Barriers to Infant Preventive Care During the COVID-19 Pandemic.

During the spring of 2020, the COVID-19 pandemic disrupted all aspects of life for Americans, including their access to health care. Hospitals and medical clinics were declared essential by government entities and professional organizations and remained open as other services closed.1 However, despite infant care being declared essential and medical professionals encouraging in-person routine vaccinations,2 preventive care visits in pediatric clinics decreased. National preliminary data of Medicaid use from March to May 2020 showed a 44% decrease in the use of preventive screening services compared with the same period in 2019.3 In our academic outpatient centers, monthly average of in-person visits, sick and preventive, dropped by almost half between March and August 2020 compared with the prior 6 months. In addition to the health risks innately imposed by COVID-19 infection, the decline in preventive visits put infants at additional risk of vaccine-preventable infections, missed identification of delayed development, and decreased ability to foster familychild mental health, all of which are mainstays of preventive care.4 Although we may be able to extrapolate from studies of adults who delayed their own preventive care visits, no studies have reported parental perception of barriers to their infant’s care during the pandemic.5 Recognizing that the increased risks of COVID-19 exposure and diagnosis are not shared equitably among populations is critical when examining use of preventive care services. Nationally, COVID-19 case rates among Blacks or African Americans were 1.1 times higher and among Hispanics or Latinos, they were 1.9 times higher than in White non-Hispanics.6 At COVID-19 testing sites organized by our institution in Washington, DC, Black or African American children were 2.3 times more likely and Hispanic or Latino children were 6.3 times more likely than White non-Hispanic children to test positive.7 This increased risk is a consequence of longstanding systemic health and social inequities, and it needs to be considered when examining community behavior during the pandemic.8 Methods