Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the increasing fear of leaving home and entering hospitals, together with guidelines to the public from Israel’s Ministry of Health recommending the use of telemedicine rather than physical visits to the doctor, led to delayed diagnoses of non-COVID-19-related medical conditions. This research letter presents a cluster of severe medical conditions that were delayed in diagnosis due to postponed presentation to healthcare facilities during the COVID-19 pandemic. Ewing sarcoma, severe hemolytic anemia, endocarditis requiring surgery, and septic hip requiring surgery are some examples of cases we encountered with delayed diagnoses. This led to the appearance of a rather low burden of disease in the pediatric population during the pandemic, and pediatric hospitals and clinics experienced a very low volume of activity. Given the low burden of COVID-19 in children, and the well-defined separation between infected and non-infected areas within the hospitals, we should consider improving the guidelines and messages conveyed to the public regarding the importance of prompt medical assessment for other medical conditions, even during a pandemic, along with reassurance of the safety of entering medical facilities given the strict isolation procedures being observed. Conclusion: Medical associations should reconsider the messages being sent to the public during future outbreaks, and encourage medical assessment.
Highlights
During March–April 2020 the pandemic of coronavirus disease 2019 (COVID-19) led to a lockdown in many countries
In this report we describe several different presentations of severe conditions in children who delayed presenting them to a doctor or complying with the recommended diagnostic workup
The boy was pale with a yellowish skin color, and blood tests were consistent with severe hemolytic anemia: hemoglobin, 4 g/dL; reticulocyte, 15.7%; lactate dehydrogenase, 870 U/L; and total bilirubin, 3.2 mg/dL, mostly indirect
Summary
During March–April 2020 the pandemic of coronavirus disease 2019 (COVID-19) led to a lockdown in many countries. Hospitals were focused on treatment of COVID-19 patients, and the public was encouraged not to go to hospitals and clinics unless absolutely essential.[1] These public guidelines together with growing fear of leaving home and attending medical facilities led to a significant reduction of activity in pediatric departments and for community pediatricians.[2,3,4] The avoidance of contact with medical facilities entailed a theoretic concern of delayed diagnosis of significant illnesses An example of this concern was the recently published cluster of cases with delayed diagnoses of diabetic ketoacidosis.[5]. In this report we describe several different presentations of severe conditions in children who delayed presenting them to a doctor or complying with the recommended diagnostic workup
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