ABSTRACT
The number of pediatric emergency department (PED) visits fell significantly during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the ongoing pandemic on PED patients suffering from asthma attacks in Taiwan has not been studied. We thus analyzed patients with asthma attacks visiting a PED during the early stage of the COVID-19 pandemic and the following (resurgent) waves. We retrospectively studied pediatric patients with asthma attacks who visited the PED from 01 January 2019 to 30 September 2021. We retrieved patient numbers, demographic characteristics, triage acuities, medications, and PED dispositions during the various waves of the COVID-19 pandemic. A total of 1842 patients with asthmatic attacks presented to the PED during the study period. PED visits caused by asthmatic attacks declined by 55% after the first COVID-19 outbreak in early 2020 (p = 0.009) and fell even more remarkably (by 85%) in mid-2021 (p = 0.038), during the time when the numbers of confirmed COVID-19 cases skyrocketed (the second wave). However, neither the high-triage acuity rate nor the rate of admission differed between the two periods (p = 0.08 and 0.406, respectively). However, the proportion of systemic corticosteroid (SCS) prescriptions increased during the pandemic (81.90 vs. 77.77%, p = 0.029). The COVID-19 pandemic notably impacted the number of asthmatic PED visits not only during the first peak period but also during the following waves, but asthma severity did not vary over time. Physicians tended to prescribe more SCSs during the pandemic to control respiratory symptoms. We suggest that SCSs should be used cautiously even during the pandemic to minimize their adverse effects. Copyright © 2022 The Author(s). Published by MRE Press.
ABSTRACT
The pandemic of coronavirus disease 2019 (COVID-19) posed a severe threat to the public health worldwide. We focus on frail elderly adults who are the most vulnerable population, especially residents of long-term care facilities or nursing homes. Studies have shown a strong correlation between frailty and COVID-19 mortality in the older population. Meanwhile, older adults possess various characteristics in immune responses, symptoms presentation, and disease outcomes. Frailty decreases resilience in older people and makes the situation more complex. Moreover, frailty is a strong predictor of prognosis in COVID-19 infected patients. Vaccination is considered an excellent way to stop SARS-CoV-2 spreading. Frail elderly adults are the most vulnerable population, and vaccination programs are implemented first in this group. However, most clinical trials did not enroll frail elderly adults in studies of COVID-19 vaccine development. Real-world evidence of vaccination in older adults with frailty is scanty. We reviewed available data from long-term care facilities and nursing homes. We focused on immune responses, vaccine effectiveness, and safety of the COVID-19 vaccine. Vaccination could elicit antibody titers and cellular T cells responses in frail elderly adults. SARS-CoV-2 infection, hospital admission, and mortality in residents and staff in long-term care facilities were decreased. COVID-19 vaccination was safe and could prevent disease outbreak in long-term care facilities. Nevertheless, doctors should evaluate frailest or terminal elderly adults carefully. Frailty-based vaccination program could help to evaluate who should receive the COVID-19 vaccine. Copyright (c) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.