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

This cross-sectional study assesses changes in numbers of pediatric outpatient visits for notifiable infectious diseases acquired through droplet transmission, contact transmission, or both after implementation of coronavirus disease 2019 (COVID-19)–related public health measures during the COVID-19 outbreak in Beijing, China.


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 χ 2 test or Fisher exact test. Two-tailed P < .05 defined statistical significance. All analyses were performed using SPSS version 25.0 (IBM).  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).

Results
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.