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The UNC School of Medicine’s Zachary Willis, MD, MPH, co-authored an editorial published in the British Medical Journal in conjunction with new research that shows dramatic reductions in hospital admissions for common and severe childhood infections in England during the pandemic.

CHAPEL HILL, NC – Since the onset of the COVID-19 pandemic, there have been dramatic reductions in hospital admissions for common and severe childhood infections in England, most likely due to social distancing measures, school and workplace closures, and travel restrictions, finds a study published in the British Medical Journal (BMJ). In an accompanying editorial in the BMJ, Zachary Willis, MD, MPH, assistant professor of pediatric infectious disease at the UNC School of Medicine, suggests that some of these precautions can be utilized routinely in the future to decrease the spread of sickness and minimize the burden on health systems.

Worldwide, the indirect effects of COVID-19 on children’s health appear to be substantial. For instance, childhood immunization programs have been disrupted and emergency department visits have been delayed, but the impact of such delays on patient outcomes is unclear.

To address this, researchers based at Oxford University assessed hospital admission rates and mortality outcomes for 19 common childhood respiratory infections, severe invasive infections, and vaccine preventable diseases before and after the onset of the pandemic in England. Common respiratory infections included tonsillitis, influenza and bronchiolitis, while severe invasive infections included sepsis, meningitis and osteomyelitis (bone infection). Vaccine preventable diseases included measles, mumps and several bacterial causes of serious illnesses.

In the 12 months after March 1, 2020, substantial and sustained reductions in hospital admissions were found for all but one of the 19 infective conditions studied. Among the common respiratory infections, the greatest percentage reduction was for influenza where the number of hospital admissions decreased by 94%. For bronchiolitis, admissions decreased by more than 80%. Among the severe invasive infections, percentage reductions ranged from 26% for osteomyelitis to 50% for meningitis. And for the vaccine preventable infections, reductions ranged from 53% for mumps to 90% for measles.

Reductions were similar across all geographical regions, deprivation and ethnic groups, as well as among children with existing conditions who are at greatest risk of severe illness and death from infection. These findings also support and expand data from the United States showing major decreases in childhood respiratory viruses.

As such, the researchers conclude that a range of behavioral changes (adoption of non-drug interventions like wearing masks and physical distancing) and societal strategies (school closures, lockdowns, and restricted travel) used to reduce transmission of SARS-CoV-2, also reduced admissions for common and severe childhood infections in England.

These findings probably reflect a real decrease in non-COVID infections, but in the editorial, Willis and his fellow author say the decrease is likely to be temporary.

As populations derive increasing protection from COVID-19 through natural infections or vaccination, and measures such as lockdowns, mask mandates, and physical distancing ease, “there will probably be an increase in the incidence of primarily, but not exclusively, viral infections,” they write.

While many of the measures taken to reduce the spread of COVID-19 are generally unsustainable outside of the pandemic because of their inherent negative financial and societal impact, Willis suggests some could be continued, especially during winter months to minimize the burden on health systems and protect vulnerable children.

“Unfortunately, some measures, including school closures, came with significant social and economic costs that are likely to increase health disparities,” Willis said. “Understanding which mitigation strategies were most effective is key to reopening safely. For example, compared with other interventions, school closures probably had a minor role in controlling COVID-19, while universal mask wearing appears to contribute substantially to reducing SARS-CoV-2 transmission within schools. Future research should evaluate whether low-cost interventions without lockdowns and school closures can also help to blunt major outbreaks of seasonal infections like influenza and RSV.”

Understanding which mitigation strategies were most effective is key to reopening safely, and as many measures are relaxed globally, they call for studies to determine which interventions provide the greatest benefit for a wide range of infectious diseases.