Eddy Lang is a professor and department head for emergency medicine for the Cumming School of Medicine at the University of Calgary. Merril Pauls is a professor in the department of emergency medicine at the Max Rady College of Medicine at the University of Manitoba.
Even as emergency care providers battle the terrible toll of the third wave, we are witnessing a remarkable shift in the non-COVID-19 patients who seek emergency care. While these observations need further confirmation, they strongly suggest that the same masking and physical distancing we have adopted to fight COVID-19 have had a significant impact on influenza transmission, and complications related to other respiratory viral infections. This presents us with a great opportunity going forward, but also with some difficult decisions.
In the months of March and April, 2020, emergency departments and hospitals around the world witnessed a dramatic reduction in demand for acute care services. This phenomenon was driven by the shock of the first wave lockdowns and a general avoidance of hospitals. This underuse has persisted, to a lesser extent, a full 14 months after the initial states of emergency were declared. While many hospitals are still struggling with the impact of COVID-19 admissions and the need for precious single-bedded rooms, we continue to see a relative underuse and lesser numbers of admitted patients due to many other conditions.
Some experts believe this is due to ongoing fears that seeking healthcare will expose individuals to COVID-19, but other possible explanations are emerging. The reduced emergency department visits and fewer hospitalizations may actually be the result of a significant reduction in many other illnesses we would normally be seeing.
One of the most astonishing developments related to the pandemic has been the eradication of the influenza virus this season. This would have seemed unbelievable to most experts before the pandemic, but throughout the summer of 2020, Australia noted a marked decrease in influenza cases during what should have been their peak season. Canadian data has shown a similar trend this past fall and winter. This means that thousands of deaths and numerous hospitalizations historically caused by influenza every year have also markedly decreased. This is almost certainly due to the public health measures we have instituted to combat COVID-19.
Along with the decrease in influenza, it appears we are seeing decreased transmission and fewer complications due to cold viruses. While most patients do not suffer long-term effects from these viruses, they can pose a significant danger to those with serious lung disease. Patients with chronic obstructive pulmonary disease (COPD) who catch colds can experience flare-ups often requiring hospitalization or intensive care, and some will even die. Pneumonia (or non-COVID pneumonia to be precise) is also a common and serious condition that is particularly hard on seniors, resulting in thousands of hospitalization and deaths in Canada every year. Many of these pneumonias are linked to viral infections that precede the pneumonia.
So this leaves us with a dilemma. As the pandemic continues, people are yearning for a relaxation of public health restrictions. No one wants to hear that perhaps we should continue these measures even after COVID-19 recedes. The good news is that we may not need all of the current restrictions to still see a benefit for our most vulnerable citizens. Ongoing research is required to clarify and quantify the connections we are seeing. Perhaps simply good hand hygiene, and indoor public masking for those at risk, will lead to lower numbers of hospitalizations for respiratory illnesses in the future.
People are desperate to reclaim their former lives and move past current restrictions, and yet we are calling for scientists, policy makers and the general public to consider a key potential learning from this difficult time. We have worked so hard to make mask-wearing the norm. If future studies confirm the significant benefits of this practice, do we really want to undo all this effort? We are not advocating for mask mandates or restrictive rules as they currently exist – but rather the maintenance of a new norm, based on collective goodwill and the realization of how many lives we could save by continuing this practice.
We need more high-quality studies to demonstrate the benefits, and identify potential harms of these measures. We also need to identify which of our current practices will have the greatest ongoing benefits and determine the least intrusive ways to use them while still being effective.
Some see masks as symbols of the anxiety and isolation the pandemic has caused. We are hoping people can instead come to see them as a tremendous gift we have given some of our most vulnerable citizens, protecting them from serious illness and even death. And we hope people will embrace the ongoing use of masks, even after the pandemic recedes.
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