Re: Letter to the editor of Public Health in response to 'Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear'.

We read with interest the reply letter of D.G. Barten et al. to our article and we do strongly agree with the authors about some indirect effects of the lockdown during the COVID-19 pandemic, such as social distancing, reduction of working hours, and traffic movements as coresponsible for the reduced access to the emergency departments by non-COVID-19 patients.

In fact, many diseases, both acute and chronic, in particular non-SARS-Cov-2 infections and trauma, may be influenced by these factors. However, some other pathologies, such as renal colic that should see an increase in incidence with prolonged sedentary activity levels, showed a reduction in the number of emergency department attendances, giving further support to the COVID-fear theory.

SARS-Cov-2 is an ongoing pandemic with disastrous effects on a global level both from the health point of view and on the economic and social system. However, although understandably most of the media focuses on COVID-19, people on every continent continue to fall ill with equally serious diseases. Our worry is that even people with serious or potentially serious pathologies will avoid or delay medical attention for fear of contracting the virus. Although it is relatively easy to access data regarding COVID-19 mortality, it is difficult to estimate the mortality related to the lack of medical attention for patients with other diseases. This could even represent the tip of the iceberg.

In this perspective, streamlined workflow in emergency departments and non-COVID departments as well as effective communication by the health care system of different countries becomes fundamental to provide patients with COVID-free pathways, thus reducing delay in diagnosis and treatment.

The media should stand side by side with national health care systems to provide clear and useful information to patients to help patients with non-COVID-19 pathologies and to decrease the fear of seeking medical attention during pandemic.