How lockdown may lead to 'avoidable harm' for the health of under 16s

Research led by Dr Rachel Isba from Lancaster University, Dr Rachel Jenner from Royal Manchester Children's Hospital, and Dr Marc Auerbach from Yale University analysed attendances and admissions to Paediatric Emergency Departments (PED) at the Royal Manchester Children's Hospital in the UK and Yale New Haven Children's Hospital in the US.

The Royal Manchester Children's Hospital, part of Manchester University NHS Foundation Trust is the largest and busiest children's hospital in the UK and the PED sees approximately 50,000 patients per year. The PED at Yale New Haven Children's Hospital sees over 38,000 patients per year. Both hospitals are in geographical areas that went into "lockdown" on March 23, 2020.

The international team compared the differences between weekly attendances and admissions (via the PED) from January 1, 2020, to May 20, 2020 compared with the same period in 2019.

Following lockdown, they found "a striking decrease" in the number of children and young people attending the PED at both hospitals.

Despite this, after lockdown they were up to 60% more likely to be admitted to hospital in 2020 compared to the same period in 2019, suggesting they may have been more unwell by the time they attended hospital.

The researchers said: "These observations likely reflect both a genuine decrease in need (eg, fewer viral infections) but also an increase in delayed and unmet need. Children and adolescents presenting later on in their illness are more likely to have a negative outcome."

"Although the direct effects of COVID-19 currently appear to be less severe in children and adolescents, only time will reveal the indirect negative impacts on this age group, including deaths, because of delayed Paediatric Emergency Department presentation."

They said that fear of COVID-19 was likely to have been a factor in the reduced numbers of under 16s attending hospital PEDs.

"Although not explored here, contributing factors are likely to include the parent or caregiver's fear of the virus, resulting in higher personal thresholds for needing to attend, and will need to be addressed proactively in case of future lockdowns.

"Those with responsibility for making and communicating decisions around lockdown need to be aware of the unintended consequences of pandemic control measures. As a minimum, there needs to be clear and consistent messaging around when it is appropriate to take an ill or injured child to hospital -- emphasising that a PED visit can be made safely -- delivered at the start of any future periods of lockdown."