Phased Reopening Research Articles

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022.

Assisted living facility (ALF) residents are especially vulnerable to SARS-CoV-2 infection due to the age and comorbidities of the resident population and the social nature of these facilities. To collate all New York State Department of Health guidance and regulations to control transmission of SARS-CoV-2 infection within ALFs from March 2020 through December 2022 and to include US Food and Drug Administration COVID-19 testing and vaccine authorizations. A narrative chronological review of all New York State Department of Health guidance. Documents and associated guidance and regulations are divided into 4 sections: (1) lockdown until COVID-19 vaccine emergency use authorization; (2) COVID-19 vaccine authorization until phased reopening; (3) phased reopening, vaccination requirements, and booster vaccination; (4) the period of the bivalent booster. Controlling the spread of SARS-CoV-2 within ALFs required a multifactorial approach that included stringent infection control measures, testing, and vaccination and careful attention to the social structure and support systems within ALFs. The SARS-CoV-2 pandemic highlighted the complexity of controlling spread of an easily transmissible respiratory pathogen in assisted living communities and the need to structure infection control programs within the diverse ALFs that provide care for our aging population.

‘We Have to Try and Teach Them from Home’ – Parents’ Perspectives on Education of Children with Disabilities During the First Year of the COVID-19 Outbreak in Uganda

ABSTRACT Since March 2020, Uganda has confirmed cases of COVID-19 and implemented a response to curb the spread, which included over 12 months of school closure for most children. In this study we investigated parents’ perspectives of the impact of the COVID-19 response on education of children with disabilities enrolled in primary schools in Central Uganda during the first 12 months of the outbreak. We conducted four rounds of interviews with 27 parents of children with disabilities, which were analysed thematically. Parents described a lack of financial resources, food, learning materials, and teaching skills necessary to provide meaningful home education. Parents were concerned about the long-term impact school closure may have on their child’s development, behaviour, and social life. Although parents were happy about the phased school re-opening, they expressed concerns about the financial costs involved in sending children back to school, and wondered how children would cope with prevention measures. School closure has greatly impacted the education of children with disabilities in Uganda. There is a need to consider inequality, poverty, and culture when studying children with disabilities during the COVID-19 outbreak, and prioritise and include this group in designing COVID-19 responses, prolonged home learning and school reopening plans.

COVID-19 associated with universities in England, October 2020–February 2022

ObjectivesThe aim of this study was to describe the epidemiology of COVID-19 cases at universities in England (October 2020–February 2022) and investigate factors associated with rates of COVID-19 among students during autumn/winter of 2021/22. Study designThe study was an observational retrospective study using routine contact tracing data. MethodsEstimates of COVID-19 cases among students and staff at universities were described. Student cases aged 18–24 years were calculated as a percentage of all cases within that age group. Count regression was used to explore university characteristics associated with case numbers. ResultsWe identified 102,382 cases among students and 28,639 among staff. Student cases reflected trends in the wider population of the same age group, but the observed fraction aged 18–24 years who were students was consistently below the expected level (32%). Phased reopening of universities in March–May 2021 was associated with small peaks but low absolute numbers. Russell group membership, campus universities, and higher student proportions in halls of residence were all associated with increased case numbers. ConclusionsCOVID-19 case numbers among students in England varied considerably. At no time were the observed case numbers as high as expected from community prevalence. Characteristics of universities associated with higher case rates can inform future guidance for higher education settings.

Bayesian clustering of spatial functional data with application to a human mobility study during COVID-19

The coronavirus (COVID-19) global pandemic has made a significant impact on people’s social activities. Cell phone mobility data provide unique and rich information on studying this impact. The motivating dataset of this study is the daily leaving-home index data at Harris County in Texas provided by SafeGraph. To study changes in daily leaving-home index and how they relate to public policy and sociodemographic variables, we propose a new Bayesian wavelet model for modeling and clustering spatial functional data, where domain partitioning is achieved by operating on the spanning trees. The resulting clusters can have arbitrary shapes and are spatially contiguous in the input domain. An efficient tailored reversible jump Markov chain Monte Carlo algorithm is proposed to implement the model. The method is applied to the spatial functional data of the daily percentages of people who left home. We focus on the time period covering both lockdown and phased reopening in Texas during the COVID-19 pandemic and study the changing behaviors of those functional curves. By linking the clustering results with the sociodemographic information, we identify several covariates of census blocks that have a noticeable impact on the clustering patterns of people’s mobility behaviors.

Social distancing and COVID-19: Randomization inference for a structured dose-response relationship

Social distancing is widely acknowledged as an effective public health policy combating the novel coronavirus. But extreme forms of social distancing, like isolation and quarantine, have costs, and it is not clear how much social distancing is needed to achieve public health effects. In this article we develop a design-based framework to test the causal null hypothesis and make inference about the dose-response relationship between reduction in social mobility and COVID-19 related public health outcomes. We first discuss how to embed observational data with a time-independent, continuous treatment dose into an approximate randomized experiment and develop a randomization-based procedure that tests if a structured dose-response relationship fits the data. We then generalize the design and testing procedure to a longitudinal setting and apply them to investigate the effect of social distancing during the first phased reopening in the United States on public health outcomes using data compiled from Unacast™, the United States Census Bureau, and the County Health Rankings and Roadmaps Program. We rejected a primary analysis null hypothesis that stated the social distancing from April 27, 2020 to June 28, 2020, had no effect on the COVID-19-related death toll from June 29, 2020 to August 2, 2020 (p-value < 0.001), and found that it took more reduction in mobility to prevent exponential growth in case numbers for nonrural counties compared to rural counties.

Gradual Recovery of Building Plumbing-Associated Microbial Communities after Extended Periods of Altered Water Demand during the COVID-19 Pandemic.

COVID-19 pandemic-related building restrictions heightened drinking water microbiological safety concerns post-reopening due to the unprecedented nature of commercial building closures. Starting with phased reopening (i.e., June 2020), we sampled drinking water for 6 months from three commercial buildings with reduced water usage and four occupied residential households. Samples were analyzed using flow cytometry and full-length 16S rRNA gene sequencing along with comprehensive water chemistry characterization. Prolonged building closures resulted in 10-fold higher microbial cell counts in the commercial buildings [(2.95 ± 3.67) × 105 cells mL-1] than in residential households [(1.11 ± 0.58) × 104 cells mL-1] with majority intact cells. While flushing reduced cell counts and increased disinfection residuals, microbial communities in commercial buildings remained distinct from those in residential households on the basis of flow cytometric fingerprinting [Bray-Curtis dissimilarity (dBC) = 0.33 ± 0.07] and 16S rRNA gene sequencing (dBC = 0.72 ± 0.20). An increase in water demand post-reopening resulted in gradual convergence in microbial communities in water samples collected from commercial buildings and residential households. Overall, we find that the gradual recovery of water demand played a key role in the recovery of building plumbing-associated microbial communities as compared to short-term flushing after extended periods of reduced water demand.

Impact of COVID-19 pandemic on control of bronchial asthma in children attending the asthma clinic in a tertiary care centre in Kerala

Abstract BACKGROUND: COVID-19 pandemic led to widespread change in the life of people across the globe, including children, with far-reaching consequences. When control of disease is considered among children with asthma, a positive impact is to be expected. This study aimed to assess the impact of the COVID-19 pandemic on disease control among children with asthma. OBJECTIVES: The main objectives are (1) to compare the level of asthma control pre-COVID versus during the COVID pandemic in terms of exacerbations and short-acting beta agonist (SABA) usage and (2) to compare the use of inhaled corticosteroids (ICS) pre-COVID versus during the COVID pandemic. MATERIALS AND METHODS: Hospital-based study was conducted among children aged 5–15 years attending the asthma clinic of Government TD Medical College, Alappuzha, during the period May 2021–January 2022. Asthma control in terms of SABA usage, emergency visits, hospitalizations, and ICS usage was compared pre-COVID (before March 2020) to Complete lockdown (March 2020–May 2020), phased reopening (June 2020–May 2021) and after the lifting of major restrictions (June 2021–January 2022). Statistical analysis was done using IBM SPSS Statistics v.26. RESULTS: In total, 139 children were included in the study. A decrease was observed in the number of children requiring SABA as reliever therapy, with 18%, 25.9%, and 33.1% not requiring SABA during the complete lockdown, during phased reopening, and after the lifting of major restrictions, respectively, when compared to pre-COVID. A statistically significant decrease in hospitalizations and visits to the emergency department due to asthma exacerbations were also observed during various phases of the pandemic. ICS was stopped in 15.1%, 30.2%, and 35.3% of the study subjects during various phases of the pandemic without further exacerbations. CONCLUSION: There was a significant impact on asthma control during the pandemic, which was sustained during various phases of lifting restrictions.

Impact of COVID-19 Pandemic on Physical Activity, Pain, Mood, and Sleep in Adults with Knee Osteoarthritis.

To examine changes in physical activity, sleep, pain and mood in people with knee osteoarthritis (OA) during the ongoing COVID-19 pandemic by leveraging an ongoing randomized clinical trial (RCT). Participants enrolled in a 12-month parallel two-arm RCT (NCT03064139) interrupted by the COVID-19 pandemic wore an activity monitor (Fitbit Charge 3) and filled out custom weekly surveys rating knee pain, mood, and sleep as part of the study. Data from 30 weeks of the parent study were used for this analysis. Daily step count and sleep duration were extracted from activity monitor data, and participants self-reported knee pain, positive mood, and negative mood via surveys. Metrics were averaged within each participant and then across all participants for pre-pandemic, stay-at-home, and reopening periods, reflecting the phased re-opening in the state of Massachusetts. Data from 28 participants showed small changes with inconclusive clinical significance during the stay-at-home and reopening periods compared to pre-pandemic for all outcomes. Summary statistics suggested substantial variability across participants with some participants showing persistent declines in physical activity during the observation period. Effects of the COVID-19 pandemic on physical activity, sleep, pain, and mood were variable across individuals with OA. Specific reasons for this variability could not be determined. Identifying factors that could affect individuals with knee OA who may exhibit reduced physical activity and/or worse symptoms during major lifestyle changes (such as the ongoing pandemic) is important for providing targeted healthcare services and management advice towards those that could benefit from it the most.

The COVID-19 Pandemic: Effects on Pediatric Fracture Patterns in the Emergency Department and Subspecialty Follow-up Care.

Purpose:The COVID-19 pandemic affected pediatric fracture injury patterns and volume. There is a paucity of research evaluating this trend throughout the pandemic and also follow-up to orthopaedic subspecialty care after emergency fracture management.Methods:This retrospective cohort study reviewed patients 2 to 18 years of age presenting for fracture care to an urban pediatric emergency department. We assessed patient demographics, clinical care, and follow-up to surgical subspecialist. Time periods investigated included March 30 to September 4, 2020 (pandemic), March 30 to September 4, 2019, and March 30 to September 4, 2018 (prepandemic). Subanalysis within the pandemic was during the “stay-at-home order” verses the phased re-opening of the state. Descriptive statistical analysis, Pearson’s χ2 or Fisher exact tests, and Mann-Whitney U tests were performed.Results:In this population, fractures overall declined by 40% (n=211) during the pandemic compared with 2019 (n=349) and 28% compared with 2018 (n=292). Lower extremity fractures accounted for a greater percentage of injuries during the pandemic compared with prepandemic. Time to surgical subspecialty follow-up was shortest during the 2020 pandemic peak at 9 days and was significantly longer during phased reopening (phase 1: 18 d, P=0.001; phase 2: 14 d, P=0.005). These patterns were also consistent for days to repeat imaging.Conclusions:We found differences in fracture prevalence, mechanisms, and follow-up care during the pandemic. Time to subspecialty follow-up care was longer during pandemic phased reopening despite overall fewer fractures. Plans to absorb postponed visits and efficiently engage redeployed staff may be necessary to address difficulties in follow-up orthopaedic management during public health crises.Level of Evidence:Level II.

Impact of the COVID-19 pandemic on emergency department visits for genitourinary trauma

IntroductionThe mean number of emergency department visits for all-cause traumas has declined significantly during the COVID-19 pandemic. We aim to identify how a global pandemic and social distancing could affect the trends and pattern of genitourinary traumas.MethodsWe queried the National Electronic Injury Surveillance System to obtain consumer product-related genitourinary injuries leading to emergency department visits. Using three key events in 2020, we divided the study period to three intervals: January 20, when the first COVID-19 case was confirmed in the United States; March 13, when a national state of emergency was declared; April 20, when Texas became the first state to start a phased reopening of economy. We compared the injury characteristics in 2020 to their identical intervals in 2019.ResultsDaily emergency department visits dropped significantly during the national lockdown (mean 131.5 vs. 78; Δ-40.7%; p < 0.01). The genitourinary injuries decreased significantly in children ≤ 17 years (p < 0.01), males (p < 0.001), and White population (p < 0.01). However, it did not change significantly in adults 18–64 years (p = 0.92), old adults ≥ 65 years (p = 0.37), females (p = 0.60), Black population (p = 0.90), other/unknown races (p = 0.93), and for injuries sustained at home (p = 0.75) and public (p = 0.11) locations. During the lockdown period, injuries associated with toilets/toilet seats (− 320, − 74.6%), day wear (− 266, − 77.7%), beds/bedframes (− 209, − 64.2%) decreased while injuries associated with knickknacks/statues/vases (+ 154, n/a), sofas/couches/divans (+ 130, 2,684%), and razors/shavers (+ 99, n/a) increased.ConclusionsThe COVID-19 lockdown had a significant impact on genitourinary traumas. The contributing factors could be investigated further to prevent such injuries during deconfinement periods.

Changes in Fall Rates From Before to During the COVID-19 Pandemic: Findings From the Prospective AMBROSIA Study.

BackgroundCOVID-19 social distancing policies resulted in reductions in community movement, however fall rates during this time have not been described.MethodsThis prospective study included adults ≥65 years old participating in the Ambulatory Blood Pressure in Older Adults (AMBROSIA) cohort and who completed ≥1 monthly falls calendar (August 2019-March 2021; n=250). Months were grouped to correspond to the fall 2020 phased re-opening (August-October) and the shelter-in-place policy during the winter 2020 surge (November-January) in Los Angeles, California and compared to the same months, one year earlier (i.e., before the pandemic).ResultsParticipants had a mean (SD) age of 75.2 (6.1) years, 49.6% were White, and 53.2% were women. We obtained 2,795 falls calendars during follow-up. Overall, 110 (44.0%) participants reported a total of 421 falls (rate 15.1 per 100 calendar months). The highest monthly fall rate during the pandemic was 22.9 (95% CI 16.4-31.1) per 100 calendar-months in August 2020. The lowest fall rate during the pandemic was 8.6 (95% CI 3.5-17.8) per 100 calendar-months in February 2021. During the pandemic, fall rates in August, September, and October 2020 were higher than the previous year (rate ratio 1.8 [95% CI 1.1-2.9]) and fall rates in November and December 2020 and January 2021 were lower than the previous year (rate ratio 0.5 [95% CI 0.4-0.8]).ConclusionsAs the pandemic continues and older adults resume community mobility after a shelter-in-place period, providers should pay attention to the risk of falls.

Re-opening the Bangladesh economy: search for a framework using a riskimportance space

The novel coronavirus has infected more than 50 million people worldwide. Countries that have been on lockdown for more than three months have partially started to reopen their economies, including Bangladesh. This study aims to assess the reopening policies in Bangladesh by mapping the economic sectors in a risk-importance space and using that to develop a phased reopening strategy. This study conducted 100 expert interviews to identify sectors critical to the reopening of the economy and sectors that carry high transmission risks of the disease. The convenience sampling and snowball method were applied to reach the economic sector experts. Quadrant analysis was applied to classify sectors according to their importance to the economy and propensity to spread the disease. Pharmaceuticals and grocery have been identified as allowed sectors due to their contribution to the economy but pose relatively less risk of spreading COVID-19, whereas RMG and other exports identify as alert sectors. Based on findings, a sector-based, three-phase reopening strategy has been proposed for the economy that might prevent the spreading of COVID-19. The proposed framework can act as a guiding principle for any country to offer a step by step reopening strategy.

Effect on Ambient Air Quality in Nagpur due to lockdown to contain the spread of COVID-19 pandemic in the year 2020: a case study

The present paper deals with the studies on the change in concentration of three standard pollutants namely, respiratory suspended particulate matter (RSPM or PM10), Sulphur dioxide (SO2) and Nitrogen dioxide (NO2) because of lockdown in India to prevent the spread of COVID-19 pandemic in 2020. The monthly average concentrations of the above pollutants observed at four monitoring stations in and around Nagpur city during January to December 2020 were analyzed and compared. Due to COVID-19 pandemic, there was a complete lockdown from 25th March to 31st May 2020 and phased reopening of areas outside containment zones from June 1st onwards. It is found that the average concentration of all the three pollutants at all four stations was reduced by about 50 % to 75 % due to lockdown. During lockdown, the minimum concentration of PM10, SO2 and NO2 amongst all stations were found to be 40, 5 and 11 µg/m3, respectively, whereas the maximum concentrations were found to be 159, 20, and 50 µg/m3, respectively. The concentrations during lockdown were below the standards prescribed by CPCB, which were found to increase due to reopening. The Air quality index (AQI) at all four stations during lockdown was less than 50 (i.e. SATISFACTORY), whereas it increased above 100 (i.e. MODERATE) after reopening. As a result, the annual average concentration of pollutants was reduced in 2020 compared to previous years.

Key links in network interactions: Assessing route-specific travel restrictions in China during the Covid-19 pandemic

We consider a model of network interactions where the outcome of a unit depends on the outcomes of the connected units. We determine the key network link, i.e., the network link whose removal results in the largest reduction in the aggregate outcomes, and examine a measure that quantifies the contribution of a network link to the aggregate outcomes. We provide an example examining the spread of Covid-19 in China. Travel restrictions were imposed to limit the spread of infectious diseases. As uniform restrictions can be inefficient and incur unnecessarily high costs, we examine the design of restrictions that target specific travel routes. Our approach may be generalized to multiple countries to guide policies during epidemics ranging from ex ante route-specific travel restrictions to ex post health measures based on travel histories, and from the initial travel restrictions to the phased reopening.

Child well-being in early childhood education and care during COVID-19: Child sensitivity in small, fixed groups.

The article explores child well‐being in Danish early childhood education and care (ECEC) during the time of COVID‐19. A phased reopening of Denmark occurred in spring 2020 under strict health guidelines. Two ECEC institutions were followed first‐hand to observe the impact of the pandemic on pedagogy and child well‐being. Observations and interviews were conducted with follow‐up interviews and an online survey a year later. The findings suggest that the pandemic caused pedagogues to work in a more child‐sensitive way with elevated staff/child ratios and children in small, fixed groups; however, child well‐being was not negatively affected, despite the acute situation

Reopening Collegiate Recreation During COVID-19: A Case Study of Plans and Policies

The COVID-19 pandemic caused most collegiate recreation facilities and programs to shut down to slow the spread of the virus. Public health guidelines from the state/province, federal, and global level have inundated recreation professionals with messaging to inform reopening strategies. Rasmussen’s risk management framework served as a guide to explore the stakeholders, decisions, and environmental conditions influencing COVID-19 reopening plans and policies in collegiate recreation. A case study of four collegiate recreation departments was conducted, with document analysis employed to examine and interpret reopening plans. The findings highlight campus offices and leadership as major stakeholders in reopening guidelines; risk management decisions utilizing a phased reopening approach that emphasized screening, mask mandates, social distancing and touch points, equipment and floor plans, and cleaning; and communication as a critical environmental condition. Implications for collegiate recreation practitioners include strategies for decision making, dissemination of information, staff training, risk mitigation, and policy enforcement.

Adolescents' Behaviors, Fitness, and Knowledge Related to Active Living before and during the COVID-19 Pandemic: A Repeated Cross-Sectional Analysis.

Background: Nearly all schools in the United States experienced shutdown followed by phased reopening during the COVID-19 pandemic, thereby limiting students’ opportunities for physical activity (PA). This study aimed to examine adolescents’ PA at school (PAS) and PA out-of-school (PAO), screen-based sedentary behaviors (SbSB), health-related fitness, and knowledge understanding about PA and fitness before and during the pandemic. Methods: Three rounds of data were collected: Time 1 pre-pandemic (January 2020; n = 405), Time 2 schools partially reopened (February 2021; n = 412), and Time 3 schools fully reopened (March 2021; n = 450). Adolescents completed the Youth Activity Profile, the 20 m Progressive Aerobic Cardiovascular Endurance Run (PACER) test and Plank test, and a written test, to measure the behaviors (T1, T2, T3), fitness (T2–T3), and knowledge (T1, T2, T3), respectively. Results: Inferential statistical analyses revealed a significant time effect for the behaviors and fitness. From T1 to T2 PAO decreased but PAS increased; whereas SbSB decreased at T3 compared to T1 and T2. Health-related fitness improved from T2 to T3. Further, the change patterns for SbSB varied by grade, and those for knowledge understanding varied by gender. Conclusion: The findings confirm the disruptive impact of the COVID-19 pandemic on adolescents’ active living but varied by school grade and gender. The favorable changes from T2 to T3 observed for fitness and other constructs may be partially attributable to an interrupted fitness education intervention. The findings may guide the design and evaluation of future interventions addressing the physical inactivity pandemic during public health crises (e.g., COVID-19).

Effect of COVID-19 on the delivery of care for thoracic surgical patients

ObjectiveIn this study we aimed to determine the effect of the COVID-19 pandemic on the delivery of care for thoracic surgical patients at an urban medical center. MethodsA retrospective analysis of all thoracic surgical cases from May 1, 2019, to December 31, 2020, was conducted. Demographic characteristics, preoperative surgical indications, procedures, final pathologic diagnoses, and perioperative outcomes were recorded. A census of operative cases, relevant ancillary services, and outpatient thoracic clinics were obtained from our institutional database. ResultsSix hundred nineteen cases were included in this study (329 pre-COVID-19 and 290 COVID-19, representing an 11.8% reduction). There were no differences in type of thoracic procedures or perioperative outcomes among the 2 cohorts. Prolonged reduction of thoracic surgical cases (50% of baseline) during the first half of the COVID-19 period was followed by a resurgence of surgical volumes to 110% of baseline in the second half. A similar incidence of cases were performed for oncologic indications during the first half whereas more benign cases were performed in the second half, coinciding with the launch of our robotic foregut surgery program. After undergoing surgery during the pandemic, none of our patients reported COVID-19 symptoms within 14 days of discharge. ConclusionsDuring the initial surge of COVID-19, while there was temporary closure of operative services, our health care system continued to provide safe care for thoracic surgery patients, particularly those with oncologic indications. Since phased reopening, we have experienced a rebound of surgical volume and case mix, ultimately mitigating the initial negative effect of the pandemic on delivery of thoracic surgical care.

Impact of COVID-19 on Primary Care Quality Measures in an Academic Integrated Health System.

BackgroundAccess to primary care was hindered by the coronavirus disease 2019 (COVID-19) pandemic.ObjectiveEvaluate changes in health screening rates before and during the pandemic.DesignRetrospective analysis of health maintenance and disease management screening rates among primary care patients before and during the pandemic.ParticipantsOver 150,000 patients of a large, academic health system.Main MeasuresSix quality measures were analyzed: colon cancer, breast cancer, cervical cancer, diabetes Hgb A1C, diabetes eye, and diabetes nephropathy monitoring. Based on US Preventative Services Task Force screening guidelines, we determined which patients were due for at least one of the quality measures. We tracked completion rates during three time periods: pre-pandemic (January 1–March 3, 2020), stay-at-home (March 4–May 8, 2020), and phased reopening (May 9–July 8, 2020). Differences in quality measure completion rates were evaluated using mixed-effects logistic regression models.Key ResultsCompared to pre-pandemic rates, completion of all health screenings declined during the stay-at-home period: mammograms (OR: 0.34; 95% CI: 0.31–0.37), cervical cancer (OR: 0.83; 95% CI: 0.76–0.91), colorectal cancer (OR: 0.25; 95% CI: 0.23–0.28), diabetes eye (OR: 0.34; 95% CI: 0.29–0.41), diabetes Hgb A1c (OR: 0.41; 95% CI: 0.37–0.46), and diabetes nephropathy (OR: 0.46, 95% CI: 0.41–0.53). During phased reopening, completion of all quality measures increased compared to the stay-at-home period, except for cervical cancer screening (OR: 0.83; 95% CI: 0.76–0.92). There was a persistent reduction in completion of all quality measures, except for diabetic nephropathy monitoring (OR: 0.99; 95% CI: 0.89–1.09), during phased reopening compared to pre-pandemic.ConclusionsHealthcare screening rates were reduced during the early part of the COVID-19 pandemic and did not fully recover to pre-pandemic rates by July 2020. Future research should aim to clarify the long-term impacts of delayed health screenings. New interventions should be considered for expanding remote preventative health services.

COVID-19 Pandemic–Related Reductions in Pediatric Asthma Exacerbations Corresponded with an Overall Decrease in Respiratory Viral Infections

BackgroundRespiratory viruses, air pollutants, and aeroallergens are all implicated in worsening pediatric asthma symptoms, but their relative contributions to asthma exacerbations are poorly understood. A significant decrease in asthma exacerbations has been observed during the coronavirus disease 2019 pandemic, providing a unique opportunity to study how major asthma triggers correlate with asthma activity.ObjectiveTo determine whether changes in respiratory viruses, air pollutants, and/or aeroallergens during the coronavirus disease 2019 pandemic were concomitant with decreased asthma exacerbations.MethodsHealth care utilization and respiratory viral testing data between January 1, 2015, and December 31, 2020, were extracted from the Children’s Hospital of Philadelphia Care Network’s electronic health record. Air pollution and allergen data were extracted from US Environmental Protection Agency public databases and a National Allergy Bureau–certified station, respectively. Pandemic data (2020) were compared with historical data.ResultsRecovery of in-person asthma encounters during phased reopening (June 6 to November 15, 2020) was uneven: primary care well and specialty encounters reached 94% and 74% of prepandemic levels, respectively, whereas primary care sick and hospital encounters reached 21% and 40% of prepandemic levels, respectively. During the pandemic, influenza A and influenza B decreased to negligible frequency when compared with prepandemic cases, whereas respiratory syncytial virus and rhinovirus infections decreased to low (though nonnegligible) prepandemic levels, as well. No changes in air pollution or aeroallergen levels relative to historical observations were noted.ConclusionsOur results suggest that viral respiratory infections are a primary driver of pediatric asthma exacerbations. These findings have broad relevance to both clinical practice and the development of health policies aimed at reducing asthma morbidity.