key: cord-288288-f7yhw3a0 authors: Cozzi, Giorgio; Zanchi, Chiara; Giangreco, Manuela; Rabach, Ingrid; Calligaris, Lorenzo; Giorgi, Rita; Conte, Mariasole; Moressa, Valentina; Delise, Anna; Poropat, Federico title: The impact of the COVID‐19 lockdown in Italy on a pediatric emergency setting date: 2020-06-29 journal: Acta Paediatr DOI: 10.1111/apa.15454 sha: doc_id: 288288 cord_uid: f7yhw3a0 Italy has been one of countries most affected by the COVID‐19 pandemic and the Government instituted a strict national lockdown on 9 March 2020 to limit the spread. Healthcare services were only open for emergencies or undelayable needs. This study describes the impact of the lockdown on the tertiary level Pediatric Emergency Department (PED) at the Institute for Maternal and Child Health IRCCS Burlo Garofolo, in Trieste, North East Italy. It is the only PED in the city and sees 25,000 patients aged 0‐17 annually. were influenced by normal seasonal variations, we also compared the post lockdown data with the same period in 2019. The Institute's Institutional Review Board approved the study protocol. The PED database provided the age and gender of the patients, date of the visit, nursing triage category, the patient's main complaint and admission status. Triage followed the four-level national triage category system, which ranges from not urgent to emergency and resuscitation ( Table 1 ). The primary outcome was urgent visits and admissions before and after the lockdown and the second outcome was the comparison between the post lockdown period in 2020 and the same period in 2019. Continuous variables were described as medians and interquartile ranges and the categorical variables as absolute numbers and percentages. The Mann-Whitney test evaluated the mean difference in the continuous variables before and after lockdown and in 2020 and 2019. Fisher's exact test or chi-square test verified the associations between the categorical variables in both 2020 and in 2019. A p-value of <0.05 was considered significant. This article is protected by copyright. All rights reserved The number of PED visits declined considerably after the national lockdown (Table 1) . This fell by 76.3%, from 2719 to 646 visits, before and after the lockdown. The decrease from 2019 to 2020 was 77.5%, which confirmed the effect of lockdown. We experienced a decrease in the absolute number of non-urgent and urgent cases. After the lockdown, there was a significant decline in respiratory infections, such as fever, respiratory distress, cough, sore throat and earache and in symptoms related to functional syndromes, such as headache, dizziness and chest pain. Injuries also declined. However, the number of agitation symptoms remain stable. The number of patients admitted to the hospital, in particular to the paediatric intensive care unit (PICU) also declined. On the other hand, the percentage of urgent triage codes and hospital admissions increased, suggesting that patients in urgent need of medical care came to the PED despite the lockdown. We did not observe a relative increase in emergent codes or in PICU admissions, suggesting the lockdown didn't cause a considerable delay in referrals. However, only a limited number of patients needed emergent care during the short study period and the real effects of lockdown on these relatively rare events must be interpreted with caution. After lockdown, a patient affected by intellectual disability arrived dead at the hospital after 10 days of fever and respiratory distress. We can't exclude that this tragic event could have been related to delaying care due to the fear of COVID-19 or to the lockdown itself. We know that epidemics can spread easily in emergency settings (1) and limited access to the PED may have helped to limit the spread of COVID-19. It is hard to estimate whether it was the fear of contagion or the lockdown that kept people from accessing PED. Reports from general emergency departments have showed reduced visits during epidemics, even without lockdown (2) . During the study period, more than 3000 people in our region tested positive for the virus and at least 280 died. In our city, 1250 adults and 60 children and adolescents tested positive, but we only admitted two paediatric patients with COVID-19. It is possible that factors apart from the lockdown, such as an independent variation in the spread of infective diseases may have influenced our findings. Our data refer to a single PED, limiting the generalizability of our findings. Nevertheless, analysing the effects of lockdown on This article is protected by copyright. All rights reserved our clinical setting was important, as it helps us to understand what can be expected when such measures are adopted. This could also help us to plan for future outbreak. The authors have no conflicts of interests to declare. This article is protected by copyright. All rights reserved MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study Impact of the 2015 Middle East Respiratory Syndrome Outbreak on Emergency Care Utilization and Mortality in South Korea