The consequences of the COVID-19 pandemic are catastrophic, resulting in millions of sick people, hundreds of thousands of deaths in the U.S., and an economy that is tanking for many Americans. Despite this, there are other consequences of the pandemic that are becoming apparent, such as Zoom investors who are now very rich and a workforce that is adapting to virtual work, thus eliminating a lot of commuting and wasted office space. One year in, has the pandemic led to better health care in some cases?
There are some medical “silver linings” to the pandemic cloud. One of them relates to a dramatic drop in kids’ asthma ER visits during the lockdown. At Boston Children’s Hospital, the number of ER visits were down by 80% during the first two months of the state’s lock-down. At first blush, that might seem bad. But in fact a recent article concluded that the decreased ER visits meant the kids were actually doing better. At first, it was assumed that the drop in admissions resulted simply from fear of going to the ER during the pandemic, which in turn meant kids with asthma were more careful about regularly using their “controller” inhalers.
The study found that there were also other factors likely at play. It wasn’t just emergency room avoidance, but also pandemic-driven changes in individual, community and environmental circumstances. Since other pediatric emergency room visits leveled off after the first few months, but asthma-related visits remained in sharp decline, the study tried to identify the reasons and why they were persisting.
One was better medication adherence. Before the pandemic, it was estimated that only 54% of children who took asthma medications used them as prescribed, which resulted in more frequent and severe asthma attacks. During the pandemic, pediatricians report patients and family members refilling inhalers earlier and more often. The conclusion was that it wasn’t just emergency room avoidance, but a family’s better understanding of how medications, properly used, were able to maintain better control of symptoms over time.
Another factor, and one that will probably apply to many areas of medicine, was increased access to telemedicine. Sheltering in place means fewer office medical visits, but it also means patients can reach their doctors earlier and more often in the course of symptoms. There were fewer asthma emergencies as a result.
The article also pointed out that better preventive hygiene, emphasized to avoid COVID infections, also resulted in many fewer infections with common viruses, some of which can be lethal for children with asthma. One doctor said: “In trying to prevent the transmission of COVID-19, we’ve also prevented the transmission of these other seasonal viruses that cause asthma exacerbations.”
A final idea suggested by the study was that environmental factors led to fewer asthma ER visits: children had less contact with outdoor allergens such as pollen and dust on playgrounds and less participation in school sports. While this may be a negative factor for social development, an inadvertent outcome may be healthier asthma patients.
The overall conclusion of the study was that “pandemic-driven lifestyle changes have brought the pediatric community closer to solving a problem that has long plagued them: how to better protect children with asthma and save lives.” No one likes to look for silver linings in disasters, but when those exist they should be studied to see how changes might result in better outcomes over time, including in medical care.
