• epidemiology
• health services research

Since the first COVID-19 cases reported in China so far, the pandemic has generated millions of cases and hundreds of thousands of deaths.1

The research response has been immediate, especially exploring diagnostic methods and therapeutic alternatives. Epidemiological research is still ongoing, as the disease passes through new countries and populations that add the special features of their cultures and health systems. Probably due to the limited direct impact of the disease on children,2 the knowledge on the subject related to paediatrics is scarce.

Recently it has been brought to attention the decline in paediatric emergency department (ED) attendance since the start of the pandemic. Isba et al reported in two hospitals in Manchester (UK) a decrease of more than 30% in paediatric ED attendance in January and February 2020 in relation to the same months in 2019.3

To address this issue, we compared the number of weekly visits of children and young people (<18 years) to the ED of a third-level paediatric hospital in the City of Buenos Aires during the first 5 months (January to May) of 2019 and 2020.

When comparing both years, we found that the number of visits to the ED in January and February was similar in both years (January: 6453 vs 6110; −5.3% and February: 6474 vs 7284; +12.5%). However, in March the attendance fell to 38.5%, in April 77.2% and in May 88.6%. Analysing the complete series of weekly attendance, the decrease becomes obvious as of the 12th week. In Argentina, the lockdown was announced as of 20 March 2020 (week 12) (figure 1).

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Figure 1

Weekly comparison of children and young people (CYP; <18 years of age at presentation), attending the emergency department (ED) at a paediatric tertiary paediatric hospital (Hospital de Niños Elizalde, Buenos Aires, Argentina), 2019 vs 2020. ARG, Argentina.

Like Isba et al 3 we ask ourselves, where have all the children gone? Like them, we think that the answer is complex and involves fear to attend a health institution which is facing an epidemic. Despite being data from a single centre, our hospital is one of the most attended by patients in the country.

But, following Isba et al 3 again, the really important issue is that there are children requiring medical attention that have not sought it, and that the health system support network has not helped them in the difficult circumstances of compulsory social distancing.

Although our report is limited to ED attendance, it is quite possible that this has been repeated among those requiring scheduled consultations. It is quite important that, after the pandemic is over, we look for the possible sequelae of the decrease in paediatric healthcare attendance (developmental disorders not timely discovered, malignant diseases not diagnosed in time, re-emergence of vaccine-preventable diseases, and so on). It is possible that, after all, SARS-CoV-2 affects children more than we thought, by mechanisms far from the direct action of the virus.