Overall, we see greater percentage reductions in visits to A&E for children and young people (aged 0–19) than we do in adults.
The difference is particularly striking for visits relating to illnesses. We see, on average, a 30% reduction in visits for adults, compared with 62% for children and young people. We can also see visits for illness for children and young people fell more sharply than those for adults and are returning to normal levels more slowly.
There is greater variation between age groups for visits relating to injury. We see greater reductions in visits for school-aged children (5–19 years of age) than for other age groups, and visits for this group remain far below normal.
Why are we seeing greater reductions in visits to A&E for children and young people?
The factors driving reductions in visits for children and young people fall under the same broad categories we have discussed in previous blogs. These are:
- Policy choices made in order to create capacity for COVID-19 patients or to protect non-COVID patients and staff.
- Changes in patient behaviour, in this case the behaviour of children and young people, and their parent or guardian.
- Changes in the prevalence of some conditions.
However, the underlying disease burden for children and young people is different to that of adults, and social distancing measures may have led to different lifestyle changes across age groups.
The next section explores how these factors, in addition to the three drivers above, may have led to the reductions in children and young people using A&E.
There has been greater reduction in infections
Schools, colleges and nurseries were closed to the majority of pupils on 20 March 2020, just prior to the national lockdown. This meant a move to home schooling for the vast majority of school-aged children, and a significant reduction in interaction with their peers. These social distancing measures have been effective not only in reducing COVID-19 cases, but also in stopping the spread of other infectious diseases.
We reported previously that there have been reductions in visits to A&E for infectious diseases and respiratory conditions, and that this is likely to be indicative of a reduction in the number of new infections.
We know that, in general, infections are a major driver of childhood visits to A&E. In a subset of major A&E departments in the first 20 weeks of 2019, 65% of visits for illness for people younger than 20 years of age fall under three diagnosis groups where infections are likely triggers for visits (compared with 42% for all age groups). These proportions did not vary significantly for the same period in 2020.