Effects of Relaxed Lockdown on Pediatric ER Visits during SARS-CoV-2 Pandemic in Italy (original) (raw)
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SARS-CoV-2 Pandemic Impact on Pediatric Emergency Rooms: A Multicenter Study
International Journal of Environmental Research and Public Health
From 9 March to 3 May 2020, lockdown was declared in Italy due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Our aim was to evaluate how the SARS-CoV-2 pandemic and related preventive strategies affected pediatric emergency rooms (ERs) during this period. We performed a retrospective cohort multicenter study, comparing the lockdown period to the corresponding period in 2019. We examined 15 Italian pediatric ERs in terms of visit rates, specific diagnoses (grouped as air communicable diseases and non-air communicable diseases), and triage categories. During the lockdown period, ER admissions decreased by 81% compared to 2019 (52,364 vs. 10,112). All ER specific diagnoses decreased in 2020 and this reduction was significantly higher for air communicable diseases (25,462 vs. 2934, p < 0.001). Considering the triage category, red codes remained similar (1% vs. 1%), yellow codes increased (11.2% vs. 22.3%), and green codes decreased (80.3% vs. 69.5%). W...
2020
IntroductionThe ongoing COVID-19 pandemic is heavily affecting healthcare services worldwide. We investigated the impact of a lockdown policy on the characteristics of patients attending a Paediatric Emergency Department (PED), in one of the first areas of COVID-19 outbreak in Europe.MethodsWe retrieved data of all PED visits in March-April 2020 (COVID-19) and March-April 2019 (non-COVID-19), comparing volume and characteristics of PED accesses in the two periods.ResultsIn COVID-19 period, total visits reduced by 67% if compared to 2019. White codes decreased from 45.8–35%. Green codes raised from 45.9–52.2%, while yellow and red codes were comparable. As a percentage, accidents increased during COVID-19, being the first cause of PED access (29.7%) (p < 0.0001), while infections and fever category dropped from 49.1–27.7%. (p < 0.001). Within the neonatal population, minor conditions raised from 56.4% to 81.3. (p < 0.001). Hospitalisation rate slightly increased, while Paedi...
Children
During the initial phase of the national lockdown, we found that there were sharp decreases in admissions to two pediatric emergency departments (EDs) in northern Italy (Cremona and Novara). Here we present a detailed analysis of these admission patterns and types of admissions over a longer timeframe. ED admissions data were anonymously extracted from the departmental management software. Admissions data from 2019 and 2020 were analyzed and compared separately for each ED and combined. There was a 73.2% decrease in total admissions compared with the same period in 2019. With respect to admission diagnoses, there was a significant (p < 0.001) drop in infectious (−51%), respiratory (−25.5%), and nervous systems diseases (−50%) and injuries and poisoning (−17%) but not endocrine, metabolic, neoplastic, circulatory, or musculoskeletal diseases. White codes (patients with minor injuries for whom ED medical care is not required) significantly decreased by 56.3% (p < 0.001). Even if...
Impact of COVID-19 pandemic and lockdown on emergency room access in Northern and Central Italy
Emergency Care Journal
In Northern Italy the coronavirus infection has spread since February 2020: the increase in admissions of COVID-19 patients corresponded to a drastic decrease in admissions of regular patients to the Emergency Room (ER). This retrospective study was conducted by Academy of Emergency Medicine and Care (AcEMC). During the lockdown period the accesses were reduced by more than 50%, and in the following months of May and June 2020, there was a recovery clearly below (70%) previous year’s numbers. We have observed a drastic reduction in white and green codes, a fair reduction in yellow codes, while red codes remained stable. The decrease in access to the ER mainly concerned patients with low priority color codes, but also the reduction in the number of accesses of yellow and red codes, insignificant at a superficial glance, is notable. If we consider that yellow and red codes during the months of the lockdown included many patients with COVIDrelated respiratory insufficiency, it is evide...
Pediatric Reports
The COVID-19 pandemic is affecting healthcare services worldwide. We investigated the impact of a strict lockdown policy on the characteristics of neonatal and pediatric attendances to our pediatric emergency department (PED). The clinical features of PED visits in March–April 2020 (COVID-19) and March–April 2019 (non-COVID-19) were analyzed. During the COVID-19 lockdown period, visits reduced by 67%, from 3159 to 1039. Neonatal access decreased from 78 to 59, mainly due to fewer pathological conditions, with a complete disappearance of respiratory infections. On the other hand, minor neonatal clinical conditions rose from 44 (56.4%) to 48 (81.4%), mostly due to feeding-related issues. Communicable diseases, particularly respiratory infections and gastroenteritis, dropped from 1552 (49.1%) to 288 (27.7%). Accident-related visits also decreased during COVID-19, from 535 (16.9%) to 309 (29.7%), becoming the most common cause of PED access. Hospital admissions reduced from 266 to 109, ...
Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital
Italian Journal of Pediatrics
Background Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children’s hospital, composed by two different pediatric centers, one located in Rome’s city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED’s) and urgent hospitalizations compared to prepandemic period. Methods The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visit...
Effect of Population Lockdown on Pediatric Emergency Room Demands in the Era of COVID-19
Frontiers in Pediatrics, 2020
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.
Impact of a Nationwide Lockdown on SARS-CoV-2 Transmissibility, Italy
Emerging Infectious Diseases
, the earliest known case of locally transmitted severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection was reported in Italy (1; D. Cereda et al., unpub. data, https://arxiv.org/abs/2003.09320). Since then, several interventions have been deployed to control disease spread in regions with sustained transmission, including quarantine of most-affected municipalities, ban of mass gatherings, and local school closures. School closure at the national level was mandated on March 5, and a national lockdown (stay-home mandate and closure of all nonessential productive activities) was issued on March 11 (2,3), then eased after May 4, 2020 (Appendix, https://wwwnc.cdc.gov/ EID/article/27/1/20-2114-App1.pdf). The aim of this study is to evaluate the impact of these interventions on SARS-CoV-2 transmissibility in Italy. The Study We measured SARS-CoV-2 transmissibility in terms of the basic (R 0) and net (R t) reproduction numbers. These quantities represent the mean number of secondary infections generated by 1 primary infector in a fully susceptible population (R 0) and in the presence of control interventions and human behavioral adaptations (R t). When R t decreases below the threshold of 1, the number of new infections begins to decline. Estimates were obtained through a Bayesian approach applied to case-based surveillance data collected by regional health authorities (Appendix). To account for the geographic heterogeneity in contacts, healthcare organization, and timelines of interventions, R t was estimated separately for different provinces and regions. We considered all 19 regions in Italy plus the 2 autonomous provinces of Trento and Bolzano. Moreover, we considered 100 of the remaining 105 provinces for which the data were sufficiently complete. The selected provinces covered 99.1% of the population of Italy and, as of May 3, 2020, accounted for 153,558 symptomatic cases (97.9% of the total recorded in the surveillance database). To evaluate the progressive decrease of transmission, we computed R t at 3 dates: the day before lockdown (March 10) and 1 and 2 weeks after lockdown (March 18 and 25). In addition, we considered the average value of R t over the successive 3 weeks (March 26-April 15). These choices were suggested by the trend of the national R t (Appendix). The R 0 range was 2.83-3.10 (Figure 1) in the 8 regions for which the estimate was possible
International Journal of Environmental Research and Public Health
In Italy, the COVID-19 epidemic curve started to flatten when the health system had already exceeded its capacity, raising concerns that the lockdown was indeed delayed. The aim of this study was to evaluate the health effects of late implementation of the lockdown in Italy. Using national data on the daily number of COVID-19 cases, we first estimated the effect of the lockdown, employing an interrupted time series analysis. Second, we evaluated the effect of an early lockdown on the trend of new cases, creating a counterfactual scenario where the intervention was implemented one week in advance. We then predicted the corresponding number of intensive care unit (ICU) admissions, non-ICU admissions, and deaths. Finally, we compared results under the actual and counterfactual scenarios. An early implementation of the lockdown would have avoided about 126,000 COVID-19 cases, 54,700 non-ICU admissions, 15,600 ICU admissions, and 12,800 deaths, corresponding to 60% (95%CI: 55% to 64%), 5...