Clinical Improvement Seen in Study of 1st Year of COVID-19 Pandemic | Better Lung Function, BMI in CF Patients Came After Increased Telehealth Use | Canada News Media
Twelve months into the COVID-19 pandemic, Australian adults and children with cystic fibrosis (CF) showed improved lung function and body mass index (BMI), as well as a lower hospitalization rate, a study reports.
“Differing models of care and major changes in community interactions both have the potential to influence clinical outcomes in chronic disease,” the researchers wrote. “This study has demonstrated that the COVID-19 pandemic forced a change in the CF model of clinical care delivery.”
Monitoring CF patients typically involves regular face-to-face clinical visits, both in inpatient and outpatient settings. However, it can also be provided by telehealth, through video or a phone call.
Telehealth benefits include improving access to specialty care, early detection of clinical alterations, and a lower risk of cross-infection.
“However, there are concerns from CF clinicians about widespread use of telehealth, including ability to complete comprehensive patient assessment and ensuring equitable access,” the researchers wrote.
In Australia, about 30% of people live outside major cities. As such, the COVID-19 pandemic required increasing use of telehealth as a replacement for clinical visits, due to travel restrictions and limited access to healthcare facilities.
Early feedback on telehealth during the pandemic indicated that CF patients were highly satisfied, showing stability in lung function and decreased pulmonary exacerbations (times when symptoms get worse, usually associated with infections).
The study and its results
Aiming to report on the impact on clinical outcomes at a national level 12 months after the onset of the pandemic, a research team in Australia used the Australian Cystic Fibrosis Data Registry, which has data from approximately 95% of adults and children with CF.
In total, data were available for 3,662 patients — 1,930 males and 1,732 females with a mean age of 20.2 years, ranging from 0 to 82. March 16, 2020, was chosen as the start date to assess outcomes, as that was when the Australian government limited the number of people allowed to gather publicly and when funding was approved to encourage telehealth evaluations.
Lung function — determined by the percent predicted forced expiratory volume in one second (ppFEV1), which is how much air is forced from the lungs in one second — and BMI, a measure of body fat, were compared 24 months before versus 12 months after the pandemic onset.
Other parameters, including the number of hospitalizations and virtual consultations, were compared 12 months before versus 12 months after the start date.
The researchers found ppFEV1 to be improved in adults (mean study entry value of 66.1%) and in children 5 to 12 (92.2%) after 12 months of COVID-19. In both, ppFEV1 went from a mean annual decline before study start of 0.38% and 0.46%, respectively, to an improvement in lung function of 1.29% in adults and 0.97% in children.
In children 12 to 17, whose mean study entry ppFEV1 was 81.7%, the annual ppFEV1 slope improved further from 0.99% to 3.78%.
As for BMI, patients 17 and older showed a significant increase in one year — 0.03 kg per square meter (kg/m2) vs. 0.30 kg/m2, with a mean entry BMI of 20.1 kg/m2. In younger patients, BMI (measured as a Z-score, the difference between a CF child’s BMI at a certain age to healthy growth reference values) was already improving before the pandemic and continued after — 0.05 kg/m2 vs. 0.12 kg/m2.
In addition, the number of hospitalizations one year after the start date dropped significantly (2,656 vs. 1,957), including a 26% reduction in those requiring into-the-vein antibiotics.
Before the pandemic, 92% of outpatient CF monitoring was done face to face, with 8% through telehealth. But one year into the pandemic in Australia, in-person visits decreased to 53%, with virtual consultations increasing to 47%.
Overall, “in the 12-months following the onset of the COVID-19 pandemic, there was an improvement in the clinical outcomes of people with CF when compared to the pre-pandemic period,” the research team wrote.
European studies also showed an increase in lung function. However, this was shown after two to three months of pandemic-related lockdown and using single lung-function values, while the Australian study used national data from a longer period of time.
Despite the observed benefits of COVID-19 restrictions and telehealth in CF, “due to the retrospective design of the study, no conclusions are able to be drawn regarding the cause of the improved clinical outcomes,” the researchers concluded. A retrospective study is one that uses data compiled from the past.
“Multiple factors, including reduced [community] interaction and reduced exposure to respiratory viruses, as well as a change to a more remote model of care may have contributed to the findings. However … causation is unable to be determined,” the scientists concluded.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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