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In a study conducted at Cardiff University and the University of Bristol, UK, scientists observed that in England the all-cause infant mortality rate dropped significantly in the first year of the 2019 coronavirus disease pandemic (COVID-19) compared to that of the pre-pandemic year. The greatest reduction in the death rate was observed in children under 10 years of age. The study is currently available on the medRxiv* preprint server.
Background
According to a report released by the National Statistics Department, England, there is a 14% increase in the death rate at the population level in 2020 compared to previous years. A significant proportion of this excess mortality is directly associated with COVID-19-related deaths. However, several other factors related to the pandemic, including saturation of essential health facilities, inaccessibility to essential health care, financial insecurity and emotional distress, can also have potential impacts.
Unlike the population death rate, an overall reduction in infant mortality has been observed across England. However, although susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and severe COVID-19 infection is significantly low in children, the impact of social restrictions and school closures about their mental health is of growing concern.
In the present study, scientists estimated the relative risk of infant mortality in England in the first year of the COVID-19 pandemic compared to previous years.
Study design
Scientists accessed the National Child Mortality Database to collect death reports from all children who died in England between April 2019 and March 2021. To estimate the all-cause mortality rate in the pre-year -pandemic and during the first year of the pandemic, they categorized the death reports collected based on two time periods: April 2019 – March 2020 (before the pandemic) and April 2020 – March 2021 (during the pandemic) .
For each case of death, they analyzed several causative factors, including suicide, substance abuse, trauma, cancer, pre-existing medical conditions, intrapartum events, premature births, infections and sudden unexpected deaths in children.
In addition, they collected information on the sex and ethnicity of the deceased child, age at death, place of death and level of deprivation.
Important Notes
During the entire study period, a total of 6,490 child deaths were reported to the National Child Mortality Database. Of all the deaths, 3,423 occurred in the pre-pandemic year (2019 – 2020) and 3,067 occurred in the first year of the COVID-19 pandemic (2020 – 2021). This indicates a significant reduction in the total number of deaths during the pandemic compared to the previous year.
Throughout the study period, only 70 deaths occurred as a result of a positive test for SARS-CoV-2. Although most of the parameters tested remained similar over two time periods, the number of deaths occurring at home was significantly higher during the pandemic year.
Moreover, the study found that the significant reduction in infant mortality varies with age. Considering the age at death, a comparatively lower mortality of children under 10 years of age was observed during the pandemic compared to that of the previous year. Likewise, considering the month of death, the number of deaths was relatively higher in October, November and December 2019.
Importantly, the reason for death analysis found that the number of deaths related to infection or other pre-existing medical conditions was significantly lower during the pandemic than during the pre-pandemic period. A similar trend was also observed for deaths caused by drug addiction.
Average number of deaths per day (21-day smoothed (arithmetic) average) divided by period. Shaded national confinement periods.
Importance of the study
Overall, the results of the study reveal that all-cause infant mortality in England declines significantly (around 10%) during the initial phase of the COVID-19 pandemic compared to pre-pandemic mortality. This reduction is most pronounced in children under the age of 10 and those with infections or pre-existing medical conditions. It is important to note that a similar decline was observed in children living in the most disadvantaged conditions.
As scientists have mentioned, this reduced mortality could be due to a lack of exposure to seasonal viruses, including influenza virus and respiratory syncytial virus. This change in the exposure pattern may have an impact on the clinical course of otherwise common infections in the years to come when exposure is higher. This, in turn, can alter the rate of infection-related morbidity and mortality in vulnerable children.
Thus, more studies are needed to identify the factors responsible for a reduction in infant mortality.
*Important Notice
medRxiv publishes preliminary scientific reports which are not peer reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.
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