COVID-19 swept across the WHO European Region in 2020, and among the people most fearful of its impact were those who already had respiratory disease, especially asthma. What would happen to the regular health services they relied on, how would the hospitals cope, and were people with asthma more vulnerable to the virus?
2 new case studies from WHO/Europe look at the response to COVID-19 of some respiratory health services in the United Kingdom of Great Britain and Northern Ireland and Belgium, accompanied by WHO/Europe’s new scientific brief on COVID-19 and asthma. These were co-funded and technically supported by the European Respiratory Society (ERS)*, the past and current presidents of which are experts in the field and took part in interviews.
The ERS, accredited by WHO, is a not-for-profit, international organization of individuals, with a growing membership spanning over 160 countries. It prioritizes science, education and advocacy in order to promote lung health, alleviate suffering from disease and drive standards for respiratory medicine globally.
Keeping patients safe
In the United Kingdom, unprecedented changes had to be made quickly both in primary care and in hospitals. Patients had to cope with fear of the virus, fear of hospitals, rearrangements, suspended diagnostic services, uncertainties, and consulting by phone or online. A practice in Kent, which overnight reorganized its entire way of working to keep patients safe, reported that patients rose to the challenge: those with asthma, concerned by early reports of the risks of hospitalization, used their preventer medication more regularly and efficiently. Acute asthma attacks went down, as did asthma consultations. This was due to many factors ironically brought about by lockdown measures, such as wearing masks and driving less. These contributed to a reduction in the normal viral infections that can trigger an attack and a decrease in air pollution. Patients with severe asthma were sheltered – part of the government scheme whereby general practitioners identified those at high risk. For 3 months they had to stay at home, were supported, and provided with free food and medicine delivered to their house.
Professor Anita Simonds, President of the ERS and Consultant in Respiratory Disease and Sleep Medicine at the Royal Brompton Hospital in London, had to combine working night and day shifts in wards for COVID-19 patients with ensuring that their regular patients at home were cared for. She said, “We have an informal contract with our patients. It all depends on the patient relationship. It is important that people know where to go with a problem and don’t have to hold back and worry about bothering you. Many very sad and terrible things have happened, but there are some encouraging things too, which will hopefully benefit all patients in the future.”
Speed of change
In the face of extreme urgency and 3 waves of infection, the response of staff and the speed of reorganization was also crucial, as all non-urgent medical care was shut down. In Belgium, Professor Guy Joos, Chair of the Department of Internal Medicine and Head of the Department of Respiratory Medicine at Ghent University, said, “We can see the super-professional energy that is being generated to fight this war against COVID-19 everywhere – in nursing staff, physicians, management, our task force, paramedics, and pharmacists.”
Much value was put on communication, and online webinars helped the public keep up with treatments and developments. Professor Joos is also on the Advocacy Council of the ERS. In September 2020, the ERS organized an online congress with over 33 000 people from across Europe attending 263 sessions that were streamed across 10 channels.
Systematic reviews
WHO/Europe’s scientific brief on Asthma and COVID-19 looks at the important question of asthma patients and their vulnerability to the virus. Generally, people with asthma are considered at higher risk from respiratory infections, as is seen annually with influenza. At the outset of the COVID-19 pandemic, people with asthma were widely assumed to be at increased risk. However, as data emerged throughout 2020, the association between asthma and COVID-19 appeared less clear. This rapid systematic review looks at the evidence related to 3 questions – Is asthma associated with: an increased risk of acquiring SARS-CoV-2 and COVID-19 disease; hospitalization with COVID-19; and the severity of COVID-19 outcomes?
The conclusions find that it remains unclear whether asthma increases risk of infection or severe outcomes from COVID-19, but systematic reviews do not detect a clear increase in risk. People with asthma who appear more vulnerable to worse outcomes included those who also had chronic obstructive pulmonary disease, and people with non-allergic asthma compared to allergic asthma. Older age and non-white ethnicity also appear to confer greater risk as would be expected from data from the general population. Some data suggest an increased risk in people with more severe asthma. High-quality primary studies report conflicting results in some areas; considerable uncertainty persists. Further primary studies and comprehensive meta-analyses are needed.
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* The ERS, an accredited organisation by WHO, is a not-for-profit, international organization of individuals, with a growing membership spanning over 160 countries. It prioritizes science, education and advocacy in order to promote lung health, alleviate suffering from disease and drive standards for respiratory medicine globally.