Effect of Population Lockdown on Pediatric Emergency Room Demands in the Era of COVID-19

Abstract

The aim of this study was to assess the impact of the COVID-19 pandemic and population lockdown on pediatric ED consultations. Methods: A cross-sectional study on pediatric emergency department consultations before and during the current COVID-19 pandemic (March-May 2019 vs. March-May 2020) was performed in two hospitals in the Campania region (Southern Italy) [i.e., Salerno University Hospital (Salerno) and Pediatric Regional Referral Emergency Hub "AORN Santobono-Pausillipon" (Naples)]. Results: 29,368 consecutive ED pediatric patients (13,430 females; mean age ± SD = 5.4 ± 4.7 years) were seen in March-May 2019 and 9,133 (4,494 females; mean age ± SD = 5.9 ± 4.2 years) in March-May 2020. Resuscitation/emergency and urgent care pediatric ED consultations were 1,388 (4.7%, 95% CI 4.5-4.9) in the 2019 trimester, while they were 648 (7.1%, 95% CI 6.6-7.6) in the 2020 trimester (p < 0.01). Mean pediatric ED daily consultations were 326.3 (95% CI 299.9-352.7) in the considered period of 2019 and 101.4 (95%CI 77.9-124.9) in the same period of 2020 (p < 0.001). COVID-19 nasal swabs were performed for 385 children; of those, six resulted positive and four of them were hospitalized. Conclusions: This work provides a unique snapshot of the pediatric EDs demands in the era of COVID-19. We witnessed a significant reduction of non-urgent health care demands during the pandemic but an increase of more severe urgent cases. The COVID-19 pandemic and the following lockdown unveiled the inappropriateness of the majority of pediatric ED consultations. Nevertheless, the current scenario highlighted the need for appropriate and timely clinical evaluations in the pediatric primary care to tackle late and more severe diagnoses in EDs.

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.…”

Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers

“…Moreover, limited access to physical examination and/or fear of SARS-CoV-2 have most likely contributed to the significant rate of self-medication and of multiple access to ED, especially in patients with long duration of symptoms. Finally, given that a higher rate of red codes was observed and that none of the patients needing intensive care had been previously seen by GP despite significant duration of symptoms, in agreement with other studies [ 12 ] we could speculate that fear of SARS-CoV-2 infection might have led to a delayed provision of care in some cases.…”

COVID-19 Pandemic: Impact on Health Care of Children and the Urgent Need to Restore Regular Healthcare Services

“…A significant reduction in numbers seeking care in the emergency services for non-COVID illnesses are now being highlighted [2][3][4][5]. Some groups/societies, have started issuing recommendations for handling children with specific problems [6]; however, children with chronic illnesses suffered as non-COVID care was largely restricted to critically-ill children.…”