To the Editor,
In March 2020, the COVID-19 pandemic was declared and led to the collapse of the healthcare system worldwide. Normal access to specialist care was negatively affected in many countries around the world. The first case of SARS-CoV-2 in Sweden was confirmed on January 24, 2020, at Ryhov County Hospital in Jonkoping. The pandemic reached Sweden in mid-March 2020, and the health authority issued recommendations for people older than 70 years and at-risk groups to take extra precautions, including social distancing. The situation in Sweden contrasted with recommendations in many other countries that implemented lockdown measures.
The incidence of scabies and tinea capitis/ tinea barbae during the COVID-19 pandemic period in Sweden has not yet been studied. This is in contrast to several other countries where the incidence of scabies has been studied.(Bonanno et al., 2022; De Lucia et al., 2021; Launay et al., 2020; Lugović-Mihić et al., 2020; Van Deursenid et al., 2022)
Our aim was to compare the incidence of scabies and tinea capitis/ tinea barbae in the Swedish health region of Jonkoping County during the 12-month period COVID-19 (April 1, 2020, to March 31, 2021) with the non-pandemic period. This was a retrospective, observational cohort study, and was conducted in the three hospitals (Ryhov County Hospital, Highland Hospital of Nässjö, and Värnamo Hospital) in Jonkoping County, which is part of the southeast health region in Sweden and provides health care for approximately 360 000 inhabitants. The study was of the quality review type, and was approved by the Operations Manager and Head of the Department of Dermatology at Ryhov County Hospital in the Jonkoping region under Section 31 of the Health and Medical Services Act (published in Lakartidningen 2015; 112: C9CL).
We included the number of patients diagnosed with scabies and tinea capitis/ tinea barbae at the Department of Dermatology in the Jonkoping health region during the pandemic COVID-19 (April 1, 2020, to March 31, 2021) and the reference period (April 1 to March 31, 2019–20). We analyzed the monthly cases of tinea capitis/ tinea barbae and scabies in the three dermatology clinics in the Jonkoping healthcare region. The cumulative incidence of tinea capitis/ tinea barbae and scabies was calculated for both study periods.
The cumulative incidence of scabies was 0.69% (6.9 per 1000 people) over the one-year pandemic period vs 0.94% (9.4 per 1000 people) over the one-year non-pandemic period. The cumulative incidence of tinea capitis/tinea barbae was 0.41% (4.1 per 1000 people) over the one-year pandemic period vs 0.34% (3.4 per 1000 people) over the one-year non-pandemic period. The difference in the number of scabies cases and tinea cases during the pandemic versus the non-pandemic period was not significant. Eighty-six scabies cases were reported during the pandemic and 106 scabies cases were reported during the non-pandemic period (p-value = 0.73, 95% CI 0.72–1.27, OR 0.95). Fifty-two cases of tinea capitis/ tinea barbae were reported during the pandemic period and 50 cases of tinea capitis/ tinea barbae during the reference period (p-value = 0.31, 95% CI 0.83–1.81, OR 1.23) (Fig. 1, Fig. 2).
Fig. 1.
Number of scabies cases during the COVID-19 pandemic (April 1, 2020, to March 31, 2021) and the non-pandemic period (April 1 to March 31, 2019–20).
Fig. 2.
Number of tinea capitis/ tinea barbae cases during the COVID-19 pandemic (April 1, 2020, to March 31, 2021) and the non-pandemic period (April 1 to March 31, 2019–20).
The results regarding scabies are not in line with results from several other countries where both increasing incidence (in the Netherlands, in Italy, in Croatia)(De Lucia et al., 2021; Lugović-Mihić et al., 2020; Van Deursenid et al., 2022) and decreasing incidence (in Portugal and in France)(Bonanno et al., 2022; Launay et al., 2020) have been reported. To our knowledge, the impact of the pandemic on tinea capitis/tinea barbae has not been investigated in EU countries. The stabilization and non-differentiation of the number of diagnosed scabies and tinea capitis/ tinea barbae cases during the pandemic could be explained by the mild COVID-19 restrictions without lockdown in Sweden, but also by the poor compliance with social distancing recommendations.
Funding
Futurum - the academy for healthcare, Region Jönköping County, Sweden.
Declaration of Competing Interest
No.
References
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