Impact of nonpharmacological COVID‐19 interventions in hospitalizations for childhood pneumonia in Brazil

Friedrich, Frederico; Garcia, Laura de Castro e; Petry, Lucas Montiel; Pieta, Marina Puerari; Carvalho, Gustavo; Zocche, Giovani; Ongaratto, Renata; Lumertz, Magali Santos; Brum, Marcos; Stein, Renato T.; Scottá, Marcelo Comerlato; Jones, Marcus Herbert; Pinto, Leonardo Araújo

doi:10.1002/ppul.25570

Cited by 16 publications

(12 citation statements)

References 28 publications

(73 reference statements)

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“…Other countries reported a massive decrease in pediatric CAP after NPIs implementation [23,24]. Among these countries, some experienced an important total duration of school closure (57 weeks in Brazil), whereas other decided to limit this measure (12 weeks in France and 6 weeks in Switzerland) [25].…”

Section: Discussionmentioning

confidence: 99%

Fall of Community-Acquired Pneumonia in Children following COVID-19 Non-Pharmaceutical Interventions: A Time Series Analysis

et al. 2021

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Non-pharmaceutical interventions (NPIs) were implemented to reduce the spread of coronavirus disease 2019 (COVID-19). A first national lockdown was decided in France on the 17 March 2020. These measures had an impact on other viral and non-viral infectious diseases. We aimed to assess this impact on community-acquired pneumonia (CAP) in children. We performed a quasi-experimental interrupted time series analysis. We used data from a French prospective surveillance system of six pediatric emergency departments (PEDs). All visits from 1 January 2017 to 31 December 2020 were included. Pre-intervention period was before 17 March 2020 and post-intervention period was after 18 March 2020. We estimated the impact on the weekly number of visits for CAP and CAP admission using quasi-Poisson regression modeling. A total of 981,782 PEDs visits were analyzed; among them, 8318 visits were associated with CAP, and 1774 of these were followed by a hospital admission. A major decrease was observed for CAP visits (–79.7% 95% CI [–84.3; –73.8]; p < 0.0001), and CAP admission (–71.3% 95 CI [–78.8; –61.1]; p < 0.0001). We observed a dramatic decrease of CAP in children following NPIs implementation. Further studies are required to assess the long-term impact of these measures.

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Section: Discussionmentioning

confidence: 99%

Fall of Community-Acquired Pneumonia in Children following COVID-19 Non-Pharmaceutical Interventions: A Time Series Analysis

et al. 2021

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“…Using an interrupted time-series design approach, we showed that decreased hospitalized patients and deaths from communityacquired pneumonia coincided with rising public awareness of personal precautions before the governmental CACPs. During the COVID-19 pandemic, a decrease in non-COVID-19 pneumonia has been reported worldwide, 3,[30][31][32][33] which was often attributed to the implementation of a wide range of NPIs including universal mask mandates, physical distancing policies, and lockdowns. However, the relative contributions of different types of NPIs are not necessarily well understood; the reduction in community-acquired pneumonia during the COVID-19 pandemic that has been reported to date was observed in the context of concurrent implementations of CACPs and personal precautions by the general public, and their separate effects could not be estimated.…”

Section: Discussionmentioning

confidence: 99%

Decreased hospitalizations and deaths from community-acquired pneumonia coincided with rising public awareness of personal precautions before the governmental containment and closure policy: A nationwide observational study in Japan

Tashiro

Sato

Endo

et al. 2022

Preprint

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BackgroundThe effectiveness of population-wide compliance to personal precautions (mask-wearing and hand hygiene) in preventing community-acquired pneumonia has been unknown. In Japan, different types of non-pharmaceutical interventions from personal precautions to containment and closure policies (CACPs, e.g. stay-at-home requests) were sequentially introduced from late January to April 2020, allowing for separate analysis of the effects of personal precautions from other more stringent interventions. We quantified the reduction in community-acquired pneumonia cases and deaths and assessed if it coincided with the timing of increased public awareness of personal precautions before CACPs were implemented.MethodsA quasi-experimental interrupted time series design was applied to non-COVID-19 pneumonia hospitalization and 30-day death data from April 2015 to August 2020 across Japan to identify any trend changes between February and April 2020. We also performed a comparative analysis of pyelonephritis and biliary tract infections to account for possible changes in the baseline medical attendance. These trend changes were then compared to multiple indicators of public awareness and behaviors related to personal precautions, including keyword usage in mass media coverage and sales of masks and hand hygiene products.FindingsHospitalizations and 30-day deaths from non-COVID-19 pneumonia dropped by 24.3% (95% CI 14.8 to 32.8, p < 0.001) and 16.1% (95% CI 5.5 to 25.5, p < 0.005) respectively in February 2020, before the implementation of CACPs, whereas pyelonephritis and biliary tract infections did not suggest a detectable change. These changes coincided with increases in indicators related to personal precautions rather than those related to contact behavior changes.InterpretationCommunity-acquired pneumonia could be reduced by population-wide compliance to moderate precautionary measures, such as wearing masks and hand hygiene.FundingJSPS KAKENHI Grant Number 22K17329 and JSPS Overseas Research Fellowships.Research in contextEvidence before this studyThe impact of personal precautions on community-acquired respiratory disease has been studied mainly for influenza and coronavirus infections, but no studies have evaluated the number of hospitalizations or 30-day deaths from overall non-COVID-19 pneumonia. We searched PubMed and medRxiv until May 3, 2022, for studies on the impact of personal precautions on community-acquired pneumonia using the following terms in the title and abstract: ((personal precaution*) OR (mask*) OR (non-pharmac*) OR (nonpharmac*)) AND (pneumonia). Before November 2019, when COVID-19 first emerged, no study was found that evaluated the impact of personal precautions such as masks on all-cause community-acquired pneumonia. After the emergence of COVID-19, there have been several reports of the relationship between non-pharmaceutical interventions (NPIs) and a decrease in non-COVID-19 pneumonia, but all reports evaluated the impact of general NPIs that aggregated different types of interventions, including personal precautions, physical distancing, and movement restrictions, and no studies were found that evaluated the impact on overall non-COVID-19 pneumonia from personal precautions alone.Added value of this studyOur study found a reduction in hospitalizations and deaths from non-COVID-19 community-acquired pneumonia in Japan, especially those among the elderly population, had been detectable before the implementation of physical distancing policy and movement restrictions including stay-at-home requests. This reduction coincided with an increase in multiple indicators of public awareness of personal precautions, suggesting the potential benefit of population-level compliance to personal precautions (mask wearing and hand hygiene) against community-acquired pneumonia.Implications of all available evidenceMaintaining a certain level of personal precautions in the population, e.g. by mask recommendations, may provide a positive public health impact even in the post-COVID era via reduced incidence of a spectrum of infectious diseases: most importantly, pneumonia as a major cause of death in the elderly. Since personal precautions are more sustainable than stringent restrictions such as lockdowns and could largely coexist with normal economic activities, long-term recommendations for personal precautions, at least in certain parts of the society, may warrant further discussion.

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“…This data analysis methodology has been well documented in the literature. 7,9 The Brazilian National Health Agency provides the percentage of the population that has health insurance per year, which we excluded from the denominator. 17 To evaluate the effect of COVID-19-containment strategy on the incidence of asthma, the average incidence (hospitalizations per 100,000 inhabitants [Brazilian Institute of Geography and Statistics]) 14 of each month (April-December) of the 2016-2019 set was compared with the incidence of asthma in the period April to December of 2020, in each age group analyzed (1-14 years, 20-59 years, and older than 60 years).…”

Section: Statisticsmentioning

confidence: 99%

“…4 Such measures may impact the epidemiology of various respiratory diseases all around the world. 3,[5][6][7][8][9][10] Patients with chronic respiratory diseases can benefit from these measures. Chronic respiratory diseases are diseases of the airways and other structures in the lung.…”

mentioning

confidence: 99%

Impact of COVID-19 mitigation strategies on asthma hospitalizations in Brazil

Friedrich¹,

Petry²,

Brum³

et al. 2022

Journal of Allergy and Clinical Immunology: Global

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Impact of nonpharmacological COVID‐19 interventions in hospitalizations for childhood pneumonia in Brazil

Cited by 16 publications

References 28 publications

Fall of Community-Acquired Pneumonia in Children following COVID-19 Non-Pharmaceutical Interventions: A Time Series Analysis

Fall of Community-Acquired Pneumonia in Children following COVID-19 Non-Pharmaceutical Interventions: A Time Series Analysis

Decreased hospitalizations and deaths from community-acquired pneumonia coincided with rising public awareness of personal precautions before the governmental containment and closure policy: A nationwide observational study in Japan

Impact of COVID-19 mitigation strategies on asthma hospitalizations in Brazil

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