COVID-19 Sparks Research Across CHOP

Children’s Hospital of Philadelphia’s (CHOP) response to the COVID-19 pandemic was swift across the institution — including the CHOP Research Institute.

Here are brief summaries of some of CHOP’s published research:

PolicyLab’s Risk Model Gains National Attention, Use

National leaders and policy makers across the country are referencing CHOP PolicyLab’s COVID-19 model that projects the risk for virus resurgence over the next four weeks depending on several factors not included in other models, such as changes in physical (social) distancing, weather and population density.

David Rubin, MD, MSCE, director of PolicyLab, and his team update the model weekly, accounting for how aggressive communities have been with reopening.

“I’m encouraged to see that our models have been accurate — that as we predicted, if communities took a slow and cautious approach to reopening they were able to do so without igniting exponential case growth,” Rubin says. “However, we found that many places moved too quickly to reopen without the necessary precautions around masking and distancing to do it safely, and we find ourselves in a dangerous situation as a second wave of COVID-19 seems to be sweeping the country.”

Learn more about the model, see the most updated data and check if your community is among the 500 counties included.

PolicyLab also collaborated with CHOP’s Division of Infectious Diseases to compile emerging evidence and considerations for local jurisdictions and school administrators to consider when planning for school reopenings and to ensure that children with disabilities are receiving the care they need during the pandemic.

Total Number of Fractures Down, But More Happen at Home

Physical distancing measures due to COVID-19 have led to a nearly 60% decrease in pediatric fractures, but an increase in the proportion of fractures sustained at home, a recent CHOP study in the Journal of Pediatric Orthopaedics found.

Some examples of these at-home fractures include bicycle and trampoline injuries, highlighting the need for heightened awareness of safety measures even for recreational activities close to home.

“It is important to remind parents about the importance of basic safety precautions with bicycles and trampolines, as many children are substituting these activities in place of organized sports and school activities,” says orthopaedic surgeon Apurva Shah, MD, MBA, a senior author of the study that compared fracture data from March-April 2020 the same months in 2019 and 2018.

Families Skipping Routine Vaccines During Pandemic

A CHOP study published in Morbidity and Mortality Weekly Report found a decline in childhood vaccination coverage during the COVID-19 pandemic.

Researchers used data from the Michigan Care Improvement Registry (Michigan’s immunization registry) to evaluate vaccination status of children at milestone ages 1, 3, 5, 7, 16, 19 and 24 months. They assessed an average sample of 9,269 children for the study years 2016 to 2019, and 9,539 patients for 2020. The study team found that up-to-date vaccination status declined for all age groups, from approximately two-thirds of children from May 2016 to 2019, to approximately half of children in May 2020.

“Providers should use their electronic health records to identify children who have missed recommended vaccinations and work with families to schedule in-person appointments. Otherwise, we run the risk of outbreaks in the community,” says Angela Shen, ScD, MPH, visiting scientist at the Vaccine Education Center and co-author of the study.

ED Visits for Asthma Drop by Three-Quarters

The number of patients visiting the emergency department (ED) for asthma treatment dropped by 76% in the first month of the COVID-19 pandemic, according to a CHOP study published in the Journal of Allergy Clinical Immunology: In Practice.

The proportion of ED visits that led to a patient being hospitalized also decreased over this period, suggesting the decrease in overall visits was not solely due to patients avoiding the hospital due to the pandemic or delays in care for less serious asthma events.

CHOP — which sees nearly 6,000 asthma patients in its ED every year, more than 2,000 of whom require hospitalization — compared data from the first 4 months of 2016 to 2019 to this year. They also compared the mean daily asthma ED visits from January 1 to March 18, 2020, before mandated social distancing measures went into effect, to the mean number of visits from March 19 to April 18, 2020.

In the pre-pandemic period, an average of 24 patients visited the ED for asthma treatment each day, similar to the prior 4 years. After March 19, when the City of Philadelphia implemented a stay-at-home order, the average number of asthma-related ED visits dropped to fewer than 6 per day.

“The COVID-19 pandemic and associated policies have had a dramatic impact on the number of patients we are seeing in the ED with asthma exacerbations,” says Chén C. Kenyon, MD, MSHP, a general pediatrician and first author of the study. “These results may offer new insights on where to best focus efforts to improve asthma outcomes.”

Telehealth Effective, Safe for Neurology Patients During Pandemic

When COVID-19 forced the cancellation of visits to the doctor’s office, the Division of Neurology at CHOP swiftly moved encounters to telehealth and then surveyed neurologists and patients/parents about their satisfaction with the change.

Overwhelmingly, both givers and receivers of care via telehealth were satisfied with the telehealth visits, either by telephone (496) or video (2,093), authors report in the journal Neurology, marking the first time telehealth had been studied in pediatric neurology patients.

Other results: 40% of encounters had some sort of technical glitch; 5% of patients were referred for an in-person follow-up visit; and racial and ethnic minority groups were more likely to have to do a telephone appointment instead of an audio-video telemedicine visit for reasons such as a lack of access to a computer, suggesting that the inequity between groups needs to be properly addressed moving forward.