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Life & Times

COVID-19, primary care, and paediatrics: winter is coming

James Hibberd and Roshni Mistry
British Journal of General Practice 2020; 70 (698): 450. DOI: https://doi.org/10.3399/bjgp20X712385
James Hibberd
Islington, London. Email:
Roles: GP
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  • For correspondence: james.hibberd@nhs.net
Roshni Mistry
North Middlesex University Hospital, London.
Roles: Paediatric ST4
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Children are unlikely to get sick, need hospitalisation, or die from COVID-19.1 This is a demonstrable fact that has been well known since the very first data sets to come out of China.2 Infrequently is data so clear cut. Medicine and disease, however, are rarely so simple. Schools re-opening combined with the approaching winter viral season will inevitably lead to an increase in paediatric infections. In the current climate new barriers to health care, namely fear of COVID-19 and the lack of easily accessible face-to-face GP appointments, are likely to result in late presentations with non-COVID-19 illnesses and increased harm. We need to start planning to prevent this.

FEAR OF THE VIRUS

The media and, to a certain extent, the medical profession have increased anxiety both among parents and GPs about the dangers of COVID-19 in children. The media’s publication3 of a very small number of children developing PIMS-TS, a multisystem inflammatory disorder similar to Kawasaki disease,4 has caused understandable anxiety among parents. Similarly the relentless focus on concerns about opening schools has led some parents to conclude it is not safe, resulting in poor attendance.5

During previous viral outbreaks, such as the H1N1 scare, evidence showed that presentations to medical services went up when the initial ‘fear’ was publicised.6 During this pandemic, however, the opposite has happened. A&E attendances in the UK have significantly reduced; by 33% in June 2020 compared to the previous year.7

The climate of fear has had severe consequences. A group of increased deaths and significant harm were reported in North London recently, many of these caused by a delayed presentation to hospital.8

BARRIERS TO PRIMARY CARE

There is scant evidence that remote assessments are effective in acute paediatrics.

Under pre-COVID-19 circumstances children often attended A&E when their care could have been more effectively managed in primary care.9 Easy access to a GP has been shown to reduce presentations to A+E by 9%.10 Primary care, then, should offer a potential alternative to A&E during this period.

Unfortunately, COVID-19 has created a situation in general practice where there is, in appearance at least, a reluctance to see patients face-to-face.11 This is especially the case if they are ‘hot’ with potential COVID-19 symptoms. This problem will be amplified as childhood respiratory viruses, with their associated ‘hot’ symptoms, begin to rise due to a combination of seasonal winter peaks12 and increased social mixing between children.13

A PERFECT STORM

This combination of factors may create a perfect storm, with parents scared to attend A&E due to concerns about COVID-19 coupled with a reluctance of GPs to see ‘hot’ patients and potentially delivering substandard care over the telephone. This could result in delayed presentations similar to those seen in North London but on a much larger scale.

Immediate action is needed to consider how we deal with the surge in ‘hot’ paediatric patients this winter. We need to make it clear to parents that GPs and A&E are open for business and create a safe, easily accessible system by which children can be seen face-to-face to minimise any risk of increased harm.14

Footnotes

  • This article was first posted on BJGP Life on 23 July 2020: https://bjgplife.com/winter

  • © British Journal of General Practice 2020

REFERENCES

  1. 1.↵
    1. Public Health England (PHE)
    Disparities in the risk and outcomes of COVID-19PHE2020
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    1. Qijun G,
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    3. Zhiguo MM D,
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    The epidemiological characteristics of 2019 novel coronavirus diseases (COVID-19) in Jingmen, Hubei, ChinaMedicine20209923e20605
    OpenUrl
  3. 3.↵
    1. Roberts M
    Coronavirus alert: rare syndrome seen in UK childrenBBC News202027Aprhttps://www.bbc.co.uk/news/health-52439005 (accessed 5 Aug 2020).
  4. 4.↵
    1. Riphagen S,
    2. Gomez X,
    3. Gonzalez-Martinez C,
    4. et al.
    Hyperinflammatory shock in children during COVID-19 pandemicLancet20203951023716071608
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Coughlan S
    Coronavirus: primary schools back but mixed picture on turn-outBBC News20201Junhttps://www.bbc.co.uk/news/education-52854688 (accessed 5 Aug 2020).
  6. 6.↵
    1. McDonnell WM,
    2. Nelson DS,
    3. Schunk JE
    Should we fear “flu fear” itself? Effects of H1N1 influenza fear on ED useAm J Emerg Med2012302275282
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. NHS England
    A&E attendances and emergency admissions May 2020 statistical commentary2020https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/06/Statistical-commentary-May-2020-jf8hj.pdf (accessed 5 Aug 2020).
  8. 8.↵
    1. Cohen D,
    2. Newman M
    Coronavirus: sick children hospital treatment ‘hit’ during pandemic — leaked emailBBC News202010Aprhttps://www.bbc.co.uk/news/uk-52239183 (accessed 5 Aug 2020).
  9. 9.↵
    1. NHS Digital
    The NHS Long Term PlanNHS Digital2019
  10. 10.↵
    1. Cecil E,
    2. Bottle A,
    3. Cowling TE,
    4. et al.
    Primary care access, emergency department visits, and unplanned short hospitalizations in the UKPediatrics20161372e20151492
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    1. Thornton J
    Covid-19: how coronavirus will change the face of general practice foreverBMJ2020368m1279
    OpenUrlFREE Full Text
  12. 12.↵
    1. Public Health England (PHE)
    Six major respiratory viruses reported from PHE and NHS laboratories (SGSS) in England and Wales between week 1, 2010 and week 18, 2020PHE2020
  13. 13.↵
    1. Ball TM,
    2. Holberg CJ,
    3. Aldous MB,
    4. et al.
    Influence of attendance at day care on the common cold from birth through 13 years of agePediatr Adolesc Med20021562121126
    OpenUrl
  14. 14.↵
    1. McKinstry B,
    2. Hammersley V,
    3. Burton C,
    4. et al.
    The quality, safety and content of telephone and face-to-face consultations: a comparative studyQual Saf Health Care2010194298303
    OpenUrlAbstract/FREE Full Text
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British Journal of General Practice: 70 (698)
British Journal of General Practice
Vol. 70, Issue 698
September 2020
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COVID-19, primary care, and paediatrics: winter is coming
James Hibberd, Roshni Mistry
British Journal of General Practice 2020; 70 (698): 450. DOI: 10.3399/bjgp20X712385

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COVID-19, primary care, and paediatrics: winter is coming
James Hibberd, Roshni Mistry
British Journal of General Practice 2020; 70 (698): 450. DOI: 10.3399/bjgp20X712385
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