Avoidance of essential pediatric ambulatory medical care due to corona-phobia: Incidence and suggested practical interventions

Objective: Although international attention is focused on the direct effects of the coronavirus disease 2019 (COVID-19), the healthcare consequences of inadequate medical care of non–Covid-19-related diseases should also be considered. We therefore aimed to describe the indirect effects of the COVID-19 epidemic on pediatric ambulatory healthcare associated with fear from Covid-19.

Methods: Epidemiologic data on number of visits to a multidisciplinary outpatient clinic, which provides care for children with chronic illnesses, were collected during a two-month period of the COVID-19 outbreak. The characteristics of patients whose avoidance of planned visits resulted in an adverse health consequence were described.

Results: During the study period, a 34% decrease in ambulatory care visits was seen, compared with the corresponding period in 2019. Forty patients avoided a scheduled essential visit. After staff intervention 36 were rescheduled and received essential care, however, four patients (4/1200 total visits, 0.33%) with a median age of 8.5 years (range: 2.5-18) remained unconvinced and avoided the visit. Their background illness included DiGeorge syndrome, Parry-Romberg syndrome, uncontrolled epilepsy and Crohn disease. Despite good compliance to follow-up prior to the outbreak, all avoided an essential outpatient visit that resulted in worsening of their chronic medical condition. Their shared reason for no-show was the fear of contracting Covid-19.

Conclusion: This series highlights the possible adverse health outcomes among chronic pediatric patients resulting from accessibility barriers posed by the fear of Covid-19. It provides another important aspect of the overall health impacts of the COVID-19 pandemic that requires targeted interventions.