Relationship between national changes in mobility due to non-pharmaceutical interventions and emergency department visits due to pediatric acute respiratory infections during the COVID-19 pandemic.

BackgroundStrong social distancing measures were quickly implemented in Chile during the SARS-CoV-2 outbreak. One of the aims of non-pharmaceutical interventions (NPI) mandates was to decrease overcrowding, thus is usually measured as mobility changes. Methodswe gather data from national health statistics for pediatric emergency (PED) visits for acute respiratory infection (ARI) in children younger than 15. We defined a historical cohort, including data from 2016 to 2019, and compared them with 2020 and 2021 pandemic years. Also, Chiles national mobility reports from the online google database were downloaded. We tested the correlation between changes in mobility and relative reduction in PED-ARI by Spearmans Rank Test. ResultsHistorical data showed a mean of 46863 {+/-} 3071 PED-ARI weekly visits with a high seasonal variation, with two peaks in weeks 20 and 28 and weeks 32 to 36. This transient drop was temporally associated with the mid-winter 2-week holiday of schools. The usual PED visits peaks did not occur in 2020 and 2021. Mobility declined from week 9, reaching lower than historical data from week 12 and a minimum of 43% in week 15 of 2020 (Figure 1). O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=124 SRC="FIGDIR/small/22276017v1_fig1.gif" ALT="Figure 1"> View larger version (19K): org.highwire.dtl.DTLVardef@1999627org.highwire.dtl.DTLVardef@50ff2aorg.highwire.dtl.DTLVardef@1a0393borg.highwire.dtl.DTLVardef@d69f1_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 1.C_FLOATNO Variables analyzed per epidemiological week. (A) pediatric emergency visits for acute respiratory infections (PED-ARI) in Chile. Historical cohort, 2015-2019 average, and consecutive weeks of pandemic, 2020 and 2021. (B) Variation between historical cohort and consecutive weeks of the pandemic, 2020 and 2021, for PED-ARI; (C) National mobility variation per epidemiological week during 2020 and 2021. (0) First COVID-19 case in Chile; (1) Mandatory School closure (2) Partial quarantines in high incidence counties; (3) National Catastrophic Disaster declaration; (4) total quarantine in major urban areas; (5) DELTA variant identified in Chile; (6) Universal Vaccination for > 16 yo; (7) Vaccination for > 12 yo; (8) Non-mandatory in-person schooling; (9) Sanitary passport for vaccination proof in >17 yo; (10) Vaccination for children 12-17 yo; (11) Vaccination for children 6-11 yo; (12) Sanitary Passport for children (12-17 yo); (13) Omicron first case in Chile; (14) Vaccination for children 3-5 yo. C_FIG The correlation between mobility and PED-ARI visits showed a strong monotonic relationship (quadratic) with a Spearmans rho of 0.80 (95% CI 0.75 to 0.86) (Figure 2). O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=53 SRC="FIGDIR/small/22276017v1_fig2.gif" ALT="Figure 2"> View larger version (14K): org.highwire.dtl.DTLVardef@a6546corg.highwire.dtl.DTLVardef@1f08804org.highwire.dtl.DTLVardef@71f2e5org.highwire.dtl.DTLVardef@101a1d8_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 2.C_FLOATNO Correlation between national change in mobility (%) and the relative reduction in pediatric emergency department visits for acute respiratory infections (D PED-ARI). Spearmans Rank Test, Spearmans rho of 0.80 (95% CI 0.75 to 0.86). C_FIG ConclusionNPI resulting in a decrease in mobility should be considered a robust public health measure to relieve the winters collapse of the national health system, decreasing morbimortality in children due to PED-ARI. WHATS KNOWN ON THIS SUBJECTA remarkable decrease in pediatric respiratory infections has been described during the pandemic, although the causes are still poorly understood. WHAT THIS STUDY ADDSIn a historical cohort before the pandemic, we observed a temporal association between mid-winter holidays and the gap between the two peaks of acute pediatric respiratory infections. We found a strong correlation between national mobility changes due to non-pharmaceutical interventions and acute pediatric respiratory infections during the pandemic. Therefore, timely implementation of non-pharmaceutical interventions might be considered as a robust public health measure to attenuate the seasonal epidemic of non-COVID viral acute respiratory infections. With these data, we wonder if the time has come to implement non-pharmaceutical interventions to mitigate the stress, and frequently collapse, of national health systems due to the increase in pediatric acute respiratory infection, placing children as a priority, and provide the best care to this vulnerable population.