Abstract
ObjectiveTo evaluate the indirect effect of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia (CAP) in older people during the first epidemic wave of COVID-19 in Tuscany, Italy. MethodsA population-based study was carried out on data from the Tuscany healthcare system. The outcome measures were: hospitalization rate for CAP, severity of CAP hospitalizations, and outpatient consumption of antibacterials for CAP in people aged 65 and older. Outcomes were compared between corresponding periods in 2020 (week 1 to 27) and previous years. ResultsCompared with the average of the corresponding periods in the previous 3 years, significant reductions in weekly hospitalization rates for CAP were observed from the week in which the national containment measures were imposed (week 10) until the end of the first COVID-19 wave in July (week 27). There was also a significant decrease in outpatient consumption in all antibacterial classes for CAP. ConclusionsThe implementation of large-scale COVID-19 containment measures likely reduced the incidence of CAP in older people during the first wave of the COVID-19 pandemic in Tuscany, Italy. Considering this indirect impact of pandemic containment measures on respiratory tract infections may improve the planning of health services during a pandemic in the future.
Highlights
Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality among all age groups, and especially in older adults
In the COVID-19 preepidemic period (Week 1 to 9, 2020), the weekly hospitalization rates for CAP were similar to the average weekly hospitalization rates registered in the previous 3 years, except for the first 3 weeks of the years (Figure 1A)
For the COVID-19 epidemic period (Week 10 to 27, 2020), the weekly hospitalization rates for CAP were significantly lower than the average of the previous 3 years; the maximum decrease from the average weekly hospitalization rates of the previous 3 years was registered in Week 22 (-46%) (Figure 1A)
Summary
Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality among all age groups, and especially in older adults. The most commonly identified pathogens of pneumonia in older people are bacteria, such as Streptococcus pneumoniae and Haemophilus influenza, and viruses (Bartlett and Mundy, 1995; Feldman, 1999; Fernandez-Sabé, 2003). These pathogens are mainly transmitted person-to-person via the respiratory route. Since the COVID-19 outbreak, large-scale measures to prevent disease transmission have been implemented worldwide. Government responses have included the prohibition of large-scale events, stay-at-home orders and national/local lockdown; people were asked to wear face masks, respect physical distancing and take other simple precautions such as handwashing, keeping rooms well ventilated, avoiding gatherings, and coughing into a bent elbow or tissue
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