Association of Public Health Measures During the COVID-19 Pandemic With the Incidence of Infectious Conjunctivitis

Abstract

IMPORTANCE Infectious conjunctivitis is highly transmissible and a public health concern. While mitigation strategies have been successful on a local level, population-wide decreases in spread are rare.OBJECTIVE To evaluate whether internet search interest and emergency department visits for infectious conjunctivitis were associated with public health interventions adopted during the COVID-19 pandemic.DESIGN, SETTING, AND PARTICIPANTS Internet search data from the US and emergency department data from a single academic center in the US were used in this study. Publicly available smartphone mobility data were temporally aligned to quantify social distancing. Internet search term trends for nonallergic conjunctivitis, corneal abrasions, and posterior vitreous detachments were obtained. Additionally, all patients who presented to a single emergency department from February 2015 to February 2021 were included in a review. Physician notes for emergency department visits at a single academic center with the same diagnoses were extracted. Causal inference was performed using a bayesian structural time-series model. Data were compared from before and after April 2020, when the US Centers for Disease Control and Prevention recommended members of the public wear masks, stay at least 6 feet from others who did not reside in the same home, avoid crowds, and quarantine if experiencing flulike symptoms or exposure to persons with COVID-19 symptoms.EXPOSURES Symptoms of or interest in conjunctivitis in the context of the COVID-19 pandemic. MAIN OUTCOME AND MEASURESThe hypothesis was that there would be a decrease in internet search interest and emergency department visits for infectious conjunctivitis after the adaptation of public health measures targeted to curb COVID-19.RESULTS A total of 1156 emergency department encounters with a diagnosis of conjunctivitis were noted from January 2015 to February 2021. Emergency department encounters for nonallergic conjunctivitis decreased by 37.3% (95% CI, −12.9% to −60.6%; P < .001). In contrast, encounters for corneal abrasion (1.1% [95% CI, −29.3% to 29.1%]; P = .47) and posterior vitreous detachments (7.9% [95% CI, −46.9% to 66.6%]; P = .39) remained stable after adjusting for total emergency department encounters. Search interest in conjunctivitis decreased by 34.2% (95% CI, −30.6% to −37.6%; P < .001) after widespread implementation of public health interventions to mitigate COVID-19.CONCLUSIONS AND RELEVANCE Public health interventions, such as social distancing, increased emphasis on hygiene, and travel restrictions during the COVID-19 pandemic, were associated with decreased search interest in nonallergic conjunctivitis and conjunctivitisassociated emergency department encounters. Mobility data may provide novel metrics of social distancing. These data provide evidence of a sustained population-wide decrease in infectious conjunctivitis.

Association of Public Health Measures During the COVID-19 Pandemic With the Incidence of Infectious Conjunctivitis—Reply

“…In Reply We thank Bradshaw et al for their comments and concerns regarding our recent publication “Association of Public Health Measures During the COVID-19 Pandemic With the Incidence of Infectious Conjunctivitis.” To summarize our findings, we believe that there was a strong association between public health measures that were instituted during the COVID-19 pandemic and a decrease in the transmission of infectious conjunctivitis. Bradshaw et al assert that there may be other factors that led to a decrease in the emergency department (ED) visits during the pandemic, such as the desire to not contract COVID-19 and to vacate medical resources for more emergent conditions, that had a larger effect on patients with infectious conjunctivitis than on patients with our control diagnoses.…”

Deep sequencing analysis of clinical samples from patients with acute infectious conjunctivitis during the COVID-19 delta surge in Madurai, India

“… 7 . As respiratory viruses are also common etiologies of infectious conjunctivitis, there was some suggestion of decreased rates of infectious conjunctivitis during the early pandemic 8 . 9 .…”

Association of Public Health Measures During the COVID-19 Pandemic With the Incidence of Infectious Conjunctivitis

“…To the Editor We read the article by Lavista Ferres et al in the current issue of JAMA Ophthalmology with interest and congratulate them on their publication, which showed a decreased incidence of infectious conjunctivitis during the COVID-19 pandemic through the use of online search trends and information from their emergency department (ED) database. Although we agree that there were fewer cases of infectious conjunctivitis during the COVID-19 pandemic, we would like to provide additional insights into possible contributing factors, besides the fear of contracting COVID-19, that may have decreased infectious conjunctivitis ED visits while leaving the number of other presenting ocular pathologies unchanged.…”

“…Conjunctivitis is common and typically presents gradually, whereas corneal abrasion and posterior vitreous detachment, the negative controls used in Lavista Ferres et al, typically develop abruptly. This abrupt change in vision or pain would more likely startle a patient into feeling more inclined to visit an ED immediately because of perceived urgency, regardless of an ongoing pandemic.…”

“…A study found that oscillating and slow onset of disease are associated with delayed help seeking compared with rapid onset of disease . This could explain why a decrease in conjunctivitis-associated ED encounters was found, while the number of patients in the ED presenting with corneal abrasions or posterior vitreous detachments remained largely unchanged …”