Changes in respiratory diseases in South Korea during the COVID-19 pandemic: an interrupted time series study

Abstract

Introduction: In South Korea, non-pharmaceutical interventions such as mask-wearing, hand washing and social distancing were strictly implemented to prevent the spread of COVID-19 after a national crisis alert was raised to the highest level early in the pandemic (23 February 2020). We aimed to investigate changes in the occurrence of respiratory diseases at the national level after the COVID-19 outbreak.

Methods: The study period was from 1 January to 1 August 2019 (213 days) and from 1 January to 31 July 2020 (213 days). Based on the National Health Insurance Service data, we analysed changes in the numbers of patients treated for respiratory diseases. The changes in the numbers of individuals using public transportation and visiting the theatre were investigated to assess the effect of social distancing after the national crisis alert was raised. Differences in daily cumulative numbers (DDCNs) in 2020 were calculated as follows: (daily cumulative number in 2020)-(cumulative number for that day in 2019). A change over time in DDCNs of <0 was taken as indication that the numbers decreased from 2019 to 2020. Segmented regression analyses were performed using generalised least squares method to identify changes in trends of DDCNs of patients treated for respiratory diseases and individuals using public transportation and visiting the theatre.

Results: After the national crisis alert was raised to the highest level, DDCNs of patients treated for respiratory diseases, individuals using public transportation, and those visiting the theatre exhibited a significant daily decline by 53.18 per 10 000 inhabitants (95% CI -65.86 to -40.49), 48.19 per 1000 inhabitants (95% CI -62.05 to -34.32) and 25.30 per 5000 inhabitants (95% CI -36.30 to -14.30), respectively, compared with before the national crisis alert was raised.

Conclusion: Non-pharmaceutical interventions to prevent the spread of COVID-19 significantly reduce the incidence of respiratory diseases.

Keywords: COVID-19; respiratory infections.

Figure 1

The daily number of patients newly diagnosed with COVID-19 and changes in numbers of patients treated for respiratory diseases and individuals using public transportation and visiting the theatre in South Korea during the COVID-19 pandemic. (A) As large-scale group infections occurred in mid-February 2020, the South Korean government raised the national crisis alert to the highest level on 23 February 2020. (B) The daily cumulative numbers of patients treated for respiratory diseases in 2020 started to decrease compared with those in 2019 after raising of the national crisis alert to the highest level. As the cumulative number of patients with COVID-19 increased, the differences in cumulative numbers of patients treated for respiratory diseases per 10 000 inhabitants and individuals using public transportation per 1000 inhabitants and visiting the theatre per 5000 inhabitants decreased.

Figure 2

The concept of DDCNs. DDCNs in 2020 were calculated as follows: (daily cumulative number in 2020)–(cumulative number for that day in 2019). A change over time in DDCNs of <0 was taken as an indication that the numbers of patients treated for respiratory diseases or individuals using public transportation or visiting the theatre decreased from 2019 to 2020. In contrast, a change over time in DDCNs of >0 was taken as an indication of the opposite trend. DDCN, difference in daily cumulative numbers.

Figure 3

Changes in trends in numbers of patients treated for respiratory diseases and individuals using public transportation and visiting the theatre. After the national crisis alert was raised to the highest level, the differences in cumulative numbers of (A) patients treated for respiratory diseases per 10 000 inhabitants and individuals using (B) public transportation per 1000 inhabitants and (C) visiting the theatre per 5000 inhabitants declined, compared with the previous year.