Indirect effects of the COVID-19 pandemic on paediatric health-care use and severe disease: a retrospective national cohort study

Williams, T. C.; MacRae, C.; Swann, O.; Haseeb, H.; Cunningham, S.; Davies, P.; Gibson, N.; Lamb, C.; Levin, R.; McDougall, C.; McFadzean, J.; Piper, I.; Turner, A.; Turner, S.; Van Dijke, M.; Urquhart, D.; Guthrie, B.; Langley, R.

Background: Severe disease directly associated with SARS-CoV-2 infection in children is rare. However, the indirect consequences of the COVID-19 pandemic on paediatric health have not been fully quantified. We examined paediatric health-care utilisation, incidence of severe disease, and mortality during the lockdown period in Scotland. Methods: This national retrospective cohort study examined national data for emergency childhood primary and secondary care utilisation following national lockdown on March 23, 2020. To determine whether social distancing measures and caregiver behavioural changes were associated with delayed care-seeking and increased disease severity on presentation, unplanned, emergency admissions requiring invasive mechanical ventilation for the two national Paediatric Intensive Care Units (PICUs) were analysed. PICU admissions were grouped by diagnostic category, and disease severity on presentation calculated. National statutory death records were consulted to establish childhood mortality rates and causes of death. For all observations, the lockdown period was compared to equivalent dates in 2016-2019. Findings: We identified 273,455 unscheduled primary care attendances; 462,437 emergency department attendances; 54,076 emergency hospital admissions; 413 PICU emergency admissions; and 415 deaths during the lockdown study period and equivalent dates in previous years. The rates of emergency presentations to primary and secondary care fell during lockdown in comparison to previous years. Emergency PICU admissions for children requiring invasive mechanical ventilation also fell, with an odds ratio of 0.52 for chance of admission during lockdown (95% CI 0.37-0.73, p < 0.001). Clinical severity scores did not suggest children were presenting with more advanced disease. The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years. Mortality during lockdown did not change significantly compared to 2016-2019. Interpretation: National lockdown led a reduction in paediatric emergency care utilisation, without associated evidence of severe harm. Funding: None.