Has respiratory emergencies changed during lockdown implemented for COVID-19 pandemic?

Abstract

Sir, Coronavirus disease (COVID-19) is an infectious disease caused by novel coronavirus named as SARS Cov-2. It originated in the city of Wuhan, the capital of Hubei province of China in December 2019 and has been declared a pandemic by the World Health Organization.[12] The disease has now spread in more than 200 countries and even our country, India has been badly affected. More than 11 lacs cases and almost 20,000 deaths have occurred till date (20th July 2020). Our Honorable Prime Minister announced a “Janta curfew” on 22nd March 2020. Thereafter, a nationwide “Lockdown” was ordered which has been effective in slowing down the growth rate of pandemic. The unprecedented COVID-19 pandemic has seriously impacted people with pre-existing health conditions and has adversely affected the management of other diseases. Lockdown not only helped in containment of COVID-19 infection but reducing air pollution as evident by a bettering in the air quality index. The short-term effects of air pollution include reduction in pulmonary function, worsening of respiratory symptoms, non-infectious exacerbations of chronic obstructive pulmonary disease (COPD), bronchial asthma (BA), and an increase in respiratory mortality.[345] Patna is among one of the most polluted cities of India and air quality index is generally more than 300 in month of April–May 2020. Air quality index of Patna during lockdown period was generally less than 100 which is considered as satisfactory. Our hypothesis was that with betterment of air quality, we should expect a reduction in hospital admission for diseases like exacerbation of COPD/BA. So, we compared the morbidity and mortality due to respiratory emergencies in same period of 2020 with 2019. Primary objective of the study was to comparison of number of episodes' and type respiratory emergency in period of lockdown to same period last year. Materials and Methods This was retrospective analysis of all the patients admitted in Pulmonary Medicine department for diseases other than COVID-19 through Emergency visits in month of April–May 2020. Sociodemographic and clinical details were recorded from case file available in hospital record system. We compared this data with same period for previous year, that is, 2019. Results A total of 41 patients were admitted in the period of lockdown between April and May 2020, which is 37.8% less, compared to same period of last year. There was reduction in admission for patients with COPD (25.7% vs. 17.0%) and asthma (6% vs. 4.8%) compared to previous year but this difference was statistically not significant and this could be due to short period of evaluation which might not reflect the actual number of patients [Table 1]. There were more cases of lower respiratory tract infection/pneumonia and post-tuberculosis sequel that were admitted in lockdown period compared to previous year for same period. There were lesser deaths among admitted patient (4.87%) in 2019 as compared to 2020 (9.8%) for the same period. In 2019, out of the 6 patients who died, 2 were patients of lung cancer and 1 each was patient of sepsis, acute respiratory distress syndrome, chronic obstructive lung disease, and interstitial lung disease.Table 1: Comparison of respiratory emergencies in 2019 with 2020We infer that air pollution is a major public health hazard, particularly in developing countries and is associated with hospitalizations from respiratory diseases.[6] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.