The Changing Virology and Trends in Resource Utilization for
Bronchiolitis since COVID-19
Abstract
Background: Bronchiolitis is a viral respiratory illness most commonly
caused by respiratory syncytial virus (RSV). COVID-19 disrupted typical
patterns of viral transmission. Our study aimed to compare low value
care for bronchiolitis in a tertiary emergency department (ED) in the
United States over the previous five years. Methods: This was a
descriptive cohort study through a retrospective chart review from
2017-2022 analyzing ED visits for bronchiolitis including disposition,
disease severity, chest radiographs, albuterol, and high flow nasal
cannula. A year was a 12 month period from March to February. Results:
In the three years prior to the pandemic, there were over 2000 ED visits
for bronchiolitis per year (3.1% of all ED visits), which decreased to
450 visits for bronchiolitis (1% of all visits) in 2020. Human
rhino/enterovirus was the most common virus detected (92%). Admission
rates, albuterol use, high flow nasal cannula use, and chest radiographs
were all higher during the first year of the pandemic. The summer of
2021 had the highest visits across the 5 study years (2743, 4.0% of all
visits) with a return to previous rates of resource utilization.
Conclusions: During the early pandemic, measures to halt the spread of
COVID-19 also altered the transmission of RSV and emergency visits for
bronchiolitis. There was an increase in lower value care while the
volume was low and rhinovirus was the dominant virus detected. As
restrictions lifted in 2021, there was a large resurgence of RSV in the
atypical summer months with a return of previous rates of resource
utilization.