key: cord-0995139-5dg5r88d
authors: Eng, Victoria; Moreno, Gary Paul; Chang, Jinny; Liebhaber, Myron
title: A Pediatric Asthma Camp Experience during the COVID-19 Pandemic
date: 2022-02-04
journal: Ann Allergy Asthma Immunol
DOI: 10.1016/j.anai.2022.01.041
sha: 17a2098f8528e06c4e4885338a59c7b4058d8738
doc_id: 995139
cord_uid: 5dg5r88d

nan

The primary aim of this study was to describe our experience with having a four day educational asthma program for children during the COVID-19 pandemic. Secondary aims were to investigate the effect of our educational program on airway inflammation and expiratory air flow from the lungs as measured by fractional exhaled nitric oxide (FENO) and peak flow (PF), respectively.

Since 1978, Camp Wheez has been a free annual day camp every August for children with asthma. Camp Wheez 2021 was open to all children with asthma aged 6 to 10 years of age, a reduced age range as compared to prior years to decrease gathering size. Camp Wheez 2021 reduced its capacity by half and decreased duration from five to four days to further decrease exposure and infection risk for campers. Written informed consent was obtained for each camper. All counselors and staff were required to be vaccinated for COVID-19 prior to camp.

Camp Wheez 2021 was conducted in accordance with CDC guidance for day camps: all activities were conducted outdoors, all campers and staff masked and maintained a physical distance of at least 6 feet, campers were cohorted into groups of 3 to 4 children to avoid mixing, campers were curbside-dropped off by parents to reduce the possible number of contacts, handsanitizing was enforced at the beginning and end of each rotation activity, point persons were designated to respond to any COVID-19 concerns, and all participants were counseled by healthcare staff to stay home for any COVID-19 symptoms. 1 Follow-up screening questionnaires for COVID-19 symptoms were done one week after camp completion. The NIOX Vero was used to measure FENO on day one (pre-camp), day four (post-camp) and about one week after camp (follow-up). PFs were measured daily at camp.

Wilcoxan signed rank test was used to compare mean FENOs pre-camp and post-camp.

A one-way analysis of variance (ANOVA) was used to compare mean peak flows between days one through four of camp. We took P <0.05 to indicate statistical significance.

Twenty children aged 6-10 years old were enrolled in Camp Wheez 2021, the average age of the campers was 8.5 + 1.3 years.

None of the children developed COVID-19 symptoms for the entire duration of camp. All follow-up screening questionnaires, done about one week after camp completion, were negative for COVID-19 symptoms. There were no statistically significant differences in mean FENO between pre-and post-camp, Table 1 . There was no statistically significant difference in mean peak flows amongst the days at camp, Table 1 . Campers were not informed of the baseline FENO nor PF and none of the campers received targeted instruction.

The COVID-19 pandemic has required flexibility to adapt to the every-changing environment. Social gatherings, including children's day camps, have been impacted and require the development of safe procedures and protocols. While a virtual platform was considered, the concern for screen fatigue was raised. 2 None of the campers developed COVID-19 symptoms throughout the camp duration nor at the one week follow-up questionnaire, though the community prevalence of COVID during early August 2021 was a daily case rate of 18.6 per 100,000 people in Santa Barbara County, which may be lower as compared to other points during the ongoing pandemic 3 . While we did not see a statistically significant difference in FENO nor PF before and after camp, the feedback and gratitude we received from both parents and campers make continuing Camp Wheez a worthy annual effort. This is one of the first studies looking at the feasibility of a pediatric asthma camp during the COVID-19 pandemic, with objective measures to evaluate the camp's effect on campers' airway status. FENO has been shown to decrease in children who attend summer asthma camps. 4 The low mean baseline FENO could represent potentially improved asthma control, reduced triggers, and medication adherence during the COVID-19 pandemic. 5 Our study should be interpreted in the context of several potential limitations. The small sample size and short duration of camp may not have been sufficiently powered to detect a statistically significant difference in FENO and PF or to prove an asthma camp does not increase the risk of COVID infection for our campers. While all counselors and staff vaccinated against COVID-19, testing was not required so asymptomatic infection may have gone undetected.

Rapid testing for COVID was not readily available at the time of Camp Wheez 2021.

Dependence on reported symptoms and questionnaires reflects subjective rather than objective measures for COVID-19 incidence.

We share our experience of having an educational asthma program for children during the COVID-19 pandemic, though no differences in FENO or peak flow were noted between groups. We strove to provide a balance of providing resources for our children with asthma while ensuring safety by following public health guidance. We wanted to be able to offer a much-loved experience for our children with asthma but understandably, the COVID-19 pandemic will make certain experiences impossible to replicate as compared to prior. The risks and benefits must always be weighed on an ongoing basis during the ever-changing climate of the COVID-19 pandemic. 

Summer Camps Toolkit: Guidance for Operating Youth and Summer Camps

Screen Time for Children and Adolescents During the Coronavirus Disease

Santa Barbara County Public Health Department. COVID-19 Community Data Dashboard

Role of asthma camp in improving the overall health of children with asthma

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort