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During the first 30 months of the COVID-19 pandemic — from March 2020 through August 2022 — serious and potentially preventable illnesses or deaths among children in Ontario, Canada, did not increase significantly, according to a new study.

At the beginning of the pandemic, rates of emergency department visits, hospital admission, and intensive care unit stays remained low, but new diagnoses of cancer and diabetes appeared to be delayed. By spring and summer 2022, hospital admissions for pneumonia and asthma increased, likely due to a longer season for influenza and respiratory syncytial virus and the easing of pandemic restrictions, the authors wrote.

"This is largely a good news story. We did not find many indicators of poor outcomes in the 2.5 years after the beginning of the pandemic, when compared to the previous 3 years," senior author Astrid Guttmann, MDCM, chief science officer and senior scientist at ICES, Toronto, Ontario, Canada, told Medscape Medical News.

"While we hope that we will not have another pandemic or similar crisis, the implications of our study are that strategies put into place in Ontario to ensure continued access to care, such as virtual care, were largely successful in protecting against poor child health outcomes," she added. Guttmann is also a staff physician and senior scientist at the Hospital for Sick Children in Toronto and professor of pediatrics and health policy and public health at the University of Toronto, Toronto, Ontario, Canada.

The study was published online on January 16 in CMAJ.

Diabetes Diagnoses Increased

The investigators conducted a repeated cross-sectional study of hospital use among patients aged 0-17 years in Ontario by analyzing linked population health administrative data and disease registry data for January 2017 through August 2022.

The researchers compared observed monthly rates of emergency department visits and hospital admissions during the first 30 months of the pandemic to predicted rates that were based on the 3 years before the pandemic. They looked at overall outcomes as well as changes among patients with chronic health conditions (such as asthma, diabetes, inflammatory bowel disease, and sickle cell anemia) and specific diseases that are sensitive to delays in care (including those with neurologic impairment requiring technological assistance).

In general, all acute care use decreased immediately at the beginning of the pandemic, reaching the lowest point in April 2020 for emergency department visits (adjusted relative rate [RR], 0.28) and hospital admissions (adjusted RR, 0.43). The decreases lasted until September 2021 for emergency department visits and May 2022 for hospital admissions. Compared with previous years, the overall adjusted RR of emergency department visits and hospital admissions was 0.73 and 0.78, respectively.

During the first 2.5 years of the pandemic, rates generally didn't exceed predicted values for all-cause mortality, admissions for ambulatory care-sensitive conditions (such as pneumonia and gastroenteritis), newborn readmissions, and emergency department visits or hospital admissions among patients with chronic health conditions.

After declining significantly between March 2020 and May 2020, however, new cases of diabetes mellitus increased significantly throughout 2021 and much of 2022, peaking in July 2021. Among these children, there were also more cases of diabetic ketoacidosis than expected, which can be a potentially life-threatening but preventable complication.

Similarly, new cancer diagnoses decreased for the first 3 months of the pandemic and increased for most of 2021, as well as during May through August 2022. At the same time, there wasn't a higher-than-expected incidence of severe cancer overall.

"Our findings around new cases of diabetes highlight the importance of continued public education on signs and symptoms in children that require medical attention, as well as the need for health systems to ensure timely access to primary and emergency care," said Guttmann.

Guttmann and colleagues called for education campaigns aimed at parents and caregivers about these signs and symptoms, as well as ongoing studies of pandemic-related care among children, particularly related to chronic conditions and long-term outcomes.

Continued Surveillance Necessary

Commenting on the findings for Medscape Medical News, Marie-Claude Pelland-Marcotte, MD, a pediatric hematologist and oncologist with CHU de Quebec and assistant professor of medicine at the University of Laval, Quebec City, Quebec, Canada, said, "Concerns have been raised that the COVID-19 pandemic disrupted healthcare-seeking behaviors and access to healthcare, affecting the diagnosis and management of other conditions such as cancer."

Pelland-Marcotte, who wasn't involved with this study, has researched the incidence of childhood cancer in Canada during the first 9 months of the COVID-19 pandemic. She and her colleagues didn't find a statistically significant difference in the incidence of new cancer cases, metastatic disease cases, the proportion of children enrolling in a clinical trial, or early deaths.

"Although these results are reassuring, continued surveillance is necessary to ascertain potential long-term negative effects of the COVID-19 pandemic among children with cancer," she said. "It is possible that fear of COVID-19 dissuaded families with children from seeking care for nonspecific symptoms such as pain, headache, or fatigue, which are typical triggers leading to a pediatric cancer diagnosis."

The study was funded by a Canadian Institutes of Health Research (CIHR) grant and a CIHR Foundation grant. It also was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. Guttmann and Pelland-Marcotte reported no relevant disclosures.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.