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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Decreased incidence of febrile neutropenia in Michigan following masking and social distancing orders for the COVID-19 pandemic: A population based cohort study
Michael Gerard Baracy Jr, Karen Hagglund, Sanjana Kulkarni, Fareeza Afzal, Katherine Arends, Robert T Morris, Leigh Ann Solomon, Muhammad Faisal Aslam, Logan Corey
Michael Gerard Baracy Jr, Sanjana Kulkarni, Fareeza Afzal, Leigh Ann Solomon, Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, MI 48236, United States
Karen Hagglund, Medical Research, Ascension St John Hospital and Medical Center, Detroit, MI 48236, United States
Katherine Arends, Surveillance and Infectious Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing, MI 48933, United States
Robert T Morris, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, MI 48201, United States
Muhammad Faisal Aslam, Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Detroit, MI 48236, United States
Logan Corey, Department of Gynecologic Oncology, Wayne State University, Detroit, MI 48202, United States
Author contributions: Corey L conceived of the idea; Baracy Jr MG and Corey L designed the protocol and wrote the manuscript; Baracy Jr MG and Corey L organized operative diagnoses, CPT codes, ICD-9 and ICD-10 codes and ensured the integrity of codification; Hagglund K verified the protocol was methodologically sound and analyzed the data; Arends K procured the data; Kulkarni S, Afzal F, Solomon LA, Morris RT and Aslam MF were integral in the design and execution of the project; all authors discussed the final results and contributed to the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ascension St. John Hospital Institutional Review Board (approval No. 1783486-1).
Informed consent statement: Informed consent has been waived by the Ascension St. John Hospital Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The dataset is available from the corresponding author at
Michael.Baracy@ascension.org. Consent was not obtained but the presented data are identified and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Michael Gerard Baracy Jr, BSc, MA, MD, Doctor, Department of Obstetrics and Gynecology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI 48236, United States.
michael.baracy@ascension.org
Received: February 8, 2022
Peer-review started: February 8, 2022
First decision: June 7, 2022
Revised: June 15, 2022
Accepted: July 6, 2022
Article in press: July 6, 2022
Published online: July 24, 2022
Processing time: 164 Days and 6.8 Hours
BACKGROUND
It has been theorized that 75%-80% of febrile neutropenia (FN) is caused by endogenous pathogens, while up to 20% of cases are thought to be caused by a viral infection. It is unknown if precautions such as masking and social distancing reduce the risk of FN in susceptible populations.
AIM
To determine whether coronavirus disease 2019 (COVID-19) infection mitigation efforts, namely masking and social distancing, were associated with a reduction in the incidence of FN.
METHODS
This was a retrospective population based cohort study comparing the incidence of FN in the 13 mo prior to (Year 0) and 13 mo following (Year 1) the public health executive orders (PHEO) in Michigan. Data was queried for all emergency department (ED) visits from April 1, 2019 to March 31, 2021 from the National Syndromic Surveillance Program, a program which collects data that is voluntarily submitted by approximately 89% of Michigan EDs. The primary study outcome was the incidence of FN as a proportion of ED visits in the 13-mo before and 13-mo after COVID-19 mitigations efforts, namely masking and social distancing. We hypothesized that there would be a significant decrease in the incidence of FN in the period following the PHEO aimed at reducing the spread of the severe acute respiratory syndrome coronavirus 2 virus.
RESULTS
There was a total of 8979221 total ED visits captured during the study period. In Year 0 there were 5073081 recorded ED visits and 3906140 in Year 1. There was a significant reduction in the proportion of total ED visits with a diagnosis of FN, decreasing 13.3% across periods (0.15% vs 0.13%, P = 0.036). In patients with a hematologic malignancy a more impressive reduction in the incidence of FN was evident following PHEO (22% vs 17%, P = 0.02).
CONCLUSION
We found a significant association between social distancing and mask guidelines implemented on a large public scale with decreased rates of FN, particularly in those with a hematologic malignancy. These findings may be useful in the design of future research and recommendations regarding the prevention of FN.
Core Tip: There has been a proven reduction in respiratory viral infections (e.g., flu, common cold, etc.) with the implementation of social distancing and masking during coronavirus disease 2019 mitigation efforts. It has been theorized that up to 20% of febrile neutropenia is caused by viral infections. We found a significant reduction in the incidence of febrile neutropenia following the implementation of public health interventions, namely masking and social distancing, with the overall incidence of febrile neutropenia decreasing by approximately 13%. The largest reduction in febrile neutropenia was found for hematologic malignancies where the incidence of febrile neutropenia declined by 22%.
