Benefits, Burden, and COVID-19: A Response to Dutheil et al. (2020)
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LETTER TO THE EDITOR
Benefits, Burden, and COVID‑19: A Response to Dutheil et al. (2020) Eric Rubenstein1 · Amy Kalkbrenner2 · Heather Volk3 · Laura McGuinn4 Accepted: 10 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
To the editor, The COVID-19 pandemic is having, and will continue to have, major impacts on individuals with intellectual and developmental disabilities (IDD), including autism spectrum disorder (ASD). Dutheil et al. have hypothesized that one such impact will be a reduction of ASD risk in children conceived during the pandemic. The authors hypothesize that due to a period with a reduction in air pollution (due to quarantine orders that reduced driving and economic activity) there will be a decreased risk of ASD. There is a considerable literature that find high levels of air pollution are modestly associated with increased occurrence of ASD in children (McGuinn et al. 2020; Kalkbrenner et al. 2018; Volk et al. 2013; Lam et al. 2016), and logically, a decrease in air pollution could reduce ASD risk. However, Dutheil et al. fail to consider the concomitant increase in other ASDrisk factors and fail to place potential ‘benefits’ in the context of the disproportionate burden the COVID-19 pandemic has placed on people on the spectrum and their families. Many maternal factors during pregnancy are associated with elevated risk of ASD and plausibly have increased during the COVID-19 pandemic: stress (Beversdorf et al. 2018), maternal mental health conditions (Hagberg et al. 2018), malnutrition (Vohr et al. 2017), and alcohol and cigarette use (Lyall et al. 2017). In addition, there is a consistent literature from both animal and human studies regarding the role of maternal immune activation in the etiology of ASD (Estes * Eric Rubenstein [email protected] 1
Department of Epidemiology, Boston University School of Public Health, Rm T318E 715 Albany St, Boston, MA 02121, USA
2
Department of Epidemiology, University of Wisconsin-Milwaukee Zilber School of Public Health, Milwaukee, USA
3
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
4
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
and McAllister 2016), which includes specific constructs of fever and infection (Zerbo et al. 2014; Croen et al. 2019). Currently, the effects of vertical transmission or COVID-19 while pregnant are unknown, but likely harmful (Rajewska et al. 2020). COVID-19 may lead to increased risk of poor birth outcomes (e.g. preterm birth, low birthweight) (Gao et al. 2020) which can increase risk of ASD (Lyall et al. 2017). Further upstream, we can hypothesize that a loss of income (Gilman et al. 2017) and delay in elective procedures and health care visits due to hospital overload (Diaz et al. 2020) can set off etiologic pathways that harm child neurodevelopment. While a reduction in air pollution may cause population-level reduction in ASD risk in a vacuum, the increase in many other
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