# The Concealing Effect of COVID-19: Unveiling the Surge in Community-Acquired Infections and Its Association With Diabetic Ketosis During the Pandemic

## TL;DR

The study found that the COVID-19 pandemic led to worse outcomes for community-acquired infections and diabetic ketoacidosis due to delayed diagnosis and treatment.

## Contribution

The study reveals how pandemic-related factors worsened the severity and management of non-COVID-19 infections linked to diabetic ketoacidosis.

## Key findings

- Patients during the pandemic experienced longer delays in diagnosis and treatment of community-acquired infections.
- Diabetic ketoacidosis was more severe during the pandemic, with longer durations and abnormal blood test results.
- Pandemic-related factors like fear of contagion and medical resource diversion contributed to increased infection severity.

## Abstract

Background

Some studies suggest that the SARS-CoV-2 pandemic has contributed to diverting attention from other community-acquired infections (CAIs), leading to an increase in their incidence and severity. Our study aimed to describe and compare clinical features of CAI before and during the pandemic as a factor precipitating diabetes ketoacidosis (DKA).

Methodology

We included 250 patients who presented with DKA due to CAIs, other than SARS-CoV-2, divided into two distinct groups: 100 patients (G1) who consulted two years before the pandemic, and 150 patients (G2) who consulted during the SARS-CoV-2 pandemic. Cases in both groups were matched for age and type and duration of diabetes. Primary outcomes were a longer diagnosis delay and more severe DKA in G2 during the pandemic. Secondary outcomes included blood test results, duration of ketosis, duration of antibiotic therapy, and diabetes treatment.

Results

The diagnosis and treatment delays were longer for patients seeking medical care during the pandemic (p < 0.001). The duration of DKA was also significantly longer in the G2 group (p = 0.007). During the pandemic, patients’ blood tests showed more anomalies with higher glycated hemoglobin (p = 0.02), C-reactive protein (p = 0.001), and lymphocytosis (p = 0.016). The duration of antibiotic therapy was also significantly longer in G2 (p = 0.01).

Conclusions

This study showed the impact of the COVID-19 pandemic on the management of diseases other than SARS-CoV-2. Indeed, several factors played a part in the increased incidence of CAIs, which were more severe than in the pre-pandemic period. These included fear of contagion, confinement, and physicians’ preoccupation with the pandemic.