P0594 - Impact of the COVID-19 Pandemic on Pediatric Inpatient Services in a New York City Community Hospital

Introduction
The COVID-19 pandemic of 2020 had caused a significant surge of hospital admissions overwhelming health care systems in China, Italy and Spain. Previous outbreaks such as the 2009 H1N1 influenza pandemic created a similar surge to the pediatric in-patient units. Although there were reports of lower rate of hospitalizations in children, ability to manage hospital capacity was legitimate concern. In anticipation of the surge and in accordance with New York state mandate, the capacity of our pediatric unit was increased by 50%. It is unclear if such a surge would occur in pediatric units.

Objective: The objective of this study is to assess the impact of COVID-19 pandemic on the in-patient services of a NY city community hospital. We postulate that the pandemic may have an opposite effect in decreasing the usual census in pediatric admissions.

Methods
We reviewed the medical records of all pediatric patients (<21 years) admitted to the in-patient unit between February 1st-April 30th, 2020. Records of admitted children for the same period during 2019 were reviewed to serve as historical controls. Data related to patient demographics, length of stay and diagnosis was collected. The results were tabulated into weeks, and the variables compared using the chi-square test with significance at p< 0.05.

Results
There were a total of 272 admissions during the study period in 2019 compared to 194 in 2020 for a decline of 29%. The weekly admission trend with COVID related events is shown in the figure. The steepest decline (80%) occurred around the 7th week when New York state lockdown was initiated. . There were significantly fewer admissions during the month of April compared to the other months (p<0.05). The average length of stay was similar during the study periods and there no statistical association with age, gender or type of diagnosis. The most common diagnoses were status asthmaticus, sickle cell crisis, and dehydration. Nine COVID-19 positive patients were treated during the study period with no COVID related mortalities.

Discussion: Unlike previous pandemics, COVID-19 had the opposite effect of decline in pediatric unit volumes rather than the surge. The declaration of emergency along with the New York pause implemented by the state may have influenced families to stay home rather than seek medical help. School closures, lack of overcrowding and less pollution during the lockdown may have also contributed to the reduction of infectious illnesses injuries and allergic illnesses.

Conclusion
Our pediatric in-patient unit did not experience the anticipated surge during the current COVID-19 pandemic, rather a significant decline in the number of patients. . This led to increasing the patient age to 30 years in the pediatric unit and redeployment of some pediatric staff to other areas in need of help.