Social Distancing Tied to Reduced Child Hospitalizations for Non-COVID Respiratory Illness

By Linda Carroll

November 04, 2020

(Reuters Health) - Social distancing measures introduced in the spring of 2020 in Massachusetts to combat SARS-CoV-2 may have reduced other respiratory illness requiring hospitalization among children, a small study suggests.

When compared to the same March-April period during four previous years, the number of children admitted to the Boston Children's Hospital for asthma, bronchiolitis and pneumonia during five weeks in spring 2020 was markedly lower, according to the report published in Pediatrics.

"Our study found that overall hospitalizations at Boston Children's Hospital declined considerably during the onset of the COVID-19 pandemic as social distancing measures were put into place," said the study's lead author, Dr. Jayme Wilder, a pediatric hospitalist at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School.

"We found that hospitalizations from conditions associated with viral illnesses, such as bronchiolitis and asthma, were significantly down, while hospitalizations associated with conditions not usually thought to be viral, such as UTIs and skin infections, didn't change," Dr. Wilder said in an email. "While it is hard to prove causality, the main takeaway is that social distancing measures may help reduce hospitalizations, at least for children. As COVID-19 cases rise and we enter flu and respiratory virus season this winter this becomes increasingly important."

Dr. Wilder and his colleagues analyzed electronic medical records from the Boston Children's Hospital.

Children hospitalized on medicine services - excluding surgery, neurology and cardiology - during the selected five weeks were included in the study. The researchers chose three diagnoses - asthma, bronchiolitis and pneumonia - as surrogates for viral illnesses. They also looked at three diagnoses - cellulitis, gastroesophageal reflux disease and urinary tract infection - that should not be impacted by social distancing.

In the COVID-era cohort, there were 339 hospitalizations, as compared with 3,292 in the cohort from the years 2016 to 2019 (an average of 823 per year). Median overall hospitalizations per week were significantly lower in the COVID-era cohort (64 per week) compared with the earlier cohort (166 per week).

There were fewer of the three diagnoses associated with viral illness in 2020 compared with the averages in the pre-COVID years: asthma, 3 vs 8.5; bronchiolitis, 1 vs 7; pneumonia, 2 vs 6.5. For the other three non-respiratory diagnoses, however, researchers found no significant difference between 2020 and the previous years.

Although kids are less likely than adults to be hospitalized for COVID-19 infections, "social distancing is still important for kids," said study coauthor Dr. Chase Parsons, a pediatric hospitalist at Boston Children's Hospital and an instructor of pediatrics at the Harvard Medical School. "If our healthcare system is again pushed to its limits and adult patients begin to fill pediatric beds, it will be essential to encourage all actions that can be taken to reduce hospitalizations across the board."

One weakness of the study is that it did not look directly at diagnoses of viral infections, said Dr. John Williams, chief of the division of pediatric infectious diseases at UPMC Children's Hospital of Pittsburgh and director of the Institute for Infection, Inflammation, and Immunity in Children (i4Kids). Other limitations are that it contains information from just five weeks at a single center, added Dr. Williams, who wasn't involved in the study.

Nevertheless, Dr. Williams said, "it's a very nice study that suggests if we do mitigation with masks and social distancing this winter, we will see not only less COVID-19, but also less influenza and less metapneumovirus. A secondary implication is that if we did more mask, social distancing and hand hygiene, it could reduce asthma and bronchitis in adults."

Dr. Aaron Milstone agreed that more, larger, studies are needed.

With that said, "it totally makes sense that the things we are doing to protect against COVID-19 will protect against most of the other respiratory viruses," Dr. Milstone said. "Anecdotally, I have talked to doctors at other children's hospitals and it does appear even now that we are in the fall, hospitalization rates are lower."

SOURCE: Pediatrics, online November 3, 2020.