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Figure.  Daily Number of Pediatric Outpatient Visits and Patients With Notifiable Infectious Diseases, Beijing Chao-Yang Hospital Western Branch, in 88 Days Since January 19 in 2019 and 2020
Daily Number of Pediatric Outpatient Visits and Patients With Notifiable Infectious Diseases, Beijing Chao-Yang Hospital Western Branch, in 88 Days Since January 19 in 2019 and 2020

The COVID-19 outbreak was from January 19 to April 15, 2020, and the 2019-matched period was from January 19 to April 16, 2019. COVID-19 indicates coronavirus disease 2019.

Table.  Characteristics of Pediatric Outpatients With Notifiable Infectious Diseases During the COVID-19 Outbreak and a 2019-Matched Perioda
Characteristics of Pediatric Outpatients With Notifiable Infectious Diseases During the COVID-19 Outbreak and a 2019-Matched Perioda
1.
Wu  Z, McGoogan  JM.  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.   JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648PubMedGoogle ScholarCrossref
2.
De Filippo  O, D’Ascenzo  F, Angelini  F,  et al.  Reduced rate of hospital admissions for ACS during Covid-19 outbreak in northern Italy.   N Engl J Med. 2020;383(1):88-89. doi:10.1056/NEJMc2009166PubMedGoogle ScholarCrossref
3.
Kutter  JS, Spronken  MI, Fraaij  PL, Fouchier  RA, Herfst  S.  Transmission routes of respiratory viruses among humans.   Curr Opin Virol. 2018;28:142-151. doi:10.1016/j.coviro.2018.01.001PubMedGoogle ScholarCrossref
4.
World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: interim guidance. Published March 17, 2020. Accessed May 25, 2020. http://www.who.int/publications/i/item/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
5.
McMichael  TM, Currie  DW, Clark  S,  et al; Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team.  Epidemiology of Covid-19 in a long-term care facility in King County, Washington.   N Engl J Med. 2020;382(21):2005-2011. doi:10.1056/NEJMoa2005412PubMedGoogle ScholarCrossref
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    Research Letter
    Public Health
    August 24, 2020

    Assessment of Pediatric Outpatient Visits for Notifiable Infectious Diseases in a University Hospital in Beijing During COVID-19

    Author Affiliations
    • 1Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
    • 2Department of Infection and Disease Control, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
    • 3Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
    • 4Department of Clinical Research and Epidemiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen City, China
    JAMA Netw Open. 2020;3(8):e2019224. doi:10.1001/jamanetworkopen.2020.19224
    Introduction

    In response to coronavirus disease 2019 (COVID-19), strict public health measures were implemented, and medical resources were enhanced to isolate and treat infected patients.1 Yet little is known about whether other types of hospital visits have been affected,2 especially visits for infectious diseases. We explored changes in pediatric outpatient visits for Chinese notifiable infectious diseases acquired through droplet transmission, contact transmission, or both during Beijing’s COVID-19 outbreak.

    Methods

    We performed a cross-sectional study at Beijing Chao-Yang Hospital Western Branch in Beijing that followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. The study was approved by the ethics committee of Beijing Chao-Yang Hospital, which waived the requirement for informed consent.

    Using the hospital’s electronic medical records and notifiable diseases surveillance system, we identified all pediatric outpatient visits during the COVID-19 outbreak (January 19–April 15, 2020) and a matched control period in the previous year (January 19–April 16, 2019) and collected demographic and diagnostic information on patients with notifiable infectious diseases. During the COVID-19 outbreak, all febrile patients underwent nucleic acid testing of nasal and pharyngeal swab specimens to rule out COVID-19. The primary outcomes were the number of pediatric outpatient visits, number of pediatric patients with notifiable infectious diseases, and proportion of pediatric patients with notifiable infectious diseases in pediatric outpatient visits. We compared continuous variables with the Mann-Whitney U test and median differences, coefficient intervals, and categorical variables with the χ2 test or Fisher exact test. Two-tailed P < .05 defined statistical significance. All analyses were performed using SPSS version 25.0 (IBM).

    Results

    A total of 2420 pediatric outpatient visits (median patient age, 4 [interquartile range, 2-6] years; 1325 [55%] male) were identified during the COVID-19 outbreak, an average of 28 per day, compared with 14 557 and 165, respectively, in 2019 (ie, an 83% decrease; Figure, panel A). Thirty-four patients with notifiable infectious diseases were reported during the outbreak, an average of 0.4 per day, compared with 383 and 4.3, respectively, in 2019 (ie, a 91% decrease; Figure, panel B). The proportion of patients with notifiable infectious diseases in pediatric outpatient visits (difference, –1.2%; 95% CI, –1.7% to –0.6%; P < .001), especially the proportion with influenza (difference, –1.3%; 95% CI, –1.8% to –0.8%; P < .001), was significantly lower during the outbreak than in 2019.

    Demographic and diagnostic characteristics are summarized in the Table. The sex distribution was similar between the 2 periods (difference, –3.1%; 95% CI, –19.5% to 13.9%; P = .73), but the median age was younger during the outbreak (difference, –1 year; 95% CI, –2 to 0 years; P = .004). No pediatric patients with COVID-19 were confirmed in this hospital.

    Discussion

    We found a decrease in pediatric outpatient visits for notifiable infectious diseases in a university hospital in Beijing during the COVID-19 outbreak. Except for scarlet fever (transmitted only via droplet) and acute hemorrhagic conjunctivitis (transmitted only via contact), the notifiable diseases studied, especially influenza, infect people via either droplet or contact transmission.3 Strict implementation of public health control measures in response to COVID-19 might have inhibited droplet and contact transmission of common infectious viruses.4 Guardian fear of contracting COVID-19 in the hospital may be a reason for the reduced number of outpatients.5 However, the reduced proportion of patients with notifiable infectious diseases confirms that these diseases were somewhat contained during the COVID-19 outbreak, especially given that febrile patients are required to seek urgent medical care.

    Limitations of this study include the single-center design, the use of retrospective data, and the possibility that not all patients were identified. However, because the study took place in a traditional university hospital, the main findings might be representative of the actual number of pediatric patients with notifiable infectious diseases in Beijing. Also, these findings highlight the importance of public health measures for controlling infectious diseases.

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    Article Information

    Accepted for Publication: July 23, 2020.

    Published: August 24, 2020. doi:10.1001/jamanetworkopen.2020.19224

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Luo Z et al. JAMA Network Open.

    Corresponding Author: Yingmin Ma, MD, Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Rd, Shijingshan District, Beijing 100043, China (mayingminicu@126.com).

    Author Contributions: Dr Ma had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Luo and N. Li and Ms S. Li contributed equally to the study.

    Concept and design: Luo, Ma.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Luo, S. Li, Zhang.

    Critical revision of the manuscript for important intellectual content: Luo, N. Li, Y. Li, Cao, Ma.

    Statistical analysis: Luo, N. Li, Y. Li.

    Obtained funding: Luo, Ma.

    Administrative, technical, or material support: S. Li, Zhang, Cao, Ma.

    Supervision: Ma.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: The study was funded by the National Key Research and Development Program of China (2019YFC0121700 [Dr Ma]), Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (XMLX201709 (Dr Ma]), and Beijing Hospitals Authority Youth Programme (QML20180303 [Dr Luo]).

    Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Additional Contributions: We thank Yi Zhang, PhD (Beijing Center for Disease Prevention and Control), for informational support. Dr Zhang received no compensation for this contribution. We also thank the medical and nursing team in the pediatric outpatient department of Beijing Chao-Yang Hospital Western Branch for risking their lives to care for patients during the coronavirus disease 2019 outbreak.

    References
    1.
    Wu  Z, McGoogan  JM.  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.   JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648PubMedGoogle ScholarCrossref
    2.
    De Filippo  O, D’Ascenzo  F, Angelini  F,  et al.  Reduced rate of hospital admissions for ACS during Covid-19 outbreak in northern Italy.   N Engl J Med. 2020;383(1):88-89. doi:10.1056/NEJMc2009166PubMedGoogle ScholarCrossref
    3.
    Kutter  JS, Spronken  MI, Fraaij  PL, Fouchier  RA, Herfst  S.  Transmission routes of respiratory viruses among humans.   Curr Opin Virol. 2018;28:142-151. doi:10.1016/j.coviro.2018.01.001PubMedGoogle ScholarCrossref
    4.
    World Health Organization. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts: interim guidance. Published March 17, 2020. Accessed May 25, 2020. http://www.who.int/publications/i/item/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
    5.
    McMichael  TM, Currie  DW, Clark  S,  et al; Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team.  Epidemiology of Covid-19 in a long-term care facility in King County, Washington.   N Engl J Med. 2020;382(21):2005-2011. doi:10.1056/NEJMoa2005412PubMedGoogle ScholarCrossref
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