The COVID-19 pandemic in Greenland led to a modest decline in acute respiratory infections without a post-pandemic infection rebound

BACKGROUND: Many countries reported declines in acute respiratory infections (ARIs) following public health and social measures to mitigate COVID-19.

OBJECTIVES: We describe the potential association with pandemic restrictions on the occurrence of non-COVID ARIs in Greenland, which experienced a late but sudden introduction of COVID-19.

METHODS: We included national electronic medical records on ARIs in Greenland across three periods: pre-pandemic (January 2018-February 2020), pandemic (March 2020-June 2022), and endemic (July 2022-December 2023). Severe ARIs were defined using a case definition based on ICD-10/ICPC-2-R codes. Oral penicillin prescriptions served as a proxy for mild ARIs due to limited primary care data.We calculated ARI incidence and used Poisson regression to compare periods. Data on Influenza A/B and RSV PCR testing activity and results were included.

RESULTS: During the pandemic, all ARIs decreased by 14% (IRR 0.86 [95% CI 0.84-0.88]) compared to pre-pandemic levels. In the endemic period, mild ARIs increased by 3% (IRR 1.03 [95% CI 1.02-1.06]), while severe ARIs increased by 40% (IRR 1.40 [95% CI 1.22-1.60]). The Influenza A/B positive rate declined during the pandemic (20.7% to 8.3%) but increased in the endemic period (14.2%), whereas RSV positive rate increased during the pandemic (19.8% to 57.2%).

CONCLUSIONS: We observed declines in mild and severe ARIs during the pandemic in Greenland. Unlike many other countries, mild ARIs did not rise during the endemic period, likely due to preventive travel measures limiting the spread of SARS-CoV-2 while allowing ongoing exposure to other respiratory viruses in society, preventing an infection rebound.