key: cord-0919790-y2hhh2ep authors: Curatola, Antonietta; Lazzareschi, Ilaria; Bersani, Giulia; Covino, Marcello; Gatto, Antonio; Chiaretti, Antonio title: Impact of COVID‐19 outbreak in acute bronchiolitis: Lesson from a tertiary Italian Emergency Department date: 2021-05-07 journal: Pediatr Pulmonol DOI: 10.1002/ppul.25442 sha: 5d68874b8e1a67965f899335c252413600af51a1 doc_id: 919790 cord_uid: y2hhh2ep AIM: To assess the impact of the coronavirus disease 2019 (COVID‐19) outbreak on pediatric emergency department (ED) visits for acute bronchiolitis during the epidemic season. METHODS: A retrospective analytical cross‐sectional study was performed in our hospital, analyzing medical charts of all children under 2 years of age with a diagnosis of acute bronchiolitis admitted to our ED in the last years. Demographics and clinical data of patients affected with acute bronchiolitis during the 2020–2021 season—COVID‐19 outbreak—were compared to those of the 5 previous years. RESULTS: We observed an average drop of 84% of the rate of acute bronchiolitis managed by pediatricians in ED in 2020–2021 compared with bronchiolitis seasons of 5 previous years. We also reported, during the COVID‐19 outbreak, a higher number of children affected by acute bronchiolitis referred to ED as Emergency Consultations who required hospitalization. Regarding etiological agents, no differences in respiratory virus circulation, especially RSV, were observed in the two groups. The multivariate analysis showed no correlation between the diagnosis of RSV bronchiolitis and COVID‐19 period or prematurity; lower age was associated with an increased likelihood of exhibiting RSV bronchiolitis (odds ratio 0.9; 95% confidence interval 0.86–0.95 p < .01). CONCLUSION: Our data emphasize the reduction in the rate of admission to pediatric ED for acute bronchiolitis during the COVID‐19 outbreak, regardless of changes in circulating respiratory viruses. Therefore we want to highlight the importance of nonpharmacological preventive hygiene measures that should be maintained even at the end of the COVID‐19 outbreak. Bronchiolitis is the most common acute infection of the lower respiratory tract in children under 2 years of age. 1 It affects around 1%-3% of all healthy children 2 and is a major cause of hospitalization during the epidemic season. Respiratory syncytial virus (RSV) is the most frequent pathogen involved, followed by other viruses such as rhinovirus, metapneumovirus, seasonal coronavirus, human bocavirus, (para) influenza, and adenovirus. 3 Every year, between September and March, pediatric hospitals in Italy note a large number of children affected by acute bronchiolitis. As with other infections, viruses that can cause bronchiolitis are transmitted through air droplets and aerosols and by direct or indirect contact with contaminated objects or surfaces. 2 As of December 2019, a new virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, quickly resulting in a pandemic 4 and different personal protective equipment have been adopted in all hospitals to prevent its circulation. 5 SARS-CoV-2 causes severe bilateral pneumonia in adult patients, which often require hospitalization in the intensive care setting and can rapidly lead to death. Otherwise, children have a lower incidence of this infection and milder clinical manifestations than adults; this could be due to specific phenotypic and functional characteristics of their immune system. 6 However, recently, cases of severe multisystem inflammatory syndrome (MIS-C) 7 and long-term coronavirus disease (COVID) effects were described in children. 8 Since the beginning of the COVID-19 outbreak, numerous sociosanitary measures have been adopted to reduce the spread of the virus: stay-at-home orders, social distancing, and nonpharmaceutical interventions, such as the use of face masks and hands hygiene. 9 These measures helped to contain the outbreak of SARS-CoV-2 but have also influenced the transmission of other respiratory viruses. 9 The aim of this study was to describe the rate of acute bronchiolitis in children admitted to the pediatric emergency department (ED) since the beginning of the pandemic, comparing these data with those of 5 previous years. We conducted a retrospective analytical cross-sectional study in a University Third-Level Hospital in Rome (Italy) with annual attendance at the pediatric Emergency Department (ED) of about 15,000 patients from 1 month to 18 years of age. In our country, parents can bring their children to ED freely, without a referral from their pediatrician. Patients were identified from the electronic hospital's information system used in the ED (Gipse®) by searching for the keywords "bronchiolitis" and "acute respiratory failure" for all patients under 2 years admitted to the ED. We excluded children with mild upper airway infections (rhinitis and pharyngitis), children over 2 years of age with other respiratory infections such as bronchitis or pneumonia, and those with other infectious diseases (gastroenteritis, encephalitis, meningitis, otitis, mononucleosis, etc.). Data were collected by pediatric specialists and included some information from the enrolled patients, such as age, sex, triage color code, pediatric clinical history (prematurity and other comorbidities), and outcome. The triage color codes, assigned to the patients by the triage nurse basing on the child's general conditions, symptoms, and vital signs, were: "red code" for emergency care, "yellow code" for high priority care, and "green code" for low priority care. We analyzed data of all children with a diagnosis of bronchiolitis admitted to our Pediatric ED from the start of the COVID-19 outbreak, February 2020-February 2021. These data were subsequently compared with that observed in the same period in the previous 5 years. In the group of hospitalized patients, we also analyzed microbiological data, especially the polymerase chain reaction for the identification of SARS-CoV-2 or other viruses on nasopharyngeal swabs. Board and Medical Ethics Committee of our institution. The number of admissions to the pediatric ED of our hospital in 2020, during the COVID-19 outbreak, was 7.873 children, compared with a median of 13,488 per year in the previous 5 years. This corresponds to a reduction of 42% of the number of total visits to our pediatric ED. Analyzing specifically the cases of acute bronchiolitis managed by pediatricians in ED, we observed 33 cases in the COVID-19 period compared to 1045 in the previous 5 years, which corresponds to a reduction of 84% in the rate of bronchiolitis admitted to ED ( Figure 1 ). This is a very important observation, given that bronchiolitis is one of the main viral infectious diseases in childhood during the epidemic season. Afterward, we compared the demographic and clinical data of patients affected by acute bronchiolitis referred to our ED in 2020-2021 season versus 5 previous years. Among the 33 children with bronchiolitis admitted to ED during the COVID-19 outbreak, 24 (72.7%) were male and the median age was 4 months (IQR 2.5-7). When comparing the 2020-2021 season to 5 previous years no major differences were found with regard to gender, prematurity, other comorbidities, and age of admission ( During the COVID-19 outbreak, our data showed a significant reduction in the total number of ED consultations, according to the literature. [10] [11] [12] [13] This was due primarily to the recommendations imposed at the beginning of the pandemic to avoid access to ED, except in cases of real need, but also to the fear of being infected with SARS-CoV-2. In the months following the national lockdown, the rate of visits to the ED remained consistently low, but the most interesting fact concerned infectious diseases. Different reports, from Italy and abroad, drawn attention to the reduction of acquired respiratory infections such as upper respiratory tract infections, streptococcal pharyngitis, otitis, bronchitis, and pneumonia. [14] [15] [16] [17] Lin et al. 18 Taiwan from February to April 2020, simultaneously to a higher proportion of urinary tract infections and asthma. According to our data, during the second COVID-19 wave in France, visits for bronchiolitis were 82.1% lower than predicted by the time series analysis. 19 After the initial "total lockdown" in Italy, the whole country Research data are not shared. ORCID Antonietta Curatola https://orcid.org/0000-0002-2430-9876 Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis Complementary and alternative medicine for the treatment of bronchiolitis in infants: a systematic review Viral bronchiolitis WHO. 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