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.