ABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused dramatic changes in daily routines and health care utilization and delivery patterns in the United States. Understanding the influence of these changes and associated public health interventions on asthma care is important to determine effects on patient outcomes and identify measures that will ensure optimal future health care delivery. OBJECTIVE: We sought to identify changes in pediatric asthma-related health care utilization, respiratory viral testing, and air pollution during the COVID-19 pandemic. METHODS: For the time period January 17 to May 17, 2015 to 2020, asthma-related encounters and weekly summaries of respiratory viral testing data were extracted from Children's Hospital of Philadelphia electronic health records, and pollution data for 4 criteria air pollutants were extracted from AirNow. Changes in encounter characteristics, viral testing patterns, and air pollution before and after Mar 17, 2020, the date public health interventions to limit viral transmission were enacted in Philadelphia, were assessed and compared with data from 2015 to 2019 as a historical reference. RESULTS: After March 17, 2020, in-person asthma encounters decreased by 87% (outpatient) and 84% (emergency + inpatient). Video telemedicine, which was not previously available, became the most highly used asthma encounter modality (61% of all visits), and telephone encounters increased by 19%. Concurrently, asthma-related systemic steroid prescriptions and frequency of rhinovirus test positivity decreased, although air pollution levels did not substantially change, compared with historical trends. CONCLUSIONS: The COVID-19 pandemic in Philadelphia was accompanied by changes in pediatric asthma health care delivery patterns, including reduced admissions and systemic steroid prescriptions. Reduced rhinovirus infections may have contributed to these patterns.
Subject(s)
Air Pollution/statistics & numerical data , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Child Health Services/statistics & numerical data , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adenovirus Infections, Human/diagnosis , Adenovirus Infections, Human/epidemiology , Adolescent , Adrenal Cortex Hormones/therapeutic use , Ambulatory Care/statistics & numerical data , Asthma/physiopathology , Betacoronavirus , COVID-19 , COVID-19 Testing , Child , Child, Preschool , Clinical Laboratory Techniques , Coronaviridae Infections/diagnosis , Coronaviridae Infections/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Emergency Service, Hospital/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Hospitals, Pediatric , Humans , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Male , Nitrogen Dioxide , Ozone , Pandemics/prevention & control , Paramyxoviridae Infections/diagnosis , Paramyxoviridae Infections/epidemiology , Particulate Matter , Philadelphia/epidemiology , Picornaviridae Infections/diagnosis , Picornaviridae Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Syncytial Virus Infections/epidemiology , SARS-CoV-2 , Telemedicine/statistics & numerical data , Telephone , VideoconferencingABSTRACT
Blood, feces, and nasal swabs specimens were collected 12 to 24 hours after birth and then 3 times/week (blood only once per week) from one group of 10 calves until they were 10 weeks old and from a second group of 10 calves until they were 10 to 20 weeks old. Colostrum was collected from all calves' dams and tears from 5 randomly selected calves in the first group. All fecal and nasal specimens were assayed for bovine coronavirus (BCV) antigens by ELISA. Nasal epithelial cells were examined for BCV antigens by direct immunofluorescence. Isotype antibody titers to BCV in all samples from 5 calves in group 1 were evaluated by ELISA. Zinc sulfate turbidity (ZST) values were determined on the first serum samples taken from all calves in group 1. To determine whether any correlation existed between ZST values, isotype antibody titers to BCV (12 to 24 hours after birth), number of respiratory sick days, number of enteric sick days, or days to first shedding of virus, a Spearman rank order correlation coefficient was done. Bovine coronavirus respiratory tract and enteric tract infections were common on this farm. Most initial infections developed when calves were 1 to 3 weeks old; however, there were also multiple incidences of shedding of viral antigens or seroconversions at later times during the study. Persistence of infection or reinfection of the upper respiratory tract with BCV was common. Colostral antibody titers to BCV (IgG1) were in all cows at moderate amounts; however, calf serum antibody titers and ZST values (12 to 24 hours after birth) were highly variable.(ABSTRACT TRUNCATED AT 250 WORDS)