Using a quasi-experimental interrupted time series analysis based on multicenter prospective French surveillance data for pediatric emergency department (PED) visits and related hospital admissions, investigators report that the COVID-19 lockdown and school closures were associated with a significant decrease in infectious diseases transmitted by airborne or fecal-oral transmission routes in children, according to the results of their study published in Clinical Infectious Diseases.

In total, 871,543 PED visits at 6 participating centers from January 1st, 2017, to April 19th, 2020, were included in the assessment. Data from 2017 to 2019 were used to generate a model fitting the observed values of the PED visits, allowing investigators to project the number of visits that could have been expected without the lockdown.

According to the analysis, the number of PED visits and hospital admissions during the lockdown period decreased significantly (-68% and -45%, respectively). A significant decrease of more than 70% in presentation for acute gastroenteritis, common cold, bronchiolitis, and acute otitis media compared with expected values was also noted.

The investigators state that they cannot exclude changes in clinical management due to COVID-19 fears that may have influenced diagnosis coding. Furthermore, data on severity were also not collected; therefore, they were unable to exclude that reductions in presentation was associated with children presenting later in their illness. However, stability of the number of urinary tract infection cases that was used as a control outcome and the significant decrease in hospital admissions do not support the idea that the dramatic decrease could be partially due to transportation limitations, fears of going to the hospital, or an increase in the use of telemedicine.


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While these unprecedented health measures were put in place to reduce the risk associated with SARS-CoV-2, the investigators conclude, “our data suggest that these measures have also a critical impact on the transmission of numerous infectious diseases, more specifically on viral or viral-induced pediatric diseases.”  They also report that although the role of children in the dissemination of SARS-CoV-2 remains unclear, their finding of decreases in other forms of illness might be an unexpected benefit of implemented health measures and could raise questions about the impact on the healthcare system as France lifts lockdown measures. They recommend complimentary studies using more granular data such as severity to better understand the impact on the lockdown on children’s health. They also state that this nation-level quasi-experiment, “provides unique evidence which could be key in the post COVID-19 era, to implement new guidelines and new routines in our way of life, and in order to fight past but also potential future infectious diseases threats reaching both children and adults.”

Reference

Angoulvant F, Ouldali N, Yang DD, et al. COVID-19 pandemic: impact caused by school closure and national lockdown on pediatric visits and admissions for viral and non-viral infections, a time series analysis [published online June 3, 2020]. Clin Infect Dis. doi:10.1093/cid/ciaa710