Impact of COVID19 epidemic and public health response on pediatric IBD presentation in selected NYC institutions

Background: COVID-19 has presented the global medical establishment with innumerable problems in the last year. The disease has a varied presentation, including severe pneumonia, acute respiratory distress syndrome, flu-like symptoms, gastrointestinal disease, and multiorgan failure. Concerning for the field of pediatric gastroenterology is the significant capacity of COVID-19 to generate an immune response which may increase risk of downstream autoimmune disease (Saad et al, 2020, Ehrenfeld et al 2020). Recent case studies have noted new onset UC associated with recent COVID infection (Aydin et al 2020). Interestingly, non-pharmaceutical interventions to prevent COVID-19 have massively decreased the incidence of infectious illnesses (Sullivan et al, 2020) which, if anything, would be expected to drive a decreased incidence of IBD. We have formed a consortium of New York City pediatric institutions aimed at characterizing this change, and here report early findings from three of our member institutions, SUNY Downstate Health Sciences University, Maimonides Medical Center, and New York University. Methods: New IBD diagnoses were identified between 2013-2019, as well as new diagnoses documented between 3/2020 and 3/2021. Data was examined using a direct comparison of new diagnostic rate 3/20-3/21 to mean diagnostic rate from 2013-2019, as well as using a mixed effects epidemiologic model to assess significance of any change. Results: An overall secular increase in IBD diagnostic rate of approximately 5% was noted, consistent with prior findings demonstrating increased incidence of IBD annually (Ye et al, 2020). Direct comparison with mean diagnostic rate over the preceding 7 years noted comparable IBD diagnostic rates in the pandemic year in comparison to pre-pandemic (50 new diagnoses vs. avg 43). Mixed effects modeling suggests a 1/3rd decrease in expected IBD diagnostic rate, although this did not meet the standard for significance. Discussion: Our initial results from three institutions suggest a maintenance of IBD diagnostic rates, despite surveillance data from NYC DOH demonstrating almost nonexistent pediatric influenza-like-illness and a significant decrease in overall pediatric gastroenterology visits. There are many possible confounding factors in this initial work, but this data is suggestive of a possible capacity for COVID19 (which per NYC records infected approximately 5% of the pediatric cohort in the city) to generate new onset IBD. Next steps will include expanding data collection to additional NYC institutions, subgroup analysis by disease type, gender, age of presentation, more detailed analysis of biomarkers, and analysis by borough given geographic variations in COVID19 infection density.