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Association of Public Health Measures During the COVID-19 Pandemic With the Incidence of Infectious Conjunctivitis

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To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What were the associations of COVID-19–associated public health measures with the epidemiology of infectious conjunctivitis?

Findings  A model involving publicly available smartphone mobility data was able to show the difference in actual behavior compared with expected trends based on data from previous years and included analysis of noninfectious eye conditions for comparison. The adoption of COVID-19–associated public health measures was associated with a 34% decrease in conjunctivitis-associated search activity and a 37% decrease in emergency department encounters for infectious conjunctivitis.

Meaning  These findings show that search metrics in conjunction with mobility data may provide quantifiable metrics of the associations of public health interventions with transmissible diseases.


Importance  Infectious conjunctivitis is highly transmissible and a public health concern. While mitigation strategies have been successful on a local level, population-wide decreases in spread are rare.

Objective  To evaluate whether internet search interest and emergency department visits for infectious conjunctivitis were associated with public health interventions adopted during the COVID-19 pandemic.

Design, Setting, and Participants  Internet search data from the US and emergency department data from a single academic center in the US were used in this study. Publicly available smartphone mobility data were temporally aligned to quantify social distancing. Internet search term trends for nonallergic conjunctivitis, corneal abrasions, and posterior vitreous detachments were obtained. Additionally, all patients who presented to a single emergency department from February 2015 to February 2021 were included in a review. Physician notes for emergency department visits at a single academic center with the same diagnoses were extracted. Causal inference was performed using a bayesian structural time-series model. Data were compared from before and after April 2020, when the US Centers for Disease Control and Prevention recommended members of the public wear masks, stay at least 6 feet from others who did not reside in the same home, avoid crowds, and quarantine if experiencing flulike symptoms or exposure to persons with COVID-19 symptoms.

Exposures  Symptoms of or interest in conjunctivitis in the context of the COVID-19 pandemic.

Main Outcome and Measures  The hypothesis was that there would be a decrease in internet search interest and emergency department visits for infectious conjunctivitis after the adaptation of public health measures targeted to curb COVID-19.

Results  A total of 1156 emergency department encounters with a diagnosis of conjunctivitis were noted from January 2015 to February 2021. Emergency department encounters for nonallergic conjunctivitis decreased by 37.3% (95% CI, −12.9% to −60.6%; P < .001). In contrast, encounters for corneal abrasion (1.1% [95% CI, −29.3% to 29.1%]; P = .47) and posterior vitreous detachments (7.9% [95% CI, −46.9% to 66.6%]; P = .39) remained stable after adjusting for total emergency department encounters. Search interest in conjunctivitis decreased by 34.2% (95% CI, −30.6% to −37.6%; P < .001) after widespread implementation of public health interventions to mitigate COVID-19.

Conclusions and Relevance  Public health interventions, such as social distancing, increased emphasis on hygiene, and travel restrictions during the COVID-19 pandemic, were associated with decreased search interest in nonallergic conjunctivitis and conjunctivitis-associated emergency department encounters. Mobility data may provide novel metrics of social distancing. These data provide evidence of a sustained population-wide decrease in infectious conjunctivitis.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: September 29, 2021.

Published Online: November 18, 2021. doi:10.1001/jamaophthalmol.2021.4852

Corresponding Author: Aaron Y. Lee, MD, Department of Ophthalmology, University of Washington, 325 Ninth Ave, PO Box 359608, Seattle, WA 98104 (

Author Contributions: Dr A. Lee and Mr Lavista Ferres had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Mr Lavista Ferres and Dr Meirick contributed equally and are co–first authors.

Concept and design: Lavista Ferres, Meirick, Lomazow, A. Lee.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Lavista Ferres, Meirick, A. Lee, M. Lee.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Lavista Ferres.

Administrative, technical, or material support: C. Lee, A. Lee.

Supervision: Lavista Ferres, Lomazow, C. Lee, A. Lee.

Conflict of Interest Disclosures: Mr Lavista Ferres is an employee of Microsoft Corporation and reported personal fees from Singularity University outside the submitted work. Dr A. Lee reported grants from Santen, Regeneron, Carl Zeiss Meditec, the National Eye Institute, and Novartis and personal fees from Genentech/Roche, Johnson & Johnson, the US Food and Drug Administration, Topcon, and Verana Health, outside of the submitted work, plus nonfinancial support from Microsoft during the conduct of the study and nonfinancial support from NVIDIA outside the submitted work. Dr C. Lee reported grants from the National Institute on Aging outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by the National Institute on Aging (grant R01AG060942 [Dr C. Lee]), the National Eye Institute (grant K23EY029246 [Dr A. Lee]), and an unrestricted grant from Research to Prevent Blindness (Drs Lomazow, C. Lee, A. Lee, and M. Lee).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: This article does not reflect the opinions of the Food and Drug Administration. Data are available on request, after receiving regulatory approvals.

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