Asthma and Susceptibility to COVID-19 in Australian Children During Alpha, Delta and Omicron Waves of the COVID-19 Pandemic

Abstract

Purpose Earlier coronavirus-19 (COVID-19) pandemic reports did not implicate increased disease burden in asthmatics while subsequent findings have been inconsistent. To date, the impact of COVID-19 on childhood asthma remains undetermined and is further complicated with ongoing emergence of new variants. This study aimed to investigate association between asthma and COVID-19 for children in New South Wales (NSW), Australia and compare its differences across four major outbreaks from alpha, delta and omicron variants/subvariants. Methods This is a retrospective cross-sectional study of all children aged ≤17 years old who sought care for COVID-19 at Sydney Children’s Hospitals Network (SCHN) between 1 January 2020 and 31 May 2022. Results Of the 18,932 children with polymerase chain reaction (PCR) confirmed COVID-19 who attended SCHN, 60% received their care during delta wave, and 5.41% (n = 913) had prior diagnosis of asthma. Among children with COVID-19, the odds of having asthma were lower during alpha (aOR = 0.43; 95% CI, 0.19–0.83) and delta wave (aOR = 0.84; 95% CI, 0.73–0.96), but were higher during omicron wave (aOR = 1.56; 95% CI, 1.23–1.95). Length of hospital stay (LOS) for asthmatic children were increased by 0.55 days and 1.17 days during delta and the second omicron wave, respectively. Intensive care and mechanical ventilation requirements were not significantly different between asthmatic and non-asthmatic children. Eleven deaths were reported but none had asthma. Conclusion Although children with asthma were more susceptible to COVID-19 infections during omicron waves compared to that of alpha or delta waves, they were not at greater risk of COVID-19 severity at any stage of the outbreak regardless of the predominant SARS-CoV-2 variants/subvariants.

Outcomes of SARS‐CoV‐2 Omicron infection in vaccinated children with asthma versus matched controls: A nationwide population‐based study

“…While no significantly increased risk of severe COVID-19 in adult asthmatics was reported in a large systematic review during the pre-Delta phase of the pandemic in asthmatic adults, 2 there is a dearth of studies investigating serious COVID-19 outcomes in children with asthma. 3 While emerging evidence suggests higher odds of COVID-19associated asthma exacerbations 1 and SARS-CoV-2 infection 4 in paediatric asthmatics during the Omicron wave, existing studies were predominantly conducted before roll-out of COVID-19 vaccination in children, [2][3][4] and hence significantly limited by the absence of vaccination data. [1][2][3][4] We examined outcomes of Omicron SARS-CoV-2 infection in a cohort of Singaporean children with asthma, contrasted against matched population controls; 79.9% (5158/6455) of asthmatics had completed two vaccine doses before infection.…”