COVID-19 And Severe Community-Acquired Pneumonia Dynamic Evaluation Study (CASCADES - ARBS CORONA III)

Bacterial community-acquired pneumonia (CAP) is a common complication of chronic heart, kidney, lung diseases and diabetes. During the COVID-19 pandemic (2020-present), changes to health care access could have increased the occurrence and death rate of CAP especially in patients with chronic heart, kidney, lung disease and diabetes. COVID-19 could increase occurrence of CAP because of over-crowding during lockdown, less frequent physician visits and thus inadequate treatment of underlying diseases, and increased alcohol and drug use (both risk factors for CAP). We chose to study effects of COVID-19 on CAP because (1) CAP is similar to COVID-19 (characteristics, treatments, and requirement for hospital and ICU admission) and (2) CAP patients may be disadvantaged during COVID-19 waves (e.g. decreased pneumococcal vaccine use, sub-optimal treatment of CAP and limited ICU bed availability). Because of changes to the frequency of CAP, patient characteristics, adherence to treatment guidelines, treatment, and ICU bed availability, we believe that the death rate of CAP patients increased during COVID-19 compared to pre-COVID-19 (2018-2019). To understand how COVID-19 has impacted CAP mortality, we will compare the number of CAP cases during the pre-COVID-19 period and during COVID-19 in sites across Canada. We will analyze the baseline characteristics, treatment, adherence to treatment guidelines to understand what changes occurred and whether these changes increased mortality of CAP. This study is a natural extension of our well established and funded ARBs CORONA program with experts in epidemiology, COVID-19, CAP, sepsis, heart, kidney and lung disease, public health, microbiology, and trials. Our study could drive changes in CAP management:(1) increased pneumococcal and H. influenza vaccine programs, (2) enhanced earlier CAP diagnosis, (3) CAP screening protocols in emergency departments, and (4) greater adherence to CAP treatment guidelines.