Introduction
The coronavirus disease 2019 (COVID-19) outbreak has led, since the
beginning of 2020, to the implementation of “social distancing”
practices including school closures in many countries, in order to
reduce the transmission of the disease1. When we
analyze the ”lockdown approach” during influenza pandemic, a mean
reduction of 29.6% in the peak of the epidemic after school closure was
reported by a systematic review of 31 studies2.
Another review presented a substantial reduction of up to 50% in the
transmission of disease among children after school closure during
influenza outbreak3,4.
To date, children appear to represent a low proportion out of total
confirmed COVID-19 cases and are usually asymptomatic or present with
mild symptoms5.
Asthma is the most common
pediatric chronic respiratory disease. Acute exacerbations continue to
be a major health concern among children worldwide and a common reason
for emergency department (ED) visits and hospitalizations in the
pediatric age. In a study examining asthma-related ED visits and
hospital admissions in the United State between 2010 and 2015, acute
asthma exacerbations accounted for 3% of ED visits and 6% of hospital
admissions among children aged 5-17 years6.
Respiratory tract infections and allergen exposure have been recognized
as the most common triggers for asthma exacerbations in children, with
suggested synergistic interactions between these
factors7. The seasonal pattern of asthma exacerbations
is well established8. A typical peak is in September,
when children return to school after the summer break. In school-aged
children, another peak has been viewed during the spring months, that
can be attributed to the spread of pollen allergens, also known as a
trigger for asthma exacerbation in this age group9.
There is scarcely any data on whether childhood asthma constitutes a
risk factor for COVID-19 severity.10
Since the introduction of the COVID-19 outbreak and education system
closure in Israel on March 15, 2020, we have noticed a decrease in
pediatric ED visits, specifically for asthma related visits, comparing
to previous years. Similar observations were recently reported with a
decline of 76% in the asthma related ED visits, and a lower
hospitalization rate, during COVID-19 lockdown.11
Therefore, we aim to examine the patterns of pediatric ED visits for
asthma exacerbations during the COVID-19 outbreak, pre- lockdown, during
lockdown and post lockdown, in comparison to the previous year.