key: cord-0900557-27j6ht8h
authors: Wakabayashi, Tomohiro; Sasaoka, Yuta; Sakai, Yoshiyuki; Hinotsu, Shiro; Kawasaki, Yukihiko
title: Decrease in unscheduled pediatric outpatient visits due to SARS‐CoV‐2
date: 2021-11-01
journal: Pediatr Int
DOI: 10.1111/ped.14748
sha: 4556a1051412054597a2e8d424597e0f3d2e8e5c
doc_id: 900557
cord_uid: 27j6ht8h

nan

the activity of pediatric practice is defined in a complex way. In 2020, the number of unscheduled outpatient visits decreased from March to July compared with the corresponding periods in the previous 4 years (Fig. S1 ). From March to July, 2020, all units experienced a decrease in unscheduled appointments below lower À2SD from 2016 to 2019, except Rumoi in the northern area in June (Table 1) . This significant decrease in visits could have an effect on healthcare policy to support pediatric practices. We suggest that there were two reasons for the reduction in outpatient visits. First, people refrained from visiting hospitals. They were not able to assess which hospitals accepted SARS-CoV-2 patients, and might have avoided any hospital as a potentially risky place for exposure to the disease. The fear from COVID-19 pandemic resulted in delayed diagnosis and higher complication rates in common pediatric medical conditions. 2 Second, the occurrence of other infectious diseases was reduced as the restrictions on normal daily activities curbed their spread. Preventive measures instituted for SARS-CoV-2 such as hand washing, wearing a mask, and avoiding close contact curbed the spread of any infectious disease; social distancing also reduced the spread of influenza and respiratory syncytial virus. 3, 4 The decrease in outpatient visits in January and February varied by regions. We believe that SARS-CoV-2-related decrease in outpatient visits occurred since March because the state of emergency was declared on February 28, 2020; almost all regions showed a marked decrease from March. The results of this study may have an effect medical staffs and health policy-makers. An investigation of medical billing by the Ministry of Health, Labor, and Welfare found a 50% decrease in medical charges of pediatric departments from February 1 to May 31, 2020 compared with the corresponding periods in the previous 2 years. 5 A decrease in the number of pediatric medical staff may result in scaling back the activities of the pediatric department or even closure of the pediatric clinic. Methods must be found to change the medical care system before collapse occurs. Health policymakers need to take countermeasures and economically support pediatric practices to avoid a collapse in the pediatric community health system. We have not analyzed any potential confounding variables such as a decrease in child population and outpatient visits. Residual confounding by unmeasured factors is also likely to exist. Our study did not specifically study the reasons for people decreasing hospital visits and whether the spread of other infectious diseases was suppressed.

In conclusion, we confirmed that the number of unscheduled pediatric outpatient visits decreased in Hokkaido during the spread of SARS-CoV-2. There is concern about the impact of this decrease in visits on the pediatric medical system due to a decrease in financial income. Future research on these topics would be helpful to understand the public's behavior during a pandemic.

A novel coronavirus from patients with pneumonia in China

Delayed access or provision of care in Italy resulting from fear of COVID-19

Effectiveness of workplace social distancing measures in reducing influenza transmission: a systematic review

Effect of social distancing due to the COVID-19 pandemic on the incidence of viral respiratory tract infections in children in Finland during early 2020

Tokyo: Ministry of Health, Labor and Welfare

We gratefully acknowledge the support provided by Toshiya Sato (Department of Pediatrics, Iwamizawa City General Hospital, Iwamizawa, Japan), Masatoshi Tatsumi 

The authors declare no conflict of interest.

T.W., Y.S, and Y.S contributed to the conception and design of this study. T.W., Y.S, and Y.S performed the statistical analysis and drafted the manuscript. H.S. supervised statistical aspects of this manuscript. Y.K. critically reviewed the manuscript and supervised the whole study process. All authors read and approved the final manuscript.

This study was approved by the ethical board of Hakodate Municipal Hospital, Hokkaido, Japan (August 11, 2020, No. 2020-55).

Additional Supporting Information may be found in the online version of this article at the publisher's web-site: Table S1 . The comparison of the scale of the hospital, the characteristics of the area, and the specialty of the institution