4% from mean of 1794 contacts to 1369 (p=0.003). The EMS contacts were more often due to trauma (+23.7%, p<0.05), dispatched in the most urgent category (+139.9%, p=0.001), additional help and the mobile intensive care unit were more frequently requested (+43.3%, p=0.040 and+46.3%, p=0.049, respectively). However, EMS contacts resulted less often in ambulance transport (-21.1%, p<0.001). Alarmingly, there were four deaths during the study period compared with 0-2 during the control periods. The number of EMS contacts decreased during the pandemic. Nevertheless, the children encountered by the EMS were more seriously ill than during the control periods.The number of EMS contacts decreased during the pandemic. Nevertheless, the children encountered by the EMS were more seriously ill than during the control periods. To describe and compare the effect of level 5 lockdown measures on the workload and case mix of paediatric patients presenting to a district-level emergency centre in Cape Town, South Africa. Paediatric patients (<13 years) presenting to Mitchells Plain Hospital were included. The level 5 lockdown period (27 March 2020-30 April 2020) was compared with similar 5-week periods immediately before (21 February 2020-26 March 2020) and after the lockdown (1 May 2020-4 June 2020), and to similar time periods during 2018 and 2019. Patient demographics, characteristics, International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnosis, disposition and process times were collected from an electronic patient tracking and registration database. The χ test and the independent samples median test were used for comparisons. Emergency centre visits during the lockdown period (n=592) decreased by 58% compared with 2019 (n=1413) and by 56% compared with the 2020 prelockdown period (n=1342). The proportion of under 1 year olds increased by 10.4% (p<0.001), with a 7.4% increase in self-referrals (p<0.001) and a 6.9% reduction in referrals from clinics (p<0.001). Proportionally more children were referred to inpatient disciplines (5.6%, p=0.001) and to a higher level of care (3.9%, p=0.004). Significant reductions occurred in respiratory diseases (66.9%, p<0.001), injuries (36.1%, p<0.001) and infectious diseases (34.1%, p<0.001). All process times were significantly different between the various study periods. Significantly less children presented to the emergency centre since the implementation of the COVID-19 lockdown, with marked reductions in respiratory and infectious-related diseases and in injuries.Significantly less children presented to the emergency centre since the implementation of the COVID-19 lockdown, with marked reductions in respiratory and infectious-related diseases and in injuries.The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services. Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges. Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted. These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices. Lenalidomide chemical structure In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.We aimed to investigate the out-of-hospital mortality, and the actual prevalence of COVID-19 in children requiring paediatric emergency department (ED) care for infectious symptoms. There were four emergency medical services (EMS) responses concerning children (age 0-15 years) leading to death on-scene in 2 months during the pandemic, and eight during the previous 12 months in the Helsinki University Hospital area, although the number of EMS missions decreased by 18%. The prevalence of COVID-19 in children contacting a paediatric ED for any infectious symptoms during the epidemic peak was only 2.7%.To review the impact of COVID-19 on postgraduate paediatric training, a 10-question online survey was designed to evaluate trainees' training opportunities. 56 trainees working at a single centre, Alder Hey Children's Hospital, completed the survey. The majority of trainees felt that COVID-19 had affected their training. Trainees wanted to become involved in Quality Improvement Programs. Face-to-face teaching was still favourable but web-based teaching methods were preferred. Novel online, Worked Based Assessment clinics were well received. COVID-19 has affected traditional learning opportunities but offered a new positive range of digital solutions to give and store educational material.The Emilia Romagna (ER) region, Italy, in March 2020 has seen one of the largest and most serious clusters of COVID-19 in the world. In the period of 30 January to 31 May 2020, the number of paediatric emergency department presentations in Bologna, ER, decreased by 50% compared with the same period of 2019. Visits declined for every age group, with a decrease of 35%, 55% and 46% for the three age groups 0-2, 2-10 and 10-14 years, respectively. The admission rate increased from 5% to 13%. Fewer non-urgent attendances, alongside a decrease in seasonal infections due to the lockdown, appear to be the main reasons.