Paediatric patients seen in 18 emergency departments during the COVID-19 pandemic

Abstract

BackgroundPublic health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians’ offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year.MethodsWe analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0–16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year.ResultsA reduction of 57% and 70% in overall visits was recorded in the children’s hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of ‘fever’ and ‘gastrointestinal’ symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively).ConclusionPaediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.

The impact of COVID-19 lockdown on infectious diseases epidemiology: The experience of a tertiary Italian Pediatric Emergency Department

“…These results could be the effect of school closures that led to an early disappearance of seasonal epidemics as well as effective containment for the SARS-CoV2 pandemic. Our observations are consistent with those reported in Singapore and in France after the implementation of public health measures for COVID-19 [ 8 , 9 ]. Similar results on pediatric respiratory infections were observable in few pre-COVID-19 era reports, referring to unusual situations: in an urban transport strike in France that led to the exceptional closure of schools in 1995, associated with a significant reduction in cases of acute bronchiolitis and in a recent Dutch study during a large measles epidemic showing a reduction in measles cases during school closures [ 11 ].…”

“…We observed a overall drop of the total number of ED consultations, consistent with recent literature reports [ [6] , [7] , [8] , [9] ], A clear reduction in community acquired respiratory infections, including streptococcal infections, was noticed during the lockdown. These results could be the effect of school closures that led to an early disappearance of seasonal epidemics as well as effective containment for the SARS-CoV2 pandemic.…”

EMS responses and non-transports during the COVID-19 pandemic

“…We also noted increases in abnormal mental status, loss of consciousness, and advanced airway utilization. While the individual differences in vital signs were rather modest, this either suggests a higher level of patient acuity during EMS encounters or could represent a similar decrease in low-acuity encounters as has been seen in emergency department utilization [ 13 , 14 , 20 , 21 ]. Despite an increase in abnormal vital signs, we saw less use of medications, cardiac monitoring, and intravenous catheter placement.…”

“…Using national hospital data, for example CDC researchers found ED visits declined by 42% in April 2020 compared to one year prior [10]. Other studies have identified parallel findings in other countries [11,12], and in specific patient populations [13][14][15][16][17][18][19]. Emergency department visits were also identified to not only be of lower volume, but lower acuity cases demonstrated the largest proportional decrease [20,21].…”

Little evidence for facemask use in children against COVID‐19

“…Most countries seem to have noted reductions in the number children visiting hospitals during the start of the global phase of the pandemic in spring 2020. Decreases have been noted in paediatric emergency departments, 2 paediatric asthma wards 3 and, in particular, for cases of influenza A 4 . But these decreases took place during the early stages of the pandemic, when few countries recommended that children used face masks.…”