TORONTO — Scientists and doctors across Canada and around the world have seen a dramatic drop in hospital cases of chronic lung diseases during the course of the pandemic and believe public health guidelines have helped halt the spread of common viruses that would typically trigger these serious respiratory illnesses.
With doctors witnessing patients becoming healthier over the last year, some say they will ask vulnerable patients to consider maintaining some of the public health measures, like wearing a mask, even when they no longer become necessary.
“The effect is staggering. The number of hospitalizations that we’ve prevented related to COPD and non-COVID pneumonia, actually exceeds the number of patients that have been hospitalized for COVID, at least in Alberta’s 15 busiest hospitals,” Dr. Eddy Lang, an emergency physician and professor at the University of Calgary, told CTV News after analyzing data from 15 hospitals in Alberta.
“What we might be looking at here is potentially the most remarkable silver lining of the whole pandemic.”
Nearly six million people around the globe died in 2019 from COPD and lower respiratory infections according to the World Health Organization and lung infections caused by COPD is the number one cause of hospitalization in most of the developed world, said Lang. He is the co-author of a study published this month that looked at the impact of COVID-19 on hospital admissions and emergency department visits. The study found that Alberta saw a dramatic 30 per cent drop in hospitalizations among those with chronic respiratory conditions, a figure Lang says is actually an underestimate.
NO MORE HOSPITAL VISITS
For chronic sufferers, pandemic-related precautions have given some of their best 15 months in years.
Louise McDonald, a 66-year-old resident of Cornwall, Ont. used to make a trip to the ER three or four times a year for a serious lung infection, at times staying overnight for a day or two. Following two open heart surgeries in 2017 and 2019, McDonald had been extra careful. But the pandemic changed everything.
“I’ve stayed so healthy — I’m probably healthier than I’ve been in a long time,” she told CTV News.
Diagnosed with COPD five years ago, McDonald was on three different inhalers and would get the cold, flu, and pneumonia all the time. The nature of COVID-19 as primarily a respiratory disease made her even more cautious.
“The pandemic scared the dickens out of me when I first heard about it,” McDonald said.
Today, her three inhaler medications are down to two. She still gets short of breath and uses Ventolin to help, but she is playing golf again, doing all her own housework, and cutting the lawn.
“The Flovent which I use morning and evening has now been eliminated,” she said. Flovent is a corticosteroid inhaler used as a long-term treatment for asthma.
McDonald’s physician Dr. Shawn Aaaron says his respirology colleagues across the country are all reporting a 15- to 20-per-cent drop in volume of patients coming into the ER with chronic lung disease.
“They’re simply not getting the other viral respiratory tract infections that they were picking up routinely prior to the pandemic,” said Aaron, who is a respirology professor at the University of Ottawa and a senior scientist with the Ottawa Hospital Research Institute specializing in COPD, asthma, and cystic fibrosis.
“They’re staying safer, they’re not in close contact with other people and therefore they’re not getting influenza, they’re not getting rhinovirus — which are the common cold viruses — and they’re not getting the other infections that set them off and make them so sick.”
If the 15- to 20-per cent drop in COPD and other lung infections can be sustained, he says it would be a “massive deal” and would “easily” save the health care system over $100 million a year and probably more.
NOT BECAUSE THEY WERE SCARED
Both Aaron and Lang say the dramatic drop in cases is not due to patients being fearful of going to the hospital during the pandemic.
“Originally, we thought it was because they were scared … But as it kept playing out over the last 16 months, we realize it has nothing to do with fear of COVID. It has more to do with the fact that they’re not getting sick,” Aaron said.
Doctors confirmed this when they saw their patients and followed up.
“Almost universally, the answer was, ‘Well you know doc, before the pandemic started, I would be in two or three times a year to be emerged because I caught a lung infection, and lately I’ve just not been getting those lung infections anymore.’ So the patients were clearly better than they were … pre-pandemic,” Aaron said.
In Lang’s research, he compared COPD and pneumonia to other common conditions, and did not see any significant changes in cases of appendicitis, heart failure, heart attacks, or strokes. While there are some tragic exceptions, Lang said only chronic lung diseases and acute lung infections like pneumonia that are associated with the common cold virus saw a dramatic drop in numbers from a population-wide perspective.
“So we’re pretty sure that this is a real effect of the reduced burden of cold viruses and not because people are scared to come to the hospital,” Lang said.
“What I think we’re seeing is something that I think all Canadians can relate to — because most Canadians have not caught a good old fashioned cold in 15 months.”
A GLOBAL TREND
And it’s not just Canada. Doctors and researchers around the world have seen similar trends and they attribute it to public health protocols like wearing a face mask and physical distancing. Korea saw a dramatic decline in billing fees for hospitalizations related to influenza, pneumonia, and COPD and asthma across all sex and age groups, according to a study published in March. A UK study found that the lockdown was associated with a 48 per cent reduction in emergency admissions for COPD in Scotland and Wales, with no corresponding increases in COPD deaths. Another study out of Singapore published in December and one conducted in Portugal from April saw similar trends.
Meanwhile, the possibility there might not be a flu season was foreshadowed at the end of last summer, when Australia reported no flu season.
“Who could have possibly imagined that a virus that kills up to 650,000 people around the globe annually, has just disappeared? So, clearly whatever we’re doing with these public health measures is suppressing the transmission of common viruses, and it’s allowing us to appreciate how important a role they play,” Lang said.
There were so few cases in Canada — only 72 confirmed as of May 22, 2021 — and no evidence of any community transmissions that the public health agency did not declare a flu season. During the 2019 to 2020 season, government data reported 55,379 cases.
“This is the first year in recorded history in the last 50 or 100 years that we have not seen influenza in this country. And again, it’s all that natural experiment of pandemic restrictions and isolation procedures,” Aaron said.
The studies along with the drop in flu cases not only demonstrate the global impact of pandemic safety protocols, but also underscores the critical role the common cold plays in oratory diseases, experts say.
“The common cold may actually be best considered the common enemy,” said Lang.
But whether the positive health impact can be sustained remains to be seen, experts say: people would need to make lasting changes to their habits and lifestyles — whether it is wearing a mask in public, or when they are sick, avoiding close contact with people outside their ‘’bubble,” or some combination of measures, for example. This applies not only to patients with respiratory conditions, but also those who are vulnerable because their immune systems do not work well or are compromised, such as cancer and transplant patients.
“Whether they comply or not is completely up to them. You cannot force anyone to wear a mask if they don’t want it once pandemic restrictions are over, but I’m going to give them the advice that they’re going to be healthier if they practice social distancing and masking and all the things we’ve been doing up to now,” said Aaron.
Lang too, makes the distinction between mandating masks as part of a public health emergency like the pandemic and giving people the choice of how to act based on emerging knowledge and research once the pandemic recedes.
Still, he says there are many questions that remain, including what aspect of these public health measures have made the greatest impact and what is the least intrusive amount that would be needed to maintain these benefits.
“In some countries it’s to prevent, to be respectful of people and not to transmit a cold. So right now the mask is hated. It’s a symbol of our imprisonment of the effect of the lockdown,” Lang acknowledges.
“But what we need to perhaps imagine in the future, is that it will be a symbol of respect and love to our elders, and to those with chronic lung disease, because we want to keep them safe.”
Many across the country are already talking about keeping some level of the habits developed during the pandemic, including mask-wearing. For McDonald, the measures have improved her health enormously.
“It surprises me that I am staying healthy. But I am so careful,” she said.
“I will continue to wear a mask in public. I think the mask-wearing has been absolutely fabulous.”
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