The COVID-19 Pandemic has caused disruptions to everyone’s lives: physically, socially, and mentally. One question less often asked is about the indirect effect of COVID-19 on our children’s health. As the Blue Cross Blue Shield of Alabama Endowed Chair in Health Economics at UAB’s School of Public Health, one of Dr. Bisakha (Pia) Sen’s charges is to examine this very topic and to also take a closer look at all of Alabama’s most vulnerable populations.

decorative imageIn early Fall 2020, following a winning UAB “Back of the Envelope” award submission, Dr. Sen and others began soliciting Alabama-specific data for their proposal entitled “Unintended Consequences of the COVID-19 Pandemic on the Pediatric Population: Emergency Care & Unmet Health Needs Among ‘Children’s of Alabama’ ED Patients.” Dr. Sen worked alongside Dr. Pallavi Ghosh, Assistant Professor and Research Director in the Division of Pediatric Emergency Medicine at UAB’s School of Medicine and attending physician at Children’s of Alabama Emergency Department (ED); and Dr. Anne Brisendine, alumna and Assistant Professor in the Department of Health Care Organization and Policy at UAB’s School of Public Health. Together, the team got access to data from Children’s of Alabama ED on patients presenting to the ED from January to December 2020 and were able to begin comparison studies to data from the same time period in 2019. Early observations indicated a significant drop in ED visits for African American children and publicly insured children in Alabama, beginning in mid-March 2020 and lasting through the end of the year. Further, while ED visits began to bounce back for non-Hispanic white children in the state once “stay at home” orders were lifted, the same could not be said for African American children.

When looking at 2020 data for ED visits, an overall decline in both high-acuity (more severe) and low-acuity (less severe) pediatric cases were also noted for the state. This motivated Sen and the team to start evaluating additional data as part of research partnerships with Alabama Medicaid and ALL Kids, Alabama’s Children’s Health Insurance Program, to determine whether telehealth visits and/or visits to a primary care doctor made up for this decline. Early evidence suggests this was not the case and, while this research is still in preliminary stages, Sen feels these findings present cause for concern for anyone who is interested in the health landscape of Alabama. “Health is a lifelong process…and if health needs go unmet when individuals are in their childhood, those effects are going to persist over a lifetime. We know this,” said Dr. Sen. “So, focusing on the health of our vulnerable children, our disadvantaged children, is honestly one of the most key investments we can make in Alabama’s future.”

Sen and her team plan to continue their research and are launching new partnerships with the Alabama Child Health Improvement Alliance at UAB and with the Division of Pediatric Endocrinology & Diabetes at UAB’s School of Medicine. Sen believes that very careful monitoring of this situation is needed for at least the next several years to help find and address gaps in necessary healthcare for children in Alabama. With cases of childhood obesity, type 2 diabetes, and mental health issues on the rise during the pandemic, it’s critical to ensure that regular “well visits” are maintained in pediatric care along with high-acuity treatment—whether these are achieved through telehealth or ED visits when access to in-person providers may be limited. Sen also points to resources such as UAB’s Live HealthSmart Alabama to help address some of these needs and create a positive impact on the future health of our children.

To learn more about Dr. Sen and her work as the Blue Cross Blue Shield of Alabama Endowed Chair in Health Economics, visit


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