Children of the Pandemic – less likely to be infected but more likely to suffer mental health issues, report of 1000 GP practices warns

Only 2% of children who contract COVID-19 are admitted to hospital.  While COVID-19 appears to have less effect on children, a comprehensive analysis of data from more than 1000 general practices in NSW and Victoria since the beginning of the pandemic has shown that it is having a profound impact on the health of Australians under 19 including:

  • An almost complete eradication of the usual Winter infective diseases like influenza, bronchiolitis and gastroenteritis, due to social distancing and school closures
  • A significant and sustained increase in anxiety, depression and eating-disorder related diagnoses – probably associated with job losses and a change in future educational and employment opportunities

The real-time reporting program was led by Monash University Adjunct Professor Chris Pearce, using data from the POLAR system produced by Outcome Health of more than 1,000 GP practices in NSW and Victoria – representing a significant percentage of the Australian populace.

The study outlines the profound public health, social and economic consequences to young people of the pandemic who, while relatively unscathed by the actual illness, are impacted in other ways, according to the report.

The general practices in the study extend from central Sydney down to Wingello and Bundanoon in rural NSW and, in Victoria, include a predominantly rural (Gippsland) and two urban (Eastern Melbourne and South East Melbourne) regions, the areas covered by five Primary Health Networks.

The data helps Primary Health Networks (PHNs) provide assistance to practices in responding to rapid change. The program was first developed to respond to the bushfire crisis – with the first data collections happening from 1 January.

For children under the age of 14, the first wave of cases was largely in NSW, occurring predominantly in Sydney during April. The second wave was focused in children in the north and west of Melbourne, in line with similar data in adults.

Of interest in the data is that during the second wave in Victoria there was a steady drop off in children between 0 and 9 years old seeing a GP for non-COVID related issues. According to Associate Professor Pearce, this trend was not seen in patients over the age of 9. “This may be due to a reduction in total illness burden in this age group. Children are staying out of childcare, kindergarten and school and getting less communicable illnesses,” he said.

This was mirrored by a reduction in the prescribing of antibiotics to this age group, “which would normally be used for infections like a strep throat,” he added.

The second wave (15 April to 11 August) showed similar prescribing patterns to the first wave, prior to 15 August. Compared to the same time in 2019, antibiotic use is down by 35%. “We are simply not seeing the usual “Winter Rise” in antibiotic use in children that we normally see,” Associate Professor Pearce said.

The move to telehealth has seen a dramatic reduction in children attending clinics, with an associated drop off in overall consultations in the 0-5 age group.

Immunisation rates increased rapidly for weeks 13 to 20 (25 Mar to 19 May) which coincided with a public program encouraging influenza immunisations.

Respiratory Illness presentations to GPs in NSW and Victoria were, in some weeks, almost wiped out. The seasonal Autumn/Winter peak of bronchiolitis which typically affects infants and young children “did simply not occur,” the report said, with only 10% of the usual infections seen in weeks 16 to 24 (14 April – 16 June) which coincided with the period between the first and second wave.

Even though the incidence of respiratory illness in this age cohort has risen since then it remains at only half of the equivalent period last year. “While this reduction may be due to clinics closing, it's likely that social distancing is reducing overall viral transmission rates in the community,” Associate Professor Pearce said.

Gastroenteritis is generally a communicable viral disease– Although usually more prominent in summer, we have seen rates drop from week 14 (1 April) onwards at 50% of last year’s levels – and have remained down.

Mental health issues have increased in children of all ages including anxiety, depression, and eating disorders. Although small in number, the rises are significant.

Anxiety-related diagnoses 0-19 years rose steadily and were almost double that of 2019 at week 30 (28 July – when the stage 4 restrictions started). There was a similar peak around the time that Victoria and NSW started to ease restrictions after the first wave, which are likely due to fears of increasing social contact.

Similar patterns were seen with depression-related illnesses in 0-19 year olds, with a peak at week 30, double that of the year before.

Eating disorders saw a significant and sustained increase from week 13 onwards (25 March) with a doubling of diagnosis rates.

The prescription of oral contraceptives has been higher than in previous years though there is no increase in teenage pregnancy or STDs.

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