COVID-19 Lockdown Linked to Fewer Flares in Children in Small Study

Limits placed on social interaction by the COVID‐19 pandemic appear to have led to a drop in the number of pulmonary exacerbations — periods of a sudden worsening in lung health — in children with cystic fibrosis (CF), according to a small U.S. study.

This finding — in children ages 2 to 11 treated at a single CF center — suggests that pandemic-enforced restrictions reduced their exposure to lung infection-causing viruses in general, supporting the known role of these viruses in pulmonary flares, the researchers wrote.

The study, “Reduction of pulmonary exacerbations in young children with cystic fibrosis during the COVID‐19 pandemic,” was published as a letter to the editor in the journal Pediatric Pulmonology.

Pulmonary exacerbations, which can lead to long-term lung damage, are frequent among people with CF. Notably, lung infections caused by respiratory viruses are a common trigger of exacerbations.

“The COVID‐19 pandemic resulted in widespread restrictions on social interactions and lockdowns in many areas of the world,” the researchers wrote, adding that these restrictions might lower the risk of pulmonary exacerbations “by reducing exposure to viruses in general, not just SARS‐CoV2,” the virus that causes COVID‐19.

To determine if a connection exists, researchers compared 2019 and 2020 rates of pulmonary exacerbations in children with CF being followed at the Riley Hospital for Children’s CF Center in Indiana.

Specifically, they retrospectively analyzed the number of exacerbations reported over two distinct time periods: Jan. 1–March 15, 2019 and 2020, with this period for last year corresponding to the months before COVID-19 detection in Indiana (pre-COVID-19 period); and those of March 16–May 1, 2019 and 2020, representing the 2020 months of peak COVID-19 incidence there (COVID-19 peak period).

A first case of COVID-19 infection in Indiana was reported on March 1, 2020, and a statewide lockdown was initiated on March 23. Spring 2020 infection rates in that state were reported to peak on April 23.

The analysis included data from 80 children treated in 2019, and 78 children in 2020.

Pulmonary flares were identified based on a child’s signs and symptoms, lung function data (when available), and the clinician’s decision to prescribe antibiotics.

For every event, demographic and clinical information, as well as the type of patient-clinician interaction (hospital visit, in-person clinic visit, telemedicine/telehealth, or phone call), were collected.

A significant drop in the number of pulmonary exacerbations was seen in both 2020 time intervals relative to those of 2019, with this decline more pronounced during the peak of COVID-19 infection. In total, 56 flares were reported in 2019 vs. 42 in 2020 for the pre-COVID period, and 35 (2019) vs. 14 during 2020’s peak period.

The drop in exacerbation rates observed during the opening months of 2020 may be related “to the fact that patients were already engaging in a degree of self‐isolation before the statewide lockdown,” the researchers wrote.

Not surprisingly, significantly fewer flares were reported through in-person clinic visits during the COVID-19 peak period compared with those months a year earlier (42.9% in 2019 and 7.1% in 2020), with a much larger proportion being identified via phone calls over the same period (45.7%  and 71.4% in 2020).

This “reflects the increased use of telehealth at the height of the COVID‐19 pandemic in Indiana,” the team wrote.

Notably, the children’s clinical features were similar for both years, suggesting that the observed differences “were not due to an overall improvement in the health of our patients,” the researchers added.

Only 16% of clinic visits during the COVID-19 peak period were conducted in‐person, compared with 100% of those in 2019 and in 2020’s pre-COVID-19 period.

“[R]estrictions on social interaction due to the COVID‐19 pandemic were associated with a lower number of [pulmonary exacerbation] events at our pediatric CF Center, suggesting that these restrictions also reduced exposure to other respiratory viral infection[s] in children with CF,” the researchers wrote.

These results are consistent with data from previous studies showing a considerable drop in the activity of other viruses, like influenza, during lockdowns. They also support viral lung infections being a key trigger of pulmonary exacerbations in CF patients.

The researchers suggested that the reduction in pulmonary exacerbations found may also be related to better treatment adherence during the COVID-19 peak period, as both patients and parents were at home.

While further studies are needed to confirm these findings, they may help clinicians “anticipate the burden of CF lung disease should severe lockdowns due to COVID‐19 occur again in their region,” the researchers wrote.