Be’er Sheva, Israel—Pharmacists did not just imagine an upsurge in respiratory infections when social restrictions were lifted during the COVID-19 pandemic.
An Israeli study involving 386,711 patients in community clinics examined whether the lifting of lockdowns and other restrictions was associated with changes in the spread of certain infectious diseases across age groups.
The report in JAMA Network Open reveals an increase in incidence rates of various infections among small children aged 0 to 3 years, as well as a jump in respiratory infections among all age groups during 3 months after the easing of COVID-19-related social restrictions.
"These findings suggest that as global COVID-19 vaccination rates increase and social restrictions are lifted, patterns of non–SARS-CoV-2 infection transmission observed late spring in Israel may be seen elsewhere, requiring early preparation," the authors advise.
The study points out that social restrictions designed to limit the transmission of SARS-CoV-2 might have also been associated with decreased rates of other communicable diseases, adding, "Evidence suggests that infection incidence rates (IRs) are rebounding after easing of social restrictions (e.g. mask mandates). The re-emergence of infectious disease complicates efforts to manage the ongoing COVID-19 pandemic."
Researchers sought to document increased rates of frequently occurring infectious diseases after a successful SARS-CoV-2 vaccination campaign in Israel and cessation of social restrictions. To do that, they reviewed records for more than 1.2 million respiratory and gastrointestinal infectious diseases at 209 community clinics in southern Israel from 2017 to 2021. Patients had a mean age of 27.29 years and were 52.3% male.
The study team estimated the incidence of infectious diseases in the first 3 months after the easing of social restrictions from April to June 2021 across age groups.
Results indicate that children aged 0 to 3 years had significantly increased rates of respiratory and gastrointestinal infection diagnoses (IR ratio, 2.64; 95% CI, 2:30-2.91; P <.001). In addition, researchers note, the incidence of non-SARS-CoV-2 respiratory infections were significantly increased across age groups (IR ratio, 1.74; 95% CI, 1.56-1.94; P <.001).
"These morbidity trends observed in Israel suggest that similar trends could occur in coming months in other countries after easing of COVID-19Ðrelated restrictions, particularly with the ongoing challenges of SARS-CoV-2 variants," the authors conclude.
In Israel, after a national campaign that vaccinated most adults in Israel against COVID-19 by March 25, 2021, the government began easing social restrictions. Those were completely rescinded on April 18, although the indoor mask requirement was later reinstated. Social restrictions included nonpharmaceutical interventions (NPIs) to reduce COVID-19 mortality and morbidity, such as shelter-in-place orders, universal masking, social distancing, and three national lockdowns.
The authors point out that the social restrictions were associated with decreases in non-SARS-CoV-2 infections, such as influenza and the common cold, adding, "There is growing global evidence suggesting that NPIs are associated with decreased rates of COVID-19 and non–COVID-19 infectious diseases, and thus a decreased burden associated with seasonal influenza, other upper and lower respiratory infections, and food-borne diseases."
They note, however, that after major declines in 2020 the incidence of respiratory infections is increasing in the Southern Hemisphere and the U.S., pointing to the sharp resurgence in respiratory syncytial virus infections among infants.
"The increase of infectious disease rates along with the arrival of the delta variant of SARS CoV-2 are of significant concern, given that already-strained health care systems may become overwhelmed," the researchers emphasize. "Now that North American and most European countries have immunized most citizens, social restrictions are being lifted. This suggests that patterns of non–COVID-19 communicable disease transmission observed in late 2021 spring in Israel may be seen in other Organization for Economic Cooperation and Development nations later this year."
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