Misc 17/01/2021

Paediatric emergencies plummet due to anti-covid measures

No cases of bronchiolitis have been recorded in Catalonia since the cold weather began

Gerard Fageda Soler
4 min
Una dona surt amb el seu nadó aquest dissabte del servei d'urgències pediàtriques de l'Hospital Sant Joan de Déu de Barcelona

BarcelonaMeasures to prevent the covid spread have ended bronchiolitis, caused mainly by respiratory syncytial virus (RSV), and have caused the number of paediatric emergencies to plummet. The annual epidemic of bronchiolitis, which occurs between November and March, usually peaks during Christmas and Boxing Day and has a high prevalence, especially throughout six weeks. At this time, along with other respiratory infectious diseases, it is the cause of more than half of the country's average paediatric emergencies. Therefore, if last year Sant Joan de Déu hospital (Barcelona) received an average of 600 emergencies per day, this year it has received only around 200. The Germans Trias i Pujol hospital (Badalona), for example, has also gone from recording between 150 and 200 daily emergencies to about 20 or 30. "In 40 years of profession I had never seen this: not a single case of bronchiolitis has been recorded in all of Catalonia", the head of the pediatric emergency service at the Sant Joan de Déu hospital in Barcelona, Carlos Luaces, notes.

In Sant Joan de Déu, ICU and ward bed occupancy has also decreased by up to 40%, since 50% of bronchiolitis cases in children under three months of age are admitted, and 25% if they are between three and six months old. In addition, Luaces adds, although mortality from bronchiolitis is very low, there are quite a few children who require respiratory support - and are therefore admitted to the ICU. "Usually around this time we are forced to postpone scheduled activity", Luaces compares.

The director of pediatrics at the Germans Trias i Pujol hospital, Carlos Rodrigo, points out that the main cause of the decrease in cases of infectious respiratory diseases are the measures that have been taken to prevent the spread of covid, such as physical distancing, face masks, and hydroalcoholic gel. "If children don't wear a mask, it means that we adults pass it on to children", Rodrigo says. Luaces also points out that currently, during the pandemic, when someone has a cold, which is when the virus can be passed on to the child, they will not meet anyone for fear that it will be covid, just as parents do not take children to daycare when they have a cough or a runny nose. In this way, the transmission of RSV is suddenly cut off.

The head of the paediatric service at the Vall d'Hebron hospital in Barcelona, Esther Lera, also points out that, although less decisive, one factor that influences the decrease in paediatric emergencies is that, in our pandemic context, there are parents who think twice before taking their child to the emergency doctor.

In addition, Luaces points out, "it is likely that covid has displaced influenza and bronchiolitis, since the viruses come sequentially throughout the year". In other words, by autumn the prevalence of RSV increases, and when this virus declines the flu increases. Even so, he points out that this theory still belongs in a "purely speculative field and has no academic basis".

The Southern Hemisphere warned them

Lera explains that every year they prepare and organize themselves to receive the avalanche of bronchiolitis cases, but this year colleagues from the southern hemisphere had already warned them that they had no cases. "We were waiting, because here the restrictions were different than they were there, and we didn't expect that there wouldn't be a single case at all" Lera explains, and, despite the experience of countries that had already spent a winter with coronaviruses, says they organized and prepared devices in case bronchiolitis appeared anyway.

Therefore, since there is no RSV, some pediatric centers have been able to help in the fight against covid in adults. During the second wave, the pediatric emergency service of Germans Trias i Pujol moved 80% of its professionals, 40 assistant doctors and 20 residents, to the adult unit of the same center, and even now there are pediatricians working there. "And I think we can still help them more", Rodrigo predicts.

Sant Joan de Déu is also helping to relieve congestion in other hospitals in Barcelona. Luaces explains that this autumn, deliveries were attended and children were admitted who were referred from the Hospital del Mar, among other centers, to provide them with more space and resources to deal with the avalanche of covid cases. In addition, Luaces says they now also have adults in their 30s and 40s with covid in their ICUs.

Will RSV come back?

On the other hand, Lera assures that there are first-year resident doctors who have not yet seen any cases of bronchiolitis and are concerned, since it is a disease that in the future they will surely have to treat in a very recurrent way and they have to know it well. Still, Luaces believes they don't need to worry. "They will have time to see cases of bronchiolitis, unfortunately. When I started working there were a lot of cases of measles and now it is a very rare disease, but I don't think that from one year to the next bronchiolitis will disappear", she predicts.

In the same vein, Lera has doubts that after covid, measures against the spread of infectious respiratory diseases will continue to be prudent and she believes that, unfortunately, bronchiolitis will return. "There are measures that have been shown to work in containing the spread of infection to babies and infants; I'm not saying you should always wear a mask, but if you have a cold you should try to refrain from having contact with children", Lera says. And Luaces adds: "In countries like Japan, which are very careful, especially when they have a cough and mucus, the number of cases of infectious respiratory diseases is a hundred times lower". Rodrigo agrees, adding that since the absence of RSV is a "brutal" anomaly and bronchiolitis only affects infants, 2020 has been "the best year to be born in".