Some unintended health consequences of the COVID pandemic for children
There have been some interesting downstream effects of the COVID pandemic on children’s health. For one, our annual influx of kids with RSV (respiratory syncytial virus) and influenza pretty much disappeared. Even the most common reason for young children to visit the doctor — ear infections (otitis media) — also was greatly reduced. My colleagues in primary care told me they went from several a day to one per month. This is quite understandable. Otitis media is essentially a complication of a a viral upper respiratory infection, a cold. With all the kids out of school and daycare closed, the usual ways children get viral infections were shut down. As an aside, now that these things are open again we’re seeing a wave of RSV, as expected. In my own PICU admissions were also down last winter, and this experience was shared by my colleagues. A recent study documented the dramatic drop in PICU admissions around the country.
PICU admissions overall were down by nearly 50% across the country. The most interesting thing was that, as expected during quarantine, admissions for respiratory critical illness were dramatically down. On the other hand, as you might also have expected, PICU admissions for poisoning, drug ingestion, suicide attempt, and endocrine issues, particularly diabetic ketoacidosis, were up. If you coop up all those kids some bad things can happen. This is shown in the graph below. It shows a moving 7-d average of daily PICU admissions during the baseline (averaged over 2017–2019) and 2020 study periods. Stay-at-home orders were initiated at all sites by March 24, 2020.
So maybe that’s good? But also, the pandemic quarantine led to a drop in essential preventative care measures in children. The most recent newsletter of the American Academy of Pediatrics raised the concern for a particular example of this — vision screening. Amblyopia is a disease of vision development affecting 3% of all children. It is highly treatable in the first years of life, but after about age 7 it becomes increasingly difficult to correct. Traditionally, screening for this condition has been part of well child visits, which were dramatically reduced with the quarantine. And it’s something that really needs to be done in person, not remotely or online. There are other examples. Only time will tell if there are other untoward effects of the lapse in well child visits. The authors of the PICU study’s conclusions are kind of glass half full, but do make an important point:
The physical distancing measures put in place to decrease transmission of SARS-CoV-2 were associated with widespread and substantial reductions in PICU admissions, suggesting that a considerable portion of pediatric critical illness may be preventable, particularly those due to respiratory and infectious illnesses. These findings may have important implications for child health and public policy. Further study is warranted to identify which strategies most effectively decrease transmission of childhood infections while avoiding the negative consequences of social isolation.