Beginning to emerge from the COVID-19 pandemic: What’s next?

Surveying the article topics in the May 2021 issue of Contemporary Pediatrics, there is a small but promising sense of comfort that perhaps, as a nation, we are at last defeating the COVID-19 pandemic. For the first time in 15 months, there are no major articles on COVID-19. The news release by the US Food and Drug Administration on May 10, 2021 and the Centers for Disease Control and Prevention on May 13, 2021 of the emergency use authorization (EUA) for the Pfizer/BioNTech COVID-19 vaccine for adolescents aged 12 to 15 years provides further assurance for defeating the COVID-19 pandemic. All pediatric health care providers and many parents have been anxiously awaiting the EUA for the Pfizer/BioNTech vaccine. The data from the randomized control trial (RCT) for 12- to 15-year-old participants are so powerful: 100% efficacy for the children enrolled in the study. Now is the time for all pediatric providers to speak with their parents about getting their children immunized.

Asthma presentation in children and adolescents during the COVID-19 pandemic

At the beginning of the pandemic, children and adolescents who had a confirmed diagnosis of intermittent or persistent (mild, moderate, or severe) asthma, were feared to be at high-risk for contracting COVID-19 and poor outcomes. However, we now know that children and adolescents with a diagnosis of asthma have not presented with increased wheezing or asthma exacerbations during the COVID-19 pandemic. After reviewing data from children and adults who were infected with COVID-19 in China during the initial outbreak, a large epidemiological study did not include asthma as a risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or an increased risk for severe COVID-19 disease or death.¹ Additionally, the pathology of SARS-CoV-2 infection shows that the virus’s spike protein binds to the angiotensin converting enzymes (ACE) 2 receptors and children have lower ACE 2 receptors than adults, thus, children have limited infection and/or less severe infection.²

Can we better control asthma in children/adolescents post pandemic?

In the article, Asthma: Everything you need to know, Ms. Zimlich describes the many medications for management of asthma that may be included in the upcoming update to the 2007 asthma guidelines. Thoughtful and evidence-based management for children and adolescents with asthma is critical to their health and well-being which includes their ability to be like other children, running and playing freely, and breathing without effort.

The COVID-19 pandemic has provided new insights on many aspects of primary care but especially for children and adolescents with a mild-to-moderate asthma diagnosis. Evidence of less disease burden for those with an asthma diagnosis during the pandemic raises 2 important questions: 1). Was the pathophysiological effects of the COVID-19 virus’s spike protein and the lesser binding ability (lower ACE 2 receptors) in children and adolescents the main reason for a reduction in asthma disease burden? and 2). Was the primary reason for decreased disease burden highly correlated to ‘stay at home orders,’ mask wearing, social distancing, and the cleanliness of the school and home environments – all primary prevention strategies?

If the answer to question 2 is yes, then the primary care management for those with asthma must be focused on primary prevention strategies as first line management. To determine the ‘next norm’ for management of asthma, it may be prudent to conduct practice quality improvement (QI) projects to determine the status of the child or adolescent’s pre-pandemic symptoms and management to his or her status during the pandemic to then improve the management for the ‘next norm.’ Pediatric nurse practitioners are uniquely prepared in primary care and many are prepared in QI initiatives to lead practice-based initiatives and problem solve to better manage the care of those with asthma through both pediatric and family-centered care management strategies. Parents and their children and adolescents should be active participants in the identification of triggers, management of the triggers prior and during the pandemic, changes in the control of their personal environment(s) pre and post pandemic, and perhaps behavioral therapies for stress reduction to clearly understand the ‘next norm’ for management of asthma without undue dependency on medications. In addition, we look forward to new asthma practice guidelines that consider the significance of pandemic outcomes for those with a diagnosis of asthma.

References

1. Lu X, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020;382(17):1663–1665. doi:10.1056/NEJMc2005073.

2. Chatziparasidis, G. & Kantar, A. Lung. 2021;1-6. doi: 10.1007/s00408-021-00419-9.