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. 2023 Dec;78(12):1248-1253.
doi: 10.1136/thorax-2022-219957. Epub 2023 Jul 9.

Examining the effect of the COVID-19 pandemic on community virus prevalence and healthcare utilisation reveals that peaks in asthma, COPD and respiratory tract infection occur with the re-emergence of rhino/enterovirus

Terence Ho  1   2 , Abdullah Shahzad  3 , Aaron Jones  4 , Natya Raghavan  5   2 , Mark Loeb  2 , Neil Johnston  2
Affiliations

Examining the effect of the COVID-19 pandemic on community virus prevalence and healthcare utilisation reveals that peaks in asthma, COPD and respiratory tract infection occur with the re-emergence of rhino/enterovirus

Terence Ho et al. Thorax. 2023 Dec.

Abstract

Introduction: Airway disease exacerbations are cyclical related to respiratory virus prevalence. The COVID-19 pandemic has been associated with reduced exacerbations possibly related to public health measures and their impact on non-COVID-19 respiratory viruses. We aimed to investigate the prevalence of non-COVID-19 respiratory viruses during the pandemic compared with prior in Ontario, Canada and healthcare utilisation related to asthma, chronic obstructive pulmonary disease (COPD) and respiratory tract infection.

Methods: This is a population-based retrospective analysis of respiratory virus tests, emergency department (ED) visits and hospitalisations between 2015 and 2021 in Ontario. Weekly virus testing data were used to estimate viral prevalence for all non-COVID-19 respiratory viruses. We plotted the %positivity and observed and expected counts of each virus to visualise the impact of the pandemic. We used Poisson and binomial logistic regression models to estimate the change in %positivity, count of positive viral cases and count of healthcare utilisation during the pandemic.

Results: The prevalence of all non-COVID-19 respiratory viruses decreased dramatically during the pandemic compared with prior. Comparing periods, the incidence rate ratio (IRR) for positive cases corresponded to a >90% reduction for non-COVID-19 respiratory viruses except adenovirus and rhino/enterovirus. Asthma-related ED visits and hospital admissions fell by 57% (IRR 0.43 (95% CI 0.37 to 0.48)) and 61% (IRR 0.39 (95% CI 0.33 to 0.46)). COPD-related ED visits and admissions fell by 63% (IRR 0.37 (95% CI 0.30 to 0.45)) and 45% (IRR 0.55 (95% CI 0.48 to 0.62)). Respiratory tract infection ED visits and admissions fell by 85% (IRR 0.15 (95% CI 0.10 to 0.22)), and 85% (IRR 0.15 (95% CI 0.09 to 0.24)). Rather than the usual peaks in disease condition, during the pandemic, healthcare utilisation peaked in October when rhino/enterovirus peaked.

Conclusions: The prevalence of nearly all non-COVID-19 respiratory viruses decreased during the pandemic and was associated with marked reductions in ED visits and hospitalisations. The re-emergence of rhino/enterovirus was associated with increased healthcare utilisation.

Keywords: COPD epidemiology; COPD exacerbations; COVID-19; asthma epidemiology; viral infection.

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Conflict of interest statement

Competing interests: TH reports grants and non-financial support from Fisher and Paykel healthcare, and personal fees from Sanofi, Astra Zeneca, and Valeo outside the submitted work, and is supported by the McMaster Department of Medicine Early Career Research Award. NR reports grants and non-financial support from Boehringer Ingelheim, and personal fees from GlaxoSmithKline outside the submitted work. NJ received unrestricted funding from Astra Zeneca Canada which was used for this work.

Figures

Figure 1
Figure 1
Respiratory virus prevalence by number of positive tests during and prior to the COVID-19 pandemic. hMPV, human metapneumovirus; PIV, parainfluenza; RSV, respiratory syncytial virus.
Figure 2
Figure 2
Respiratory-related emergency department (ED) visits during and prior to the COVID-19 pandemic. COPD, chronic obstructive pulmonary disease; RTI, respiratory tract infection.
Figure 3
Figure 3
Respiratory-related hospital admissions during and prior to the COVID-19 pandemic. COPD, chronic obstructive pulmonary disease; RTI, respiratory tract infection.
See this image and copyright information in PMC

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