The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the Bronx, an epicenter

Abstract

Background: The Bronx has the highest prevalence of asthma in the United States (US), and was also an early COVID-19 epicenter, making it a unique study location. Worldwide reports describe significant declines in pediatric emergency department (PED) visits during COVID-19. The ongoing impact of COVID-19 on all PED presentations, including asthma, at an early epicenter has not been studied beyond the pandemic peak and into the early phases of state re-opening. Objectives: To compare PED health-seeking behaviors and clinical characteristics during the 2020 pandemic and subsequent initial New York State (NYS) phased re-opening to the same period in 2019. Methods: Retrospective chart review of children <21 years utilizing the PED at a high-volume quaternary children's hospital in The Bronx, NY from March 15th 2020 -July 6th 2020 (pandemic cohort) and the same interval in 2019 (comparison cohort). Visits were assigned to pre-determined diagnostic categories. Demographic and clinical data were compared. Results: 19,981 visits were included. Visits declined by 66% during 2020. Proportions of asthma visits (2% vs. 7%, p < 0.0001) and minor medical problems (61% vs. 67%, p < 0.0001) had significant declines in the pandemic cohort, while major medical problems (13% vs. 8%, p < 0.0001), appendicitis (1% vs. 0.4%, p < 0.0001) and other surgical complaints (1% vs. 0.5%, p < 0.0001) had proportional increases in the pandemic cohort. No significant proportional changes were noted among psychosocial and trauma groups between the two cohorts. Conclusion:The pandemic cohort experienced a substantial decrease in PED volume, but an increase in acuity and admission rates, which was sustained through the NYS phase-II re-opening. Despite being located in an asthma hub, the incidence of asthma-related PED visits declined appreciably in the pandemic cohort. Future studies examining the effects of indoor allergens in isolation on pediatric asthma are warranted.

Paediatric asthma exacerbation admissions and stringency of non‐pharmaceutical interventions: Results from a developing country

“…Similar results were also reported from Taiwan 28 and Slovenia 29 . Others also suggested a significant decrease in asthma‐related paediatric emergency visits 25,26 …”

“…Reports from western countries suggested that COVID‐19‐related lockdowns significantly decreased asthma‐related attendance to primary care, and hospital admission, with no corresponding increase in asthma deaths 23‐26 . However, there is a lack of data about the impact of NPI measures on paediatric asthma exacerbation admissions in developing countries where resources are limited and health service utilisations are believed to have been negatively impacted by COVID‐19.…”

Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas

“…Our study is consistent with prior literature reporting a decrease in healthcare utilization during the pandemic, particularly hospitalizations and emergency department visits. [ 8 , 9 , 10 , 11 ]. However, our study adds to the sparse literature, by evaluating 79 clinics across four large, academic institutions in the Southeastern US, indicating decreased utilization of pediatric primary care [ 12 , 19 ].…”

“…The pandemic has resulted in a significant decrease in pediatric emergency department visits and hospitalizations. [ 8 , 9 , 10 , 11 ]. There has also been a decrease in pediatric primary care visits due to concerns about children becoming infected with SARS-CoV-2, or in order to comply with stay-at-home orders [ 12 ].…”

“…Telehealth has emerged as a tool for patients to access primary care during the pandemic, although how much impact telehealth has had on closing the gap in pediatric primary care is still unclear. While there has been growing literature about the impact of the COVID-19 pandemic on pediatric healthcare utilization [ 8 , 12 , 17 , 18 , 19 , 20 ], there are still limited data on the effect of the pandemic on the volume of pediatric primary care visits and the characteristics of patients who did and did not attend a visit during the pandemic.…”