Impact of the COVID-19 pandemic on pediatric inpatient servicesin a new york city community hospital

ABSTRACT

Introduction The COVID-19 pandemic of 2020 had caused a significant surge of hospital admissionsoverwhelming health care systems in China, Italy and Spain. Previous outbreaks such as the 2009 H1N1influenza pandemic created a similar surge to the pediatric in-patient units. Although there were reports oflower rate of hospitalizations in children, ability to manage hospital capacity was legitimate concern. Inanticipation of the surge and in accordance with New York state mandate, the capacity of our pediatric unitwas increased by 50%. It is unclear if such a surge would occur in pediatric units. Objective: The objective ofthis study is to assess the impact of COVID-19 pandemic on the in-patient services of a NY city communityhospital. We postulate that the pandemic may have an opposite effect in decreasing the usual census inpediatric admissions. Methods We reviewed the medical records of all pediatric patients (<21 years) admittedto the in-patient unit between February 1st-April 30th, 2020. Records of admitted children for the same periodduring 2019 were reviewed to serve as historical controls. Data related to patient demographics, length of stay and diagnosis was collected. The results were tabulated into weeks, and the variables compared using the chi-square test with significance at p< 0.05. Results There were a total of 272 admissions during the study periodin 2019 compared to 194 in 2020 for a decline of 29%. The weekly admission trend with COVID related eventsis shown in the figure. The steepest decline (80%) occurred around the 7th week when New York statelockdown was initiated. . There were significantly fewer admissions during the month of April compared to theother months (p<0.05). The average length of stay was similar during the study periods and there no statisticalassociation with age, gender or type of diagnosis. The most common diagnoses were status asthmaticus,sickle cell crisis, and dehydration. Nine COVID-19 positive patients were treated during the study period withno COVID related mortalities. Discussion: Unlike previous pandemics, COVID-19 had the opposite effect ofdecline in pediatric unit volumes rather than the surge. The declaration of emergency along with the New Yorkpause implemented by the state may have influenced families to stay home rather than seek medical help.School closures, lack of overcrowding and less pollution during the lockdown may have also contributed to thereduction of infectious illnesses injuries and allergic illnesses. Conclusion Our pediatric in-patient unit did notexperience the anticipated surge during the current COVID-19 pandemic, rather a significant decline in thenumber of patients. . This led to increasing the patient age to 30 years in the pediatric unit and redeploymentof some pediatric staff to other areas in need of help.