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

doi:10.5306/wjco.v13.i7.609

Decreased incidence of febrile neutropenia in Michigan following masking and social distancing orders for the COVID-19 pandemic: A population based cohort study

World J Clin Oncol. 2022 Jul 24;13(7):609-615. doi: 10.5306/wjco.v13.i7.609.

Authors

Michael Gerard Baracy Jr¹, Karen Hagglund², Sanjana Kulkarni³, Fareeza Afzal³, Katherine Arends⁴, Robert T Morris⁵, Leigh Ann Solomon³, Muhammad Faisal Aslam⁶, Logan Corey⁷

Affiliations

¹ Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, MI 48236, United States. michael.baracy@ascension.org.
² Medical Research, Ascension St John Hospital and Medical Center, Detroit, MI 48236, United States.
³ Department of Obstetrics and Gynecology, Ascension St. John Hospital, Detroit, MI 48236, United States.
⁴ Surveillance and Infectious Disease Epidemiology Section, Michigan Department of Health and Human Services, Lansing, MI 48933, United States.
⁵ Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, MI 48201, United States.
⁶ Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Detroit, MI 48236, United States.
⁷ Department of Gynecologic Oncology, Wayne State University, Detroit, MI 48202, United States.

Abstract

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.

Keywords: COVID-19; Febrile neutropenia; Hematology; Malignancy; Public health; SARS-CoV-2.