The impact of National Containment Measures on a Pediatric Italian regional Hub for COVID-19, an observational study

Abstract

Background: Numerous studies described the epidemiological link and main clinical features of pediatric COVID-19, during the first pandemic period. Our study encompasses several different phases since the National Lockdown in Italy. The primary outcome is (I) to analyze the prevalence of positive NST (Nasopharyngeal Swab Test) among the largest Italian Pediatric cohort admitted to a single regional PED Hub for COVID-19 during an eight-month period. Secondary outcomes are: (II) the description of trend of admissions in our PED and (III) the categorization of the positive patients according to clinical manifestations and epidemiological link.

Methods: We described 316 patients with a positive NST for SARS-CoV2, on a total of 5001 nasopharyngeal swabs performed among 13,171 admissions at our PED, over a period starting from March 17th, 2020 to December 1st, 2020. Age, epidemiological link, clinical features and hospitalizations were analyzed according to different lockdown phases. Data were collected anonymously from electronic records and analyzed using SPSS 22.00 statistics software (Chicago, IL).

Results: Thirty-six percent of total admissions have been tested. During the post lockdown period, we performed the highest percentage of NST (Nasopharyngeal Swab Test) 49.7%, and among them 7.9% were positive. The prevalence of infection during a 10-month period was 2.3%. Mean age was 6.5 years old. Familial Link accounted for the 67.7% of infection, while Extrafamilial and Unknown link accounted for 17 and 14.9%, respectively. Familial link is predominant during all phases. Seventeen patients showed an intra-scholastic link, and the highest prevalence was observed in the 7-10 years age group, with a prevalence of 12.8% (5 patients). Fever was the most frequent symptom (66%), in particular among preschooler children aged 0-6 years (71.9%). Older children were more frequently symptomatic. Seven patients were admitted with MIS-C diagnosis.

Conclusions: Different levels of containment measures caused important changes in number of positive NST for SARS-CoV2. Familial link was predominant in our cohort, during all phases of Lockdown. The risk of being infected at home is four time greater than the risk of being infected from an extra familial individual. Further studies are needed to evaluate the clear impact of intra-scholastic link. The constant improvement in knowledge on onset symptoms and risk factor for SARS-CoV2 infection and its complications (e.g. MIS-C), can impact on number of hospitalizations, ICU admissions and early management.

Keywords: COVID-19; Children; Emergency department; Pediatric; SARS-CoV 2.

Fig. 1

This figure shows the trend of admissions in our PED in three different years. PED = pediatric emergency department

Fig. 2

a In this figure it is shown the total number of NST per Lockdown phase. Total admission (N): National Lockdown: 1157, Phase 2: 1586, Phase 3: 5435, Phase 4: 3775, New Containment Measures: 1750. Total NST (N): National Lockdown: 358, Phase 2: 425, Phase 3: 1478, Phase 4: 1879, New Containment Measures: 860. Tot Admissions = total admissions, tot NST = total nasopharyngeal swab test, N = number of patients, % = percentage. We have found P < 0.05 for all the variables and trends through categories (ANOVA with post HOC analysis). b In this figure it is shown the trend of NST effectuated during the different Lockdown phases. Positive NST (N): National Lockdown: 12, Phase 2: 5, Phase 3: 24, Phase 4: 24, New Containment Measures: 125. N = number of patients. NST = Nasopharyngeal Swab Test. % = percentage. We have found P < 0.05 for all the variables and trends through categories (ANOVA with post HOC analysis)