When the COVID-19 pandemic first hit the UK, MRF’s support team fielded lots of questions – many from people highly alert to potential health threats because of their own painful experiences of meningitis in their families. Could COVID-19 cause meningitis? Were their children likely to be at greater risk from COVID-19 because they’d had meningitis? Would getting COVID-19 increase the chances of getting meningitis in the future?

Truthfully, we don’t know the answers yet, since this is a new disease, but it seems that the direct association between meningitis and COVID-19 is likely to be small. It’s important that we keep looking at this as the pandemic continues, but see the MRF website for our best answers to these questions for now.  

Meanwhile, there may already be substantial indirect impacts of COVID-19 on meningitis here in the UK, and other wealthy countries – and this is likely to be even worse around the world where more fragile health systems could be overwhelmed by the onslaught of COVID-19.

There are many contributing factors. Parents and individuals may be more reluctant than usual to take a sick child or other family member to hospital or to the GP, either because they are afraid of exposure to COVID-19 or because they want to protect the NHS from being overburdened. There have already been cases of parents delaying taking a sick child to hospital because of COVID-19 until it is too late. Even parents who do try to get medical help may have difficulty getting through to NHS111 or their GP. The Royal College of Paediatrics and Child Health (RCPCH) has highlighted a worrying number of cases where children may have become very unwell or even died because they weren’t seen early enough, and a recent study from Italy reported 12 cases of delayed access to hospital care for children during a single week in March, resulting in four deaths.

In the UK we know that Public Health England’s Meningococcal Reference Unit is receiving only half the expected number of samples for PCR testing from suspected cases of meningitis and septicaemia. Although they are meanwhile very busy processing COVID-19 tests, they are concerned that doctors aren’t suspecting meningococcal disease as often as they should, and parents aren’t taking sick children to hospital.

 It’s possible that fewer children are going to hospital because social distancing and staying at home are reducing infections and injuries.  However, children and older individuals still get sick and it’s as important as ever that anyone with symptoms of serious illness gets medical help quickly.  We know sick children can become dangerously ill quickly, and the RCPCH has reminded doctors that although the symptoms of severe illness may overlap with COVID-19, an unwell child is more likely to be unwell due to other causes, since children rarely get seriously ill with COVID-19 and are less likely to show typical symptoms.

The other major impact of COVID-19 on meningitis is likely reductions in uptake and coverage of vaccines. Some parents have misinterpreted the ‘stay at home’ COVID-19 guidance to mean that they should not take their child for routine immunisation appointments, or they may be afraid of exposing children to the virus. Others may have difficulty accessing routine immunisations because primary care staff are very busy or away ill or self-isolating due to COVID-19.
 
Despite the circumstances, it's very important for everyone to ensure that they and their children get all their immunisations on time – now more than ever we need to do all we can to stay healthy. GP surgeries have clear guidance to prioritise routine immunisations, and public health authorities in the UK and Ireland and the WHO have emphasised the importance of maintaining routine immunisation services.

This will be a challenge in low and middle income countries, and UNICEF is already highlighting how the COVID-19 pandemic is disrupting immunisation and basic health services. In the midst of this, the long-awaited Global Roadmap to Defeat Meningitis by 2030 is on the cusp of moving forward, with more potential than ever before to save lives and prevent suffering from meningitis. Let us hope the COVID-19 pandemic does not throw it off course.