Delays in Care for Pediatric Patients Leave Them Vulnerable During COVID-19 Pandemic

Although COVID-19 has been generally considered milder for the pediatric population, pediatricians are still concerned for their patients. And that concern expands beyond the threat of COVID-19.

Recent analyses point to delays in preventive care. Data from the CDC indicate that routine vaccinations are down significantly from 2019, which will leave some children more vulnerable to diseases, including measles, whooping cough, rotavirus and chicken pox. In a survey from the American Academy of Pediatrics, seven in 10 primary care pediatricians reported decreases of 50% or more in preventive care visits, and eight in 10 reported similar declines in sick visits. While some of these visits could be managed via telehealth platforms, the physical exam and routine vaccinations are very important aspects of preventive pediatric visits.

Hospital systems throughout the United States are also reporting dramatic declines in emergency visits for asthma, even in April when respiratory viruses and high pollen levels generally exacerbate symptoms. Others are reporting dramatic declines in visits to ambulatory clinics.

Other countries are experiencing similarly delayed care. In a recent survey of pediatricians in the United Kingdom and Ireland, more than half of respondents who worked in emergency departments witnessed delayed presentations, and 18% of community pediatricians witnessed delayed presentations. Diabetes was by far the most common delayed presentation in emergency care; other diagnoses included sepsis, malignancy and appendicitis.

“A lot of people are understandably and very realistically fearful of going out and interacting with other people, but hospitals are some of the safest places to be right now,” says Karen Murray, MD, Physician-in-Chief of Cleveland Clinic Children’s and President of Cleveland Clinic Children’s Hospital for Rehabilitation. “It’s important to share the message with parents that delaying care can cause more harm than good.”

Ensuring safe care

As pediatricians across the country seek to decrease delays in care, Dr. Murray recommends several steps to encourage patients to return to the medical office, clinic or hospital for care, while keeping them safe. These include:

• Screen everyone who enters your building for symptoms of COVID-19, including temperature. This is a great opportunity to have people use hand sanitizer and remind them to wear a face mask (as well as to provide masks for those who may not bring one).
• Enforce face masking for adults, including all staff and caregivers, as well as adult family members. Pediatric patients should be encouraged to mask as tolerated.
• Move furniture in exam and waiting rooms to allow for greater physical distancing of at least 6 feet between all individuals.
• Enhance cleaning and disinfecting protocols.
• Post signs throughout the building encouraging hand hygiene, reinforcing physical distancing, and encouraging face-mask wearing over nose and mouth at all times.
• Separate the sick from the well. Designate specific locations for COVID-19 testing, with separate entrances and waiting rooms for symptomatic patients.
• Test surgical patients for COVID-19 prior to the procedure.
• Limit nonessential visitors and attendants – friends, siblings and extended family members should stay home.
• Extend hours to accommodate families, including early morning, later in the evenings, and on weekends.
• Communicate with parents in the community through traditional and social media, sharing the message that the hospital is safe and explain what parents and patients should expect when they arrive for care.
• Call families to reschedule in-person visits that were delayed due to COVID-19.
• Encourage patients to get the influenza vaccine when it is available this fall.

“Cleveland Clinic Children’s has taken extra precautions so that we deliver the safe care the way that we usually do, but also with COVID-19 in mind. Everyone who enters our buildings is screened, all caregivers wear masks, and we ask that all adult patients and visitors do the same. Cleveland Clinic Children’s has always been very serious about cleaning, and we’ve increased the frequency of cleaning and disinfection, especially in high-traffic areas. None of our caregivers have contracted COVID-19 from delivering patient care, which is a testament to our cleaning and safety protocols. We are in the process of rescheduling visits that were delayed, and encouraging parents to seek urgent and routine care for their children as needed.

It is important that children get the care they need so they remain well, illness is quickly treated if it develops, and children are not left vulnerable to preventable infections that might slow them down. Children deserve to be children, unencumbered by illness, and at Cleveland Clinic Children’s that is our number one Care.” concludes Dr. Murray.