91 The impact of non-pharmaceutical public health interventions on hospital admissions and mortality from common causes of pediatric respiratory distress: a single center perspective

BACKGROUND: In response to the COVID-19 pandemic, jurisdictions around the world implemented policies to reduce COVID-19 transmission through public masking, travel restrictions, and closure of non-essential businesses. Collectively known as non-pharmaceutical interventions (NPI), these strategies reliably reduce the spread of COVID-19. International data suggests NPI also reduce hospitalizations for pediatric respiratory infections and their consequences, particularly asthma exacerbation. However, few Canadian studies have examined the impact of NPI on hospitalizations for common causes of pediatric respiratory distress. OBJECTIVES: This study describes the impact of NPI on admissions for bronchiolitis, pneumonia, and asthma at a Canadian pediatric tertiary care centre. DESIGN/METHODS: A retrospective chart review was conducted including all pediatric patients <18 years admitted to the general pediatric and pediatric intensive care units with bronchiolitis, pneumonia, or asthma. Data regarding diagnosis, length of hospitalization, and mortality were collected before (September 2016-March 2020) and in the 6 months after provincial NPI implementation (March 2020-September 2020). NPI were present throughout this period, however, specific measures varied due to evolving public health orders. Chi-squared testing was conducted to describe the impact of NPI on number of admissions, length of hospitalization, and mortality. RESULTS: Participants (n=1631) included 111 (6.8%) patients <1 month, 878 (53.8%) patients 1-23 months, 331 (20.3%) patients 24 months-4 years, and 311 (19.1%) patients ≥5 years. A mean of 205 patients were admitted every 6 months with respiratory distress (bronchiolitis, pneumonia, and/or asthma) prior to NPI implementation. During this timeframe, the 6-month mean admissions due to asthma, pneumonia, and bronchiolitis were 48, 56, and 101, respectively. In the 6 months following NPI implementation, there were 56 admissions for respiratory distress, including 15 for asthma, 19 for pneumonia, and 22 for bronchiolitis. Mean length of stay increased following the implementation of NPI from 8.49 to 11.68 days, whereas 6-month mean mortality decreased from two to zero deaths. Results did not attain statistical significance (p>0.05). CONCLUSION: Results suggest NPI reduce hospitalizations and mortality from bronchiolitis, pneumonia, and asthma. Given the similar seasonality of these conditions, periodic use of NPI beyond the COVID-19 pandemic may reduce pediatric morbidity and mortality from common causes of respiratory distress. However, additional research is needed to describe the relationship between NPI and length of hospitalization. Future studies should also examine the impact of NPI on other pediatric infectious diseases to better characterize their utility.