Caring for Children With Medical Complexity in the Early COVID-19 Pandemic in an Ambulatory Primary Care Setting.

Allison Driansky,Sophia Jan,Mariecel Pilapil,Sheri Feigenbaum,Kristina Bianco,Anna Yang,Caren Steinway

doi:10.3389/fped.2022.813393

Abstract

BackgroundChildren with medical complexity (CMC) have multiple chronic conditions and require a high level of coordinated healthcare. The risk of COVID-19 among CMC is unclear.ObjectivesWe aim to identify and describe the prevalence and experience of COVID-19 among CMC and their caregivers during the initial weeks of the COVID-19 pandemic in the NY metropolitan area.MethodsWe performed a cross-sectional study of children enrolled in a structured clinical program for CMC at a large urban, academic general pediatrics practice in NY.ResultsIn our patient population (n = 132), 16 patients had a known exposure with parents being the most common exposure in 37.5% (n = 6). Two patients were hospitalized for COVID-19 while the remainder of the confirmed or suspected COVID-19 cases were managed as an outpatient.ConclusionsCommon sources of COVID-19 exposure were family members and home care providers. Almost all of our patients experienced interruption of medical care including missed therapies and visits.

Highlights

The COVID-19 pandemic caused by severe acute respiratory syndrome (SARS-CoV2) is a major health crisis affecting all aspects of society
While COVID-19 infection in the pediatric population appears to have a mild course in comparison to adults, children are still vulnerable to infection and complications [1, 2]
No studies have yet evaluated the effect of COVID-19 on the Children with medical complexity (CMC) population, CMC are generally at higher risk for developing respiratory complications due to factors such as chronic lung disease, impaired airway clearance, and ventilatory support at baseline, likely putting them at increased risk for morbidity

Summary

Introduction

The COVID-19 pandemic caused by severe acute respiratory syndrome (SARS-CoV2) is a major health crisis affecting all aspects of society. Children with medical complexity (CMC) have multiple chronic conditions affecting many organ systems and require a high level of coordinated healthcare [3]. No studies have yet evaluated the effect of COVID-19 on the CMC population, CMC are generally at higher risk for developing respiratory complications due to factors such as chronic lung disease, impaired airway clearance, and ventilatory support at baseline, likely putting them at increased risk for morbidity. CMC typically require multiple therapists, home nurses or home health aides, and case managers, increasing the number of individuals they are exposed to and subsequently their risk of exposure to COVID-19. Missed primary care and sub-specialty appointments due to the COVID-19 pandemic may disproportionately affect CMC, who require significantly more health resources and coordinated healthcare than the general pediatric population. Children with medical complexity (CMC) have multiple chronic conditions and require a high level of coordinated healthcare.

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