Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study

• Main Authors: Catherine Hyams (Author), Robert Challen (Author), Elizabeth Begier (Author), Jo Southern (Author), Jade King (Author), Anna Morley (Author), Zsuzsa Szasz-Benczur (Author), Maria Garcia Gonzalez (Author), Jane Kinney (Author), James Campling (Author), Sharon Gray (Author), Jennifer Oliver (Author), Robin Hubler (Author), Srinivas Valluri (Author), Andrew Vyse (Author), John M. McLaughlin (Author), Gillian Ellsbury (Author), Nick A. Maskell (Author), Bradford D. Gessner (Author), Leon Danon (Author), Adam Finn (Author), Amelia Langdon (Author), Anabella Turner (Author), Anya Mattocks (Author), Bethany Osborne (Author), Charli Grimes (Author), Claire Mitchell (Author), David Adegbite (Author), Emma Bridgeman (Author), Emma Scott (Author), Fiona Perkins (Author), Francesca Bayley (Author), Gabriella Ruffino (Author), Gabriella Valentine (Author), Grace Tilzey (Author), Johanna Kellett Wright (Author), Julia Brzezinska (Author), Julie Cloake (Author), Katarina Milutinovic (Author), Kate Helliker (Author), Katie Maughan (Author), Kazminder Fox (Author), Konstantina Minou (Author), Lana Ward (Author), Leah Fleming (Author), Leigh Morrison (Author), Lily Smart (Author), Louise Wright (Author), Lucy Grimwood (Author), Maddalena Bellavia (Author), Madeleine Clout (Author), Marianne Vasquez (Author), Milo Jeenes-Flanagan (Author), Natalie Chang (Author), Niall Grace (Author), Nicola Manning (Author), Oliver Griffiths (Author), Pip Croxford (Author), Peter Sequenza (Author), Rajeka Lazarus (Author), Rhian Walters (Author), Robin Marlow (Author), Robyn Heath (Author), Rupert Antico (Author), Sandi Nammuni Arachchge (Author), Seevakumar Suppiah (Author), Taslima Mona (Author), Tawassal Riaz (Author), Vicki Mackay (Author), Zandile Maseko (Author), Zoe Taylor (Author), Zsolt Friedrich (Author)
• Format: Book
• Published: Elsevier, 2022-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2666-7762; 10.1016/j.lanepe.2022.100473
• Keywords: Pneumonia; Lower respiratory tract infection; Cardiac failure; COVID-19; SARS-CoV-2; Public aspects of medicine; RA1-1270
• Source: The Lancet Regional Health. Europe, Vol 21, Iss , Pp 100473- (2022)

Summary: Background: The emergence of COVID-19 and public health measures implemented to reduce SARS-CoV-2 infections have both affected acute lower respiratory tract disease (aLRTD) epidemiology and incidence trends. The severity of COVID-19 and non-SARS-CoV-2 aLRTD during this period have not been compared in detail. Methods: We conducted a prospective cohort study of adults age ≥18 years admitted to either of two acute care hospitals in Bristol, UK, from August 2020 to November 2021. Patients were included if they presented with signs or symptoms of aLRTD (e.g., cough, pleurisy), or a clinical or radiological aLRTD diagnosis. Findings: 12,557 adult aLRTD hospitalisations occurred: 10,087 were associated with infection (pneumonia or non-pneumonic lower respiratory tract infection [NP-LRTI]), 2161 with no infective cause, with 306 providing a minimal surveillance dataset. Confirmed SARS-CoV-2 infection accounted for 32% (3178/10,087) of respiratory infections. Annual incidences of overall, COVID-19, and non- SARS-CoV-2 pneumonia were 714.1, 264.2, and 449.9, and NP-LRTI were 346.2, 43.8, and 302.4 per 100,000 adults, respectively. Weekly incidence trends in COVID-19 aLRTD showed large surges (median 6.5 [IQR 0.7-10.2] admissions per 100,000 adults per week), while other infective aLRTD events were more stable (median 14.3 [IQR 12.8-16.4] admissions per 100,000 adults per week) as were non-infective aLRTD events (median 4.4 [IQR 3.5-5.5] admissions per 100,000 adults per week). Interpretation: While COVID-19 disease was a large component of total aLRTD during this pandemic period, non- SARS-CoV-2 infection still caused the majority of respiratory infection hospitalisations. COVID-19 disease showed significant temporal fluctuations in frequency, which were less apparent in non-SARS-CoV-2 infection. Despite public health interventions to reduce respiratory infection, disease incidence remains high. Funding: AvonCAP is an investigator-led project funded under a collaborative agreement by Pfizer.