Reduction in heart failure admissions with concomitant respiratory viral infections during the novel coronavirus disease-2019 pandemic: Unintended consequence of public health measures in Singapore

Abstract

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Reduction in asthma admissions during the COVID-19 pandemic: consequence of public health measures in Singapore

“…While outdoor air pollution in Singapore also significantly decreased during the lockdown period due to movement restrictions [ 8 ], the reduction in asthma admissions was sustained for more than 6 months after the lifting of lockdown. The trends seen for asthma admissions mirrored observations for other chronic diseases, including chronic-obstructive-pulmonary-disease (COPD) and heart failure [ 9 , 10 ]. While the single-centre nature of our study potentially restricts the generalizability of our observations, the complementary role of simple preventive measures such as wearing of face coverings, hand hygiene and social distancing in mitigating asthma exacerbations deserves further evaluation and investigation.…”

Long-Term Acceptability of Hygiene, Face Covering, and Social Distancing Interventions to Prevent Exacerbations in people living with Airways Diseases

“…The basic premise of our survey was that widespread, continued implementation of pandemic infection control measures was able to reduce the transmission of other viruses which in turn reduced exacerbations of airways diseases in both community and hospital settings [12][13][14][15][16][17][18][19][20] (noting that other circumstances of the pandemic such as cleaner air may also have contributed). Importantly, the pattern of residual disease severity does not support the counter-hypothesis that this reduction is due to patients avoiding healthcare during the pandemic.…”

“…The reduction in hospitalisation is of greater magnitude than ever previously achieved with optimisation of nonpharmacological and pharmacological care [1][2][3]. For example, Tan et al reported a 50% reduction in hospitalised COPD [14] (and asthma [17]) exacerbations in Singapore, and a reduction in the proportion of residual exacerbations associated with respiratory viruses. In a hospital in Hong Kong, admissions for COPD exacerbations decreased by 44% during the first three months of 2020 compared with the previous year [13].…”

“…The pandemic was associated with a dramatic fall in cases of influenza [11] and multiple studies have reported a substantial reduction in hospitalisations due to asthma and COPD exacerbations, temporally associated with the COVID-19 pandemic including introduction of respiratory virus infection control measures [12][13][14][15][16][17][18][19][20], likely because vulnerable people avoiding SARS-CoV-2 were also avoiding other respiratory viruses that are common causes of exacerbations [21].…”

Decline in respiratory and cardiac admissions during the COVID‐19 pandemic: What is the role of common respiratory virus infections?

“…Due to the nature of observational data, it is not possible to pinpoint the exact causes of the reduction in cardiac admissions, but two likely candidates are a change in the threshold to present to healthcare facilities and lack of exposure to common viruses. The pattern of abrupt and temporary decline in cardiac admissions, related only to implementation of the most severe NPIs, was also seen in South Korea, Singapore and the U.K. 4,7,8 The authors of a large U.K. study argued towards fear of hospital attendance as the biggest driver, 7 whereas a study from Singapore was able to clearly demonstrate a significant relative reduction in admissions due to a decline in heart failure with concomitant reductions in respiratory viral infections. 8 The influence of respiratory virus infections on the aetiology of acute episodes of cardiovascular disease is yet to be fully clarified.…”