• Vol. 50 No. 2, 126–134
  • 01 February 2021

Paediatric emergency department attendances during COVID-19 and SARS in Singapore



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Introduction: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. Methods: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). Results: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January–July 2019, to 274 per day in January–July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January–July 2019 (19,629) to January–July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January–July 2019 and 21% in January–July 2020. Conclusion: Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative cases worldwide and a higher case fatality rate of 11%. While the high transmissibility and broad clinical spectrum of SARS-coronavirus-2 (SARSCoV-2) may render COVID-19 more difficult to eradicate than SARS, stringent physical distancing and hygiene measures are effective in reducing the effective transmission coefficient and associated mortality.

Initial reports of paediatric COVID-19 infection
described a milder course of illness than in adults. In
May 2020, a novel Kawasaki-like shock syndrome
associated with COVID-19, designated as multisystem
inflammatory syndrome in children (MIS-C), was
described in Europe and North America. This severe
paediatric disease phenotype has not been observed in
Asia as yet.

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