Pete Seeger’s classic anti-war folk song lamented about where had all the flowers gone (as a metaphor for soldiers). The song could be re-written for 2020 with the title, “Where Have All the Sick Children Gone?” Two publications in Pediatrics this month highlight the effects of the COVID-19 pandemic on pediatric emergency department (PED) visits (10.1542/peds.2020-039628) and bronchiolitis admissions (10.1542/peds.2021-050103) to the PICU. Looking at Pediatric Health Information System (PHIS) data from 27 children’s hospitals across the US, Laroche et al found that PED visits fell in the spring of 2020 by 46% compared to the 3 prior years, with a 70% decrease in respiratory infections. Similarly, in Paris, France, Rambaud et al found an 85% reduction in bronchiolitis admissions to the PICU compared to the expected number based on historical trends. Anecdotally, pediatricians across the country are reporting a marked drop off in sick child visits in the office, the PED, and inpatient units – especially in community hospitals.
As I am not an infectious disease epidemiologist, I won’t spend too much time theorizing on the reasons why. Likely explanations include the fact that the coronavirus mitigation measures of remote schooling, masking, increasing hygiene, and physical distancing also prevent transmission of common respiratory viruses. Data from Australia demonstrated a 98% and 99.4% reduction in respiratory syncytial virus (RSV) and influenza detections respectively in western Australian children through winter 20201, attributed to their COVID-19 prevention measures. Additionally, given the fear of the pandemic, many people may have avoided seeking care for respiratory illnesses that they would have sought care for in the past in order to avoid being exposed to COVID-19.
Overall, the impact has been dramatic and has significant implications. Financially, the decline in acute respiratory infections has been felt at all levels of the care continuum. The Children’s Hospital Association estimated that children’s hospitals have lost $10 billion as a result of the pandemic2. Many community hospitals have shuttered their inpatient pediatric units and downsized their PED presence due to lack of volume. And the pandemic may have dealt a fatal blow to a number of community pediatric practices whose volumes plummeted precipitously and haven’t fully recovered. Removing “sick children” from the day to day volume of expected acute care visits pediatric care has led to a situation no one would have predicted a year ago. On top of that, many parents were scared to bring in their healthy children for routine care and immunizations leading to a further drop in volume. The question is whether we will still be in the same situation a year from now. Let’s hope not.
As we head into the second year of a COVID-19 world, there are more questions than answers. Will we have a summer RSV and influenza season as many children go back to school this spring? Will we go back to “normal” next winter if enough people are vaccinated against SARS-COV-2? Or will we actually end up with a “twindemic” next year that many of us feared would happen this year and just didn’t pan out? Alas, only time will tell.
References
- Yeoh DK, Foley DA, Minney-Smith CA, Martin AC, Mace AO, Sikazwe CT, Le H, Levy A, Blyth CC, Moore HC. The impact of COVID-19 public health measures on detections of influenza and respiratory syncytial virus in children during the 2020 Australian winter. Clin Infect Dis. 2020 Sep 28:ciaa1475. doi: 10.1093/cid/ciaa1475.
- Ray G. Children’s Hospitals’ Statement on Essential COVID-19 Relief. https://www.childrenshospitals.org/Newsroom/Press-Releases/2020/Childrens-HospitalsStatement-on-Essential-COVID19-Relief
