FEWER RESPIRATORY ADMISSIONS IN COVID‐19 ERA

Abstract

Thankfully none of 3686 children under the age of 18 in Australia with proven COVID-19 has died.1 Despite little acute illness in children due to COVID-19, we have witnessed extraordinary changes in the case mix of in-patient children managed at Gold Coast University Hospital (GCUH) during 2020. We conducted an audit of the registrar handover sheets used for the daily report and compared 01 May to 31 July 2020 to the corresponding period of 2019. We assessed the number of admissions and average length of stay (ALOS) for respiratory and mental health admissions. The results are shown in Table 1. The most obvious finding was a dramatic reduction in respiratory admissions with 101 fewer respiratory admissions and a 77% reduction in the average number of acute respiratory patients each day from 5.8 to 1.2 patients each day in 2020. Notable changes included a large drop in bronchiolitis, pneumonia, and upper respiratory infection admissions. The reduction in respiratory infection is consistent with the drop in influenza cases in Australia from 106 000 between 01 May to 31 July 2019 to just 642 in 2020.2 Another contributor has been the collapse of tourism, with a 97% reduction in arrivals to Gold Coast Airport from May to July 2019 from 1 530 000 to 50 000 in 2020 meaning interstate children have not required admission to GCUH.3 A troubling finding was a doubling of cases of children requiring acute in-patient care for eating disorders (EDs). Children admitted with EDs in 2020 also required an increased ALOS. Each day in 2020 we saw almost three times as many children acutely unwell with EDs compared to 2019. We speculate that the increase in stress and anxiety in the broader community has affected our teenage children on the Gold Coast and led to an increase in the number of severe EDs requiring hospitalisation.4 In addition, many mental health services were temporarily closed and moved to online during these months. These changes in service accessibility may have contributed to children with EDs being sicker at the time of admission. EDs during adolescence can be associated with a lifetime morbidity and mortality. We need to support the mental health of our children to ensure the broader impacts of the COVID-19 crisis, such as this apparent increase in severe EDs, are minimised.