ABSTRACT
Background Social distancing policies to reduce transmission of covid-19 also reduced children's exposures to endemic respiratory viruses. We aimed to examine the impact of the covid-19 pandemic on lower respiratory tract infections in under 5s presenting to primary care in England. Methods Longitudinal trends analysis using electronic health records from a nationally representative primary care database. Our target population was children aged <5 years registered with a primary care practice from January 2015 to March 2021. Our main outcome was total weekly contacts with primary care for a lower respiratory tract infection (LRTI). We defined three pandemic phases from March 2020 - March 2021: i) first national lockdown (late March to early June 2020), ii) childcare settings reopened and second national lockdown with schools open (mid-June to mid-December 2020) and iii) third national lockdown with schools closed (late December 2020 to end of March 2021). We compared outcomes during each of the three phases with corresponding calendar weeks during pre-pandemic years 2015 to 2019. Results Our study population included 843 020 children <5 years who had 1 076 181 contacts with primary care for LRTIs. During the first phase (first lockdown) there were falls of 79.3% (95% CI: 73.6 to 84.5) from an average of 28 547 primary care contacts for LRTI in 2015 - 2019 to 5915 in 2020;there was a 78.9% (95% CI: 73.7 to 83.9) fall in phase two (childcare settings reopened and second lockdown) from 107 873 to 22 792 contacts;and a 77.7% (95% CI: 73.5 to 81.4) fall in phase three (third lockdown) from 57 200 to 12 764 contacts. Conclusions Children under 5 in England had fewer contacts with primary care for LRTIs during the covid-19 pandemic. This change likely reflects lower prevalence of respiratory illness due to fewer social contacts. This may impact on future health service use as these children have had less exposure, and therefore may have less immunity, to respiratory diseases. Key messages • Children under 5 had fewer contacts with primary care for lower respiratory tract infections during the covid-19 pandemic in England likely due to the restrictions in place to reduce social contacts. • The falls in lower respiratory tract infections during the covid-19 pandemic in under 5s may mean they have less immunity to respiratory viruses which may impact upon their future health service use.
ABSTRACT
Background: To investigate the outcome (30-day in-hospital mortality, length of stay and readmission within 28 days) of emergency inflammatory bowel disease (IBD) care in the Covid-19 pandemic. To quantify the reduction in provision of IBD investigations and procedures during the pandemic. Methods: Nationwide observational study using administrative data (Hospital Episode Statistics) for England (2015-2020). Autoregressive integrated moving average (ARIMA) forecast models were run to estimate the counterfactual IBD admissions and procedures for February 2020 onwards had the pandemic not occured. Results: Large decreases in attendances to hospital for emergency treatment were noted for both acute ulcerative colitis (UC) and Crohn's disease (CD) (17.4% and 10.3%). The prevalence of concomitant Sars-CoV- 2 infection during the same episode was low for UC and CD [1.7% (247/14,708) and 1.3% (179/14,126), respectively]. All IBD procedures and investigations showed marked decreases in volume to December 2020 compared to the counterfactual estimates. The largest absolute deficits were in lower gastrointestinal endoscopy (16,223, 35.7% reduction), reversal of ileostomy (2,489, 39.7% reduction) and right sided/ileal resection or strictureplasty for Crohn's disease (879, 12.5% reduction). There were no significant clinical differences in case mix or outcome of emergency admission for IBD in the pandemic compared to a historical cohort. Conclusion: There is likely a significant burden of untreated IBD in the community exacerbated by the pandemic based on reductions in emergency IBD care and IBD procedures undertaken in 2020. Patients with IBD may experience significant clinical harm or a protracted decrease in quality of life if care is not prioritised.