Fewer Milwaukee kids seen by doctors
Health care experts say they are seeing troubling trends as fewer children get regular checkups during the coronavirus pandemic. And those trends, they fear, could lead to fewer immunized children and chronic health conditions in kids that are not caught.
As more children go without primary wellness visits, indicators of chronic disease, important lab tests and immunizations — which are often required for kindergarten and day care enrollment — could be missed, said Dr. Margaret Hennessy, a physician at Ascension All Saints Hospital in Milwaukee.
Two indicators are especially concerning: an expected drop in the number of children being immunized on schedule and a decrease in the number of kids being tested for lead levels in the blood.
These are examples of the pandemic’s “unintended consequences” as fear of COVID-19 discourages people from seeking routine medical care, Hennessy said.
Immunization rates are expected to drop precipitously
Between the ages of birth and 3, it’s recommended that children receive immunizations for diphtheria, tetanus, and whooping cough (DTap); polio; measles, mumps, and rubella (MMR); Hib meningitis, pneumonia and pericarditis (Hib); hepatitis B (HepB); chickenpox (Var); and pneumonia (PVC immunizations). Some of these require multiple shots over a set schedule. But the pandemic changed things. A report in May examining immunization data from Michigan found that recommended vaccinations had dropped from two-thirds of children to less than half.
Angela Shen, a scientist at Children’s Hospital of Philadelphia at the Vaccine
Education Center and a retired captain in the U.S. Public Health Service, co-authored the report, which was published by the Centers for Disease Control and Prevention.
The report looked at the state’s immunization registry — the closest thing to real-time immunization data available.
The U.S. is not the only country facing this challenge, with researchers like Shen projecting that immunization rates will show a serious dip by next year. In fact, the World Health Organization and UNICEF released a joint pamphlet detailing statistics and concerns about low immunizations.
According to the City of Milwaukee, immunization rates are comparable to what they were the previous year — 60% in 2020 versus 62% in 2019. But Shen said that’s no reason to feel reassured.
“It doesn’t mean that you’re doing pretty OK because it matches last year’s numbers because all those (children) that missed their shots, they are not counted this year,” Shen said.
While she understands the fear caused by the pandemic, Hennessy said primary care clinics are some of the safest places to go. “I think there was a perception that we shut down because it was a dangerous place, but that was so we could shift our resources and reconfigure our spaces,” she said.
Among the precautions clinics are taking: Mask requirements, carefully scheduled visits, socially-distanced waiting rooms, stringent exam room cleanings and the use of different entrances and exits for sick patients.
Children who miss immunizations may not be fully protected against diseases, Hennessy said.
“If you look back at this area and the pandemic hitting in March (and) you haven’t been to the doctor in that long, you have missed out on a lot of vaccines,” she said. “For a lot of the childhood vaccines that we give to infants and young children, you’re not fully protected until you finish the series.”
And getting behind on a vaccination schedule makes it harder for children to get back on track, she said, which puts not only them but also immunocompromised people — children with weak immune systems or people going through cancer treatments — at risk as well.
“Vaccines don’t just protect you, they protect the community that you live in,” Shen said. “Low coverage in your community means your community is vulnerable to outbreaks of vaccine-preventable diseases.
“Keeping up with immunizations is not just about getting them, but getting them on time.”
Lead testing is down
While concerns about immunization rates are only now beginning to rise, Milwaukee’s problematic levels of lead are well known.
Helen Meier, an assistant professor of epidemiology at the University of Wisconsin-Milwaukee’s Zilber School of Public Health, said that part of the danger with lead is that it can show up in different forms, including paint dust and chips, contaminated soil and water contaminated from lead-lined pipes.
With more children staying inside due to the pandemic, there could be more exposure.
Lead poisoning is usually detected in blood tests, which Meier described as “snapshots in time.” According to the City of Milwaukee’s health department, the number of lead tests for children ages 6 and under has gone from 20,849 in 2019 to 15,937 in 2020.
The drop in tests means that any spike in lead levels might be missed along with the chance to identify the source.
Iron-rich foods and iron supplements can help push lead out of the body, but early detection of lead poisoning allows parents to discover and eliminate sources of lead and prevent longterm harm, Hennessy said.
“Lead is the kind of thing where it can get high without any symptoms and if you don’t know, you can’t intervene,” she said. “It impacts a lot of different organs, and the most worrisome part of that is how it impacts children’s brains that are still developing.”
In general, Hennessy said that waiting to take your children — or anyone — in for primary care wellness visits is “very risky.”
“Most people aren’t going to have bad things happen to them. But we have our wellness schedules set up to catch things ... that may be missed until you’re very sick, such as diabetes or heart murmurs,” she said. “Those are things where you’re not going to know something’s wrong until it’s too late.”