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
Aims Covid testing and primary care data for Children and Young People (CYP) has not yet been linked at the national level in England. However, such linkage has been established using the Discover Whole System Integrated Care (WSIC) database in Northwest London (NWL). We describe pattern of primary care utilisation, among CYP of 0 - 24 years of age in NWL before and after testing positive for Covid-19 infection. The insights are needed in understanding the impact of Covid-19 infection on both the patient and the health care system. Methods We conducted a retrospective cohort study using routinely collected primary care health care data in NWL from the Discover WSIC de-identified database. It is a local warehouse of electronic patient records for research, the database is de-identified. Four cohorts were studied to represent CYP at various key Covid-19 vaccination focused age groups of 0-4 years, 5-11 years, 12-15 years and 16-24 years. Their GP events 180 days preceding and following the confirmed PCR positive test result were analysed. GP events were counted as number of distinct days with one recorded activity. Results By 16th February 2022, positive PCR results were obtained for 104,702 CYP, 14% (d=745,268) of registered CYP population in NWL. The frequency of GP events in the first seven days of the post-test period was similar to the frequency in the seven days preceding, however outside this period they differed substantially, from 279 per 1,000 pre-test to 92 per 1,000 post-test. The 16-24 year age group showed the largest decrease at 150 to 180 days after a confirmed positive PCR test result, from 1,290 GP events pre-test to 195 post-tests. There was no increase in GP events for any age group from two weeks post confirmed PCR positive test. Conclusion Our analyses showed that there is evidence of increase GP activity by CYP a week before and after a Covid- 19 infection diagnosis. However, we did not find any evidence at population level of prolonged post Covid-19 infection symptoms for which GPs were contacted.
ABSTRACT
Aims: The covid-19 pandemic has brought many challenges to medical training and education. Clinical guidelines are an important resource especially for redeployed healthcare professionals (HCPs) to manage diabetes emergencies. Our aim is to understand how non-specialist HCPs prefer the diabetic ketoacidosis (DKA) and hyperosmolar hyper-glycaemic state (HHS) guidelines to be presented to improve accessibility and adherence. Methods: An online survey was conducted in January 2021, using a QR code to access the survey via digital platforms including email, posters and MS teams. Results: Among the 101 responders, 42% were core-medical or trust-grade doctors, 22% foundation year 1 doctors, 17% higher specialty trainees and the remainder nurses, healthcare assistants, pharmacists and consultants. Despite online access to national-based trust diabetes guidelines, only 17% of surveyed HCPs were confident in prescribing and administering treatment for DKA or HHS. 92% responders had managed DKA or HHS more than once in the last 6 months. Despite the majority (88%) knowing where to access the current guidelines, only 13% of prescribing responders followed the guideline in prescribing regular basal insulin with fixed-rate intravenous insulin infusion. 88% preferred a pre-printed proforma of the guideline with examples of model prescriptions. Most useful features rated were flowcharts (76%), checklists (72%), criteria for escalation (62%) and model prescriptions (58%). Guidance on fluid management, especially in renal and heart failure, was most frequently requested. Conclusions: An online survey with QR code access has facilitated a good response and has allowed diabetes emergency guidelines to be tailored to the needs of non-specialists during the covid-19 pandemic.