Big decrease in bronchiolitis admissions seen in pandemic


By Michael Woodhead

21 Sep 2020

The lockdowns and handwashing policies introduced to curb COVID-19 have had the unexpected spin-off of a huge decrease in hospital admissions for paediatric acute respiratory illness, NSW figures show.

Rates of paediatric emergency department attendances, RSV positive tests and admissions for bronchiolitis in children under 16 are down substantially this winter compared to previous years, according to data released by the Sydney Children’s Hospitals Network (SCHN).

RSV is usually one of the most common viruses that cause hospitalisation in children in the cold season, but from April to June the observed mean frequency of RSV detection among Sydney paediatric hospital EDs was 94·3% lower than predicted on the basis of data from previous years (6 vs 105 positive tests), the figures show.

The reduction in RSV detections could not be accounted for by reduced testing because the number of tests done in 2020 was double the number done in previous years, the report authors said.

Similarly bronchiolitis admissions were down 85·9% (21 observed vs 151 expected) and ED attendances down 70·8% (377 observed vs 1292 expected) compared to predicted levels, according to an article published in Lancet Child and Adolescent Medicine.

Clinicians also observed an 89·1% reduction in bronchiolitis admissions to the intensive care unit.

The report authors said some reduction in RSV had been expected due to the public health measures such as physical distancing and school closures, but the size of the impact at a population level was startling.

They speculated that much of the benefit may have derived from enhanced handwashing, because this  damages the lipid envelope that surrounds respiratory syncytial virus, thereby impairing its ability to infect host cells. Conversely a similar impact was not expected for rhinovirus because the virus is non-enveloped and may be inherently less susceptible to inactivation by handwashing.

“The aggressive public health interventions aimed at preventing SARS-CoV-2 transmission has created a natural experiment of their effect on respiratory syncytial virus-associated illness and other communicable diseases. Here, we show a strong association between the implementation of these measures and the burden of respiratory syncytial virus disease among children in Sydney, NSW,” they wrote.

“There are legitimate concerns about a range of potential negative effects of lockdowns; it will be crucial to assess and quantify these consequences, and we support efforts to actively mitigate them. Nonetheless, our results suggest that the beneficial effect of lockdown on transmission of respiratory syncytial virus in NSW has been impressive.”

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