Impact of Non–Coronavirus -2019 (Non–COVID-19) Respiratory disease Hospital Admissions: A Single Centre experience.

Hospital admissions due to non-coronavirus disease 2019 (nonCOVID-19) respiratory diseases decreased in Teaching Hospital Jaffna following social distancing, other public health measures (face mask wearing) and due to lock down imple mented by authorities in 2020.


Introduction
Impact of COVID -19 pandemic in year 2020 are many including economic deprivation and disturbance in routine health care of other ailments. Lock down and social distancing was implemented in many regions throughout the globe in 2020 to limit the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel coronavirus was first identified in Wuhan, China in December 2019 and since then it has spread globally resulting in an on-going pandemic in 2020.
On 12th March 2020 World Health Organization (WHO) declared covid-19 as a global pandemic and a public health emergency of international concern and called all the communities to participate cooperatively to prevent further spreading (1,2). Sri Lanka was not an exception and the first imported case of the COVID-19 was identified on 27 January 2020, and in March 10 the first Sri Lankan national confirmed for COVID-19 positive (3).
Preventive strategies have been adopted to combat the COVID-19 transmission in Sri Lanka including closing of the public places and establishing quarantine centres. In addition, until May 2020, Sri Lankan government imposed strict lockdown and public were encouraged to stay indoors and work from home. This caused several impacts on routine health care including accessing for critical care. For example number of coronary angiograms and percutaneous coronary interventions at Teaching Hospital Jaffna showed significant drop (4).
Few researchers in different part of the world observed a reduction in hospital admissions due to non COVID-19 respiratory illness such as asthma, COPD exacerbation after implementing social distancing in their respective regions (5)(6)(7). Similarly, analysis of routine surveillance system in Australia showed drop in Flu cases by 99% due to physical distancing and good hand hygiene (8). This is the first report from Sri Lanka attempting to explore pattern of non COVID -19 related respiratory diseases hospital admissions observed in our region.

Methods
Data was extracted from the hospital records (which were collected routinely for audit) with the permission of the Director Teaching hospital, Jaffna for the period of March -September in 2019 and 2020. We compared the monthly admissions in 2019 and 2020 by using Figures and tables. In addition to routine statistics (mean and median), Chi squared test and Extended Mantel-Haenszel test were used in appropriate places and P< 0.05 was considered as statistically significant. As no data collection involved with subjects ethical clearance is was not applicable for this report.

Results
Monthly total hospital admissions (number and pattern) due to non COVID-19 related respiratory diseases to professorial unit (medical) in 2019 and in 2020 compared in the Figure 1 for the study period (March -September). As shown in the figure monthly admission in 2020 is less than 2019 for most of the months except August.   With limited data available different respiratory conditions were separated and compared of the year 2019 and 2020 (Table 1 and Table2).     (7,(11)(12)(13)(14). even though our study failed to show statistical significant due to small number. Possible explanation for observed reductions could be patient altered health behaviour due to COVID -19 Pandemic, making them less likely to seeking treatment but we feel alternative explanation as a reduction in rates of common circulating respiratory viruses (RVI) infections most possible explanation because of the fact that a significant reduction in non-specified respiratory infections from 64.18% in 2019 to 30.84% in 2020 and it was previously postulated in other study as well (15). Irrespective of the economic status and geographical location of the country community based public health measures adopted to prevent transmission of SARS-CoV-2, face masking and social distancing, could reduce community transmission of common RVI potentially decreasing asthma exacerbations and hence reducing hospitalizations and related economic burden.

Limitations
As no organized data collection involved in the study it is not possible to exclude confounding effect of other factors and also in our region laboratory diagnosis respiratory viruses are not routinely carried our except for COVID-19 as a result exact diagnosis of respiratory infection is not possible.