The coronavirus disease 2019 (COVID-19) has caused unprecedented morbidity and mortality across the globe. However, the influence of COVID-19 mitigation strategies such as social distancing, facemask use, hygiene and sanitation campaigns, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing on pediatric deaths has not been well-characterized.

In a recent study published on the medRxiv* preprint server, researchers in the United States assess quantitative pediatric lives saved due to non-pharmacological interventions (NPIs) during COVID-19 waves among United States residents.

 Study: An estimate of pediatric lives saved due to non-pharmacologic interventions during the early COVID-19 pandemic. Image Credit: Monkey Business Images / Shutterstock.com

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

About the study

In the present study, researchers evaluate the impact of NPI implementation on pediatric mortality during the COVID-19 pandemic.

The team modeled excess deaths among pediatric U.S. residents less than nine years of age using data on month-wise mortality between 2015 and 2019, as well as the annual population between 2014 and 2019. Monthly estimated deaths from natural or medical causes, non-natural or external causes, and any-cause death during the COVID-19 pandemic from March 2020 onward were also projected.

Estimates were obtained by combining those for small age groups younger than one year, one to four years, and five to nine years. To project expected deaths, seasonal autoregressive integrated moving average (SARIMA) modeling was performed, and estimates between January 2015 and February 2020 were used.

For each month, the originally projected population for less than one year, one to four years, and five to nine years groups were defined. Mortality causes were based on the International Classification of Diseases, tenth revision (ICD-10) codes.

Medical causes included particular infectious and parasitic diseases, neoplasms, hematological diseases, specific immunological, circulatory, metabolic, nutritional, and endocrinal diseases, as well as psychiatric disorders and nervous system disorders.

Ophthalmic disorders, auditory and mastoid disorders, respiratory disorders, digestive disorders, dermatological diseases, musculoskeletal diseases, genitourinary diseases, particular perinatal conditions, and congenital anomalies were also included.

External causes of death included transport accidents, accidental injury from other causes, intentional self-injury, assault, undetermined intent events, legal interventions, and war operations, medical and surgical complications, and sequelae of external morbidity and mortality causes.

Study findings

During the initial COVID-19 wave, a 7% reduction in natural-cause deaths was observed among children aged between zero and nine years of age, 5% among infants below one year of age, and 1% among those between one and nine years of age.

In total, 1,488 medical-cause deaths were averted among children aged less than nine years, and 1,938 deaths were avoided in those over two years of age. The expected winter surge in medical cause-associated deaths, especially among children over one year of age, was not observed. However, minor increments in external deaths were observed, thereby reducing pediatric lives saved throughout the COVID-19 pandemic.

A 5% reduction in medical mortality in the initial year was observed among infants below the age of one, whereas a 16% reduction was observed in children between one and four years of age. Furthermore, 187 fewer deaths were reported in children aged five to nine years, which reflects a 13% reduction. Among children aged one to nine years, 539 fewer deaths due to medical causes were noted during the initial COVID-19 wave, which was a 15% decrease.

In relative terms, the largest reductions in deaths due to medical causes and any cause occurred in December of 2020 among infants aged below one year of age. For children aged one to four years, the largest reductions occurred in the last month of 2020 for any- and medical-cause deaths by 18% and 11%, respectively.

For children aged five to nine years, the largest reductions occurred in the last month of 2020 for any-cause deaths and in March of the same year for medical-cause deaths by 27% and 19%, respectively. Mortality associated with common infections was lower than usually expected, and age-wise variations were noted in alterations in the leading causes of mortality.

There was an increase in external deaths, mainly among older children. Non-traffic-associated accidental trauma was the most commonly reported external cause of death.

In the second COVID-19 period, when few NPIs were relaxed, reductions in medical- and any-cause deaths were lowered; however, excess external deaths were reported. An increase in pediatric deaths from COVID-19 was also reported during the period.

The any-cause observed/expected ratios in the pandemic period among those less than one, one to four, five to nine, one to nine, and zero to nine years of age were 0.97, 0.98, 1.0, 0.98, and 0.97, respectively.

For medical causes, the observed/expected ratios in the corresponding groups were 0.96, 0.92,0.92, 0.92, and 0.96, respectively. For external causes, the observed/expected ratios in the corresponding groups were 1.03, 1.06, 1.11, 1.08, and 1.06, respectively.

Conclusions

NPIs led to 1,468 fewer any-cause deaths and 1,938 fewer medical-cause deaths; however, 470 more deaths from external causes among children over nine years of age in the initial two years of the pandemic were reported.

COVID-19 mitigation strategies prevented the expected upsurge in deaths due to medical causes during the winter season between December 2020 and March 2021. Unlike medical-cause deaths, seasonal patterns for external-cause deaths remained undisturbed by COVID-19 mitigation measures and were significantly greater than expected.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.