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We thank Chuah et al 1 for their interest in our study reporting on the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) in a case series of patients with systemic lupus erythematosus (SLE) under long-term treatment with hydroxychloroquine.2 Chuah et al point to an indirect consequence of the COVID-19 pandemic, the reluctance of patients to come to the hospital because of the fear to contract COVID-19 that is reinforced by the awareness of the contagious nature of SARS-CoV-2. The experience of Chuah et al is instructive in this regard. The authors observed a decline of 65.4% in the SLE hospitalisation rate in their medical centre during the containment period, as compared with the same period in 2019. Moreover, five out of the six new patients with SLE presented to the hospital long after the first clinical manifestations. This finding should be put into perspective with the increase in the number of in-hospital deaths of patients with SLE related to infections apparently independent of SARS-CoV-2, which suggests a harmful increase in the diagnostic delay and/or in the …
Footnotes
Handling editor Josef S Smolen
Contributors AM and ZA wrote the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.