• Pediatric Infection and Vaccine
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• v.29 no.3
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• pp.131-140
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• 2022

Purpose: Since the coronavirus disease 2019 (COVID-19) pandemic began, new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged, and distinct epidemic waves of COVID-19 have occurred for an extended period. This study aimed to analyze the clinical and epidemiological characteristics of children with COVID-19 from the third wave to the middle of the fourth epidemic wave in Korea. Methods: We retrospectively reviewed the medical records of hospitalized patients aged ≤18 years with laboratory-confirmed COVID-19. The study periods were divided into the third wave (from November 13, 2020 to July 6, 2021) and the fourth wave (from July 7 to October 31, 2021). Results: Ninety-three patients were included in the analysis (33 in the third and 60 in the fourth waves). Compared with the third wave, the median age of patients was significantly older during the fourth wave (6.7 vs. 2.8 years, P=0.014). Household contacts was reported in 60.2% of total patients, similar in both periods (69.7 vs. 55.0%, P=0.190). Eighty-one (87.1%) had symptomatic SARS-CoV-2 infection. Among these, 10 (12.3%) had no respiratory symptoms. Anosmia or ageusia were more commonly observed in the fourth epidemic wave (10.7 vs. 34.0%, P=0.032). Most respiratory illness were upper respiratory tract infections (94.4%, 67/71), 4 had pneumonia. The median cycle threshold values (detection threshold, 40) for RNA-dependent RNA polymerase (RdRp) and envelope (E) genes of SARS-CoV-2 were 21.3 and 19.3, respectively. There was no significant difference in viral load during 2 epidemic waves. Conclusions: There were different characteristics during the two epidemic waves of COVID-19.

• Health Policy and Management
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• v.34 no.1
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• pp.38-47
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• 2024

Background: Korea's population of children and adolescents has decreased by 2.88 million over the past decade and is expected to decline further due to the unprecedented low birth rate. In the fee-for-service compensation system, the decline in the pediatric population relates directly to the profit decrease in the pediatric clinics. This study analyzed whether the worsening profits of pediatric clinics impacted their closure. Methods: We built annual data for pediatric and other department clinics (internal medicine, otolaryngology, and family medicine) using the status of medical institute and health insurance claims data from 2012 to 2022. Then, we analyzed whether institutional variables such as annual profit and regional variables (Herfindahl-Hirschman index, the number of clinics per 100,000, etc.) affected the closure of clinics. The methods used in this study are descriptive statistics and chi-square analysis. Odds ratios for each variable were estimated by generalized estimating equations (GEE). Results: The closure rate of pediatric clinics was 2.66%-7.04% in 2012-2022, which was consistently higher than those of internal medicine, otolaryngology, and family medicine clinics. The profit gap per institution between the pediatric and the other clinics grew from 126 million won in 2012 to 245 million won in 2019. In the GEE analysis, profit decrease compared to the previous year with lower profit was the main factor that increased the closure of pediatric and other department clinics. After adjusting profit-related variables, the decrease in the pediatric population itself did not relate to the closure of pediatric clinics. The number of pediatric clinics or monopolies also did not affect the closure of pediatric clinics. Conclusion: The worsening profit is the crucial factor for the closure of pediatric clinics, while the pediatric population is decreasing. For this reason, it is necessary to actively seek ways to maintain a stable treatment system for children and adolescents.