 ) and theoretical forecasting (Bavli et al, 2020 ). At the macro level, no conclusive results are available to date.…”