Facing SARS-CoV-2 Pandemic at a COVID-19 Regional Children’s Hospital in Italy

• Published in: The Pediatric infectious disease journal Vol. 39; no. 9; pp. e221 - e225
• Main Authors: Ciofi degli Atti, Marta Luisa, Campana, Andrea, Muda, Andrea Onetti, Concato, Carlo, Ravà, Lucilla, Ricotta, Lara, Reale, Antonino, Barbieri, Maria, D’Argenio, Patrizia, Lancella, Laura, Villani, Alberto, Raponi, Massimiliano
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-09-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Adolescent; Ambulatory Care; Betacoronavirus - isolation & purification; Child; Child, Preschool; Civil Defense; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; Coronavirus Infections - virology; COVID-19; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - statistics & numerical data; Female; Hospitalization - statistics & numerical data; Hospitals, Pediatric - organization & administration; Hospitals, Pediatric - statistics & numerical data; Humans; Infant; Italy - epidemiology; Male; Pandemics; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Pneumonia, Viral - virology; SARS-CoV-2; Tertiary Care Centers - organization & administration; Tertiary Care Centers - statistics & numerical data; Italy
• DOI: 10.1097/INF.0000000000002811
• EISSN: 1532-0987
• ISSN: 0891-3668

BACKGROUND:In Italy, the response to coronavirus disease 2019 (COVID-19) pandemic upgraded from social distancing on February 23, 2020, to national lockdown on March 11, 2020. We described how the pandemic affected a tertiary care children hospital with a dedicated COVID-19 regional center.
METHODS:We analyzed the characteristics of emergency department (ED) visits, urgent hospitalizations and severe acute respiratory syndrome (SARS)-COV-2 reverse transcription-polymerase chain reaction testing, and COVID-19 patients across 3 response phasesbefore the first Italian case, before national lockdown and during lockdown.
RESULTS:ED visits decreased from a daily mean of 239.1 before the first COVID-19 Italian case, to 79.6 during lockdown; urgent hospitalizations decreased from 30.6 to 21.2. As of April 20, 2020, 1970 persons were tested for SARS-CoV-2 reverse transcription-polymerase chain reaction and 2.6% were positive. Positive rates were 1.2% in the ED, 21.1% in the COVID center and 0.5% in other wards. The median age of COVID-19 patients (N = 33) was 6.7 years, 27% had coexisting conditions and 79% were related to family clusters.
CONCLUSIONS:The pandemic strongly impacted on the use of hospital services, with a 67% reduction in ED visits and a 31% reduction in urgent hospitalizations. Separating the flows of suspected patients from all other patients, and centralization of suspected and confirmed cases in the COVID center enabled to control the risk of nosocomial SARS-CoV-2 transmission. Delay in hospital use for urgent care must be avoided, and clear communication on infection prevention and control must be provided to families. Further studies are needed to assess how the reduction in hospital use affected children healthcare needs during the pandemic.