Journal article
Concurrent Viral Transmission and Wildfire Smoke Events Following COVID-19 Pandemic School Closures in New York City: Associations of a Large Natural Experiment With Acute Care for Pediatric Asthma, 2018-2023
Journal of the American College of Emergency Physicians Open, v 7(1), 100273
01 Feb 2026
PMID: 41333709
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Pediatric asthma is multifactorial: social, environmental, and infectious exposures trigger exacerbations. School COVID-19 policies, including closures, mask mandates, and reopenings, provide a natural experiment to discover associations between the severity of pediatric asthma exacerbations, viral transmission, and exposure to wildfire smoke. We investigated the epidemiology of acute unscheduled care for asthma in children aged 5 to 17 years, including emergency department (ED) visits, hospital and intensive care unit (ICU) admissions, and viral testing.
This observational study used a retrospective review of all electronic health records from New York City’s largest health system over 5 school years, from 2018 to 2023. Comparison groups included citywide surveillance data and all-cause visits. We investigated population-level exposures, including COVID-19 mitigation policies and wildfire smoke events.
In the postpandemic period, fewer children presented to the ED for asthma (P < .0001); however, more children required hospital or ICU admission (P < .001). Viral testing was employed more frequently and was more often positive in the postpandemic period (P < .0001). Rhinovirus was positive in a greater proportion of pediatric asthma visits than in all-cause adult or pediatric visits (P = .02). After mask mandates ended in early 2022, pediatric asthma visits peaked during the return-to-school fall period, slightly preceding the winter 2022 viral illness peak. Wildfire smoke events were not associated with pediatric asthma visits.
Viral transmission and school policies were associated with pediatric asthma exacerbations during and after the COVID-19 pandemic. Increased acuity, despite lower volumes, may help guide health systems as they strive to increase readiness to care for pediatric populations in response to future pandemics or environmental exposures.
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Details
- Title
- Concurrent Viral Transmission and Wildfire Smoke Events Following COVID-19 Pandemic School Closures in New York City: Associations of a Large Natural Experiment With Acute Care for Pediatric Asthma, 2018-2023
- Creators
- Sarah McCuskee - Mount Sinai Health SystemRishi Kowalski - Icahn School of Medicine at Mount SinaiCindy Mei - Icahn School of Medicine at Mount SinaiAlexis Zebrowski - Icahn School of Medicine at Mount SinaiAman Patel - Icahn School of Medicine at Mount SinaiLauren Zajac - Icahn School of Medicine at Mount SinaiHashem Zikry - QB3Ali Ayyash - Drexel UniversityNicholas DeFelice - Mount Sinai Health System
- Publication Details
- Journal of the American College of Emergency Physicians Open, v 7(1), 100273
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001622896100001
- Scopus ID
- 2-s2.0-105021654023
- Other Identifier
- 991022197020604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Emergency Medicine