Regarding "The orthopaedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war" a Mexican perspective.

To the editor,

We sincerely applaud the work done by Benazzo et al. [1] analyzing it with deep concern. This observational study describes the drastic activity decrease of 15 Italian orthopaedic centres during the COVID-19 outbreak as a consequence of strict confinement imposed by the Italian authorities.

It is important to mention that at the time of writing this communication, Mexico has overtaken Italy in the death-toll from COVID19 [2] with a few controversies in the management of the pandemic, focusing on social mobility the government has urged people to “stay home”, although quarantines have not been strictly enforced [3] during the last four months.

With preliminary results, our team has also documented reductions comparing hospitalizations in 2020 with the same periods in 2018 of 21%, 66%, 57%, and 45% as well as 2019 of 24%, 66%, 55%, and 33%, respectively for March, April, May, and June (reopening) in our group of four private hospitals being evaluated (Christus Muguerza Alta Especialidad, Hospital Sur, Hospital General Conchita and Hospital Vidriera) in Monterrey, Mexico.

Our results partially correspond with the results by Benazzo et al. [1]; however, differences in percentages of decreased activity are related to how strict confinement has been managed by Italian authorities compared with that of Mexican Federal health authorities, as well as the population cultural features [3]. Therefore, the less strict the management and the more laxity of quarantine measures implies more social mobility with the increase in accidents as well as the number of COVID-19 infections and dead toll [4] with the consequent socioeconomic, medical, and orthopaedic implications, as well as the decrease in the learning curves of residents [5] and the number of infections among colleagues.

We agree that lockdown and quarantine measures are deeply related to the decrease in the number of accidents as well as the number of patients received for care in the emergency departments.

Finally, we appreciate the work carried out by Benazzo et al., in which in an important multicenter study, the decrease of surgical procedures in orthopaedic and trauma services is described as a consequence of progressive closing of commercial activities and industries due to quarantine measures in a setting of national disaster by COVID19.