key: cord-0766832-f3iog2sn
authors: MohammadSadeghi, Ashkan
title: Reduction in the incidence of infectious diseases during the COVID-19 pandemic: A hypothesis
date: 2020-12-22
journal: Med Hypotheses
DOI: 10.1016/j.mehy.2020.110465
sha: 99ab23b6eb386571b564f013e9408b40dc9719de
doc_id: 766832
cord_uid: f3iog2sn

nan

Dear editor, I have read the article published in Medical Hypotheses by Xianqiang Yu with enormous interest which is about the COVID-19 changes the lifestyle of the population and subtly reduces the incidence of metabolic disease [1] . I agree with the author and I also believe that the incidence of infectious diseases, especially respiratory tract infections, may decrease during the COVID-19 pandemic.

The pandemic of SARS-CoV-2 has affected health care service practices worldwide and has changed it in the same vein. Population-wide anti-SARS interventions such as the use of Personal Protective Equipment (PPE), population-based sanitation and other measures have had an effect on other respiratory tract infections during the SARS outbreak in 2003. It was investigated whether the frequency of some common acute viral respiratory infections was also influenced by such interventions. A connection between public hygienic interventions and the diminished occurrence of influenza and other acute respiratory viral infections was indicated [2] . Furthermore, the weekly influenza activity in the 2019/ 2020 season compared with 5 previous seasons was assessed on seasonal influenza activity during the SARS-CoV-2 outbreak in Japan and it was deduced that in 2020, seasonal influenza activity in Japan was lower than previous years [3] .

In the present study, a hypothesis is offered and described which is presented based on three major factors:

In order to minimize the spread of COVID-19, public health interventions, including public education, physical distancing, the use of masks, hand washing, remote work and the avoidance of major events, have been promoted worldwide. The influenza activity indicators for 2020, before and after public health interventions to minimize the coronavirus disease 2019, were compared with the corresponding indicators for the previous three years. Influenza incidence has decreased dramatically, implying that the measures introduced for COVID-19 have been successful in reducing the spread of other respiratory viral diseases [4] .

Since the COVID-19 pandemic, the number of newly diagnosed tuberculosis patients has decreased dramatically in Japan and Taiwan. In many areas, the COVID-19 outbreak required lockdowns and limited access to hospitals, particularly for people with non-emergent symptoms and medical check-up was also canceled or postponed. In fact, avoidance of medical care is a significant factor in this regard [5] .

The diagnosis has been shifted toward SARS-COV-2 in the current COVID-19 era, and during this pandemic, there is a significant probability of premature diagnosis. Patients who probably may have COVID-19 need crucial re-evaluation for other diagnoses at frequent intervals in the absence of a confirmatory test [6] . The diagnostic process is highly vulnerable to cognitive bias and the current COVID-19 pandemic can trigger incorrect decisions to be made by normally accurate healthcare professionals. The COVID-19 pandemic undermines not only health care providers physical and psychological health, but also the health care system itself, which could have an effect on clinical diagnosis and judgement [7] .

Given the above, it is very likely that according to this hypothesis, the rate of other infectious diseases in the current pandemic period could decrease, which is an important issue and can be used for future planning and health care policy making.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 

COVID-19 changes the lifestyle of the population and subtly reduces the incidence of metabolic disease

Respiratory infections during SARS Outbreak

Seasonal influenza activity during the SARS-CoV-2 outbreak in Japan

Decreased influenza incidence under COVID-19 control measures

The COVID-19 pandemic and the true incidence of Tuberculosis in Japan

Misdiagnosis related to premature diagnostic closure during the COVID-19 pandemic

Reducing the risk of diagnostic error in the COVID-19 era

address: sadeghi_ash@sums.ac.ir