key: cord-0727942-71pd79w5 authors: Scheier, Eric; Levick, Nadine; Guri, Alex; Balla, Uri title: The injury-illness dichotomy of COVID-19 on the pediatric ED date: 2021-03-30 journal: Am J Emerg Med DOI: 10.1016/j.ajem.2021.03.086 sha: 65715eefbec99f5c9995cbcfd885ba9766f1d0ec doc_id: 727942 cord_uid: 71pd79w5 nan previous three year average in September ( Figure 2 ). Only 59 PED patients have had positive polymerase chain reaction tests for SARS-CoV-2 through January 31, 2021. Forty three of those cases were recorded after September 1. Injury requiring physician intervention (laceration, dislocation, fracture, open wound) neared the pre-pandemic average from June, and exceeded prior years averages from November through January. Visits for burns were higher than the three year average in six of last eight months. Head injury was higher than average in only three of the first nine months, and 56% higher over the last three months. There was a decrease in the number of visits for minor injury with the exception of December ( Figure 3 ) and an increase in all injury as a percentage of visits throughout the pandemic. Severity of injury seen in the PED increased as well: fractures treated surgically were decreased from average through most of the year before becoming above average toward the end of the pandemic year ( Figure 4 ). The three national lockdowns were characterized by a consistent decrease in infectious disease diagnoses. However, as the lockdowns progressed, we saw an increase in the numbers of injuries when compared to the previous three year average for those periods ( Figure 5 ). Adherence to lockdown may be reflected in the decrease in motor vehicle crash related visits which spanned from 71% over March and April compared to the three year average to only 11% over November through January. Severity of patients' conditions increased as the lockdowns progressed. During the first lockdown, the percent of infectious disease and the percent of fracture/dislocation admitted to the hospital was less than the previous average for that period, roughly equal to the previous average J o u r n a l P r e -p r o o f Journal Pre-proof during the second lockdown, and greater than the previous average during the third lockdown ( Figure 6 ). Recent reports show a sustained decrease in pediatric emergency department (PED) volumes worldwide over the COVID-19 pandemic [1] [2] [3] [4] [5] , characterized primarily by a decrease in presentations for infectious disease [6, 7] , and absence of seasonality [8] . Lack of out-of-home child care is associated with lower incidence of infectious disease [9] , but data from the SARS pandemic showed that school closure did not contribute to control of the epidemic [10] . Data from England shows that infections did increase after returning to school in the Fall, but not at a rate higher than the adult population [11] . Contradictory reports exist for the relationship between out-of-home child care and incidence of injury [12, 13] . Reports early in the pandemic note a decrease of up to 43% in pediatric fractures, mostly due to the absence of organized sports and decreased playground use [14] . A recent report from a large sample of US PEDs shows a similar drop in fractures by 40% from January to June 2020 [15] . Others have reported a decrease of 34% in all injury diagnoses and a 73-77% decrease in minor injury diagnoses early in the pandemic [2, 3, 16] . The majority of Israelis live in apartments with an average size of around 150 square meters, which may not be as suitable for extended play as school. In conclusion, repeated national lockdowns were associated with a sustained decrease in PED presentations for infectious disease compatible with periods of social distancing, and an increase in injuries which may reflect "lockdown fatigue" combined with the lack of organized activity (school and summer camp) during this period. J o u r n a l P r e -p r o o f Trends in US Pediatric Hospital Admissions in 2020 Compared With the Decade Before the COVID-19 Pandemic Infectious disease in pediatric out-of-home child care School Closure During the Coronavirus Disease 2019 (COVID-19) Pandemic: An Effective Intervention at the Global Level? JAMA Pediatr SARS-CoV-2 infections in children following the full re-opening of schools and the impact of national lockdown: Prospective, national observational cohort surveillance Infectious diseases and injuries in child day care. Opportunities for healthier children How safe are day care centers? Day care versus home injuries among children in Norway Admission Rate 2020 Average Admission Rate Admission Rate 2020 Average Admission Rate Admission Rate 2020 Average admission Rate Fracture / Dislocation Infectious Disease