The effects of COVID‐19 outbreak on pediatric emergency department admissions for acute wheezing

Abstract

Introduction: Acute wheezing is a common clinical presentation of viral respiratory infections in children, which can also be caused by exposure to allergens and, rarely, by foreign body inhalation. Since the beginning of the COVID-19 (coronavirus disease 2019) outbreak, several public health interventions have been adopted to reduce viral spread. The aim of this study was to analyze the impact of the COVID-19 pandemic and lockdown measures on Pediatric Emergency Department (ED) admission for acute wheezing. Materials and Methods:We compared demographics and clinical data of patients admitted to the ED for acute wheezing during the COVID-19 outbreak and in the 5 previous years through a retrospective cross-sectional study.Results: During the COVID-19 outbreak we observed an average drop of 83% in pediatric ED admission for acute wheezing, compared to the 5 previous years. In this period, 121 (80.7%) children presented with wheezing and 29 (19.3%) with bronchiolitis. The mean age of the sample was higher compared to the 5 previous years. We also noted an increased number of children presenting with higher acuity color codes during the COVID-19 period, while no differences emerged as for the hospitalizations. During the pandemic we recorded a decrease in the number of viral infections detected. Only two cases of wheezing associated with SARS-CoV-2 were identified. Conclusion:The COVID-19 outbreak and the national lockdown led to a drop of the number of admission to the ED for wheezing in children. This could be due to a reduction in the circulation of common respiratory viruses and partially to a reduced exposure to aeroallergens during the COVID-19 period. Future epidemiological surveillance studies will be needed to support these prelimianry findings.

Pediatric respiratory admissions and related viral infections during the COVID‐19 pandemic

“…Our results of an overall decrease in pediatric admissions, and a decrease in pediatric respiratory admission and the change in the annual pattern of admissions are consistent with numerous previous worldwide reports. 12,16,17 These reports show a decrease in admissions for croup, viral wheeze, URTI, pneumonia, bronchiolitis, asthma, stridor, wheezing, [10][11][12][13][14][16][17][18] and as well as a decrease in emergency department visits for respiratory diseases during the COVID-19 pandemic. 19,20 We similarly show a decrease in all pediatric respiratory admissions, as well as decrease in all pediatric admissions.…”

“…However, when evaluating the decrease in respiratory admissions relative to all pediatric admissions, we demonstrate a decrease in admissions for bronchiolitis and pneumonia and not for other pediatric respiratory diseases. Previous studies describing the decrease in pediatric respiratory admissions, [10][11][12][13][14]16,17 did not evaluate the change in admissions relative to the overall decreased seek for medical attention (and overall reduction in all pediatric admissions) observed during the COVID-19 pandemic. 21,22 Our consideration for the change in respiratory admission relative to the overall reduction in seek for medical care allows a better estimation of the effect of social distancing on communicable pediatric respiratory diseases.…”

“…These reports show a decrease in admissions for croup, viral wheeze, URTI, pneumonia, bronchiolitis, asthma, stridor, wheezing, 10–14,16–18 and as well as a decrease in emergency department visits for respiratory diseases during the COVID‐19 pandemic 19,20 …”

“…There was a global decline in admissions for bronchiolitis during the pandemic, 10 and the usual winter bronchiolitis infection peak was not evident in 2020 11 . Studies also show a decrease in admission for croup, upper respiratory tract infections (URTIs), pneumonia, 12 exacerbations in asthma patients, 13 and wheezing 14 . Furthermore, a decrease in respiratory infections requiring admission to the pediatric intensive care unit (PICU) was also described 15 …”

“…11 Studies also show a decrease in admission for croup, upper respiratory tract infections (URTIs), pneumonia, 12 exacerbations in asthma patients, 13 and wheezing. 14 Furthermore, a decrease in respiratory infections requiring admission to the pediatric intensive care unit (PICU) was also described. 15 The aim of this study was to perform a comprehensive assessment of pediatric respiratory admissions to the Hadassah Hebrew University Medical center, Jerusalem, Israel, and associated respiratory viral infections during the pandemic.…”