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Objective The World Health Organization declared COVID-19 a pandemic on 11th March 2020. The UK government introduced strict social distancing measures on 23rd March 2020, with the country put into a full lockdown to further halt the spread of the virus. The aims of this article are to ascertain whether there was a rise in the incidence of deliberate self-harm (DSH) presentations to the emergency department at a level one trauma center associated with the introduction of lockdown measures. Method An observational study from a level one trauma center was carried out. Retrospective data from 23rd March 2020 to 1st May 2020 was collected and compared to the same time period in 2019. Data was collected from coded electronic patient records. Results Total attendances to the Emergency Department (ED) reduced from 2019 to 2020 (5198 and 3059 respectively). There was a significant increase in the total number of self-harm presentations between 2019 and 2020 (103 vs 113, p-value <0.001) as well as paracetamol, NSAID and opiate overdoses, with more cases requiring hospital admission in 2020 vs 2019. Conclusions Societal lockdown measures secondary to the COVID-19 pandemic have had a significant effect on the mental health of patients. One way this can be detected is through an increased incidence and severity of deliberate self-harm injuries presenting to the ED. These findings, in conjunction with the available, literature provide valuable implications for community and emergency physicians and psychiatrists for any future wave of disease or pandemic.

significant changes to society. It has changed the way people behave and how healthcare is provided. In our study, we seek to evaluate the impact of the pandemic on the epidemiology of burns in the paediatric population. Government-implemented lockdown measures and school closures have led to reduced outdoor activities and lifestyle changes. Our regional Paediatric Burns Centre introduced a new standard operating protocol involving a new phone consultation pathway, a secure email platform for effective communication with parents and tertiary referring hospitals. The aim is to reduce physical attendance to hospital where possible, streamline our referral service, avoid unnecessary admissions and empower parents where appropriate. We performed a retrospective comparison over five weeks in which the government imposed lockdown instructions from 23/3/2020 to 30/04/2020 (lockdown period) and compared it to a similar period from a year ago 23/03/2019 to 30/04/2019 (control period). During this period, the total attendance to our Emergency Department (ED) has decreased by 60% in the lockdown period (7127 versus 2936), as expected due to the national advice to avoid unnecessary visits to hospital. The incidence of burn injuries reported was instead greater in proportion-2.8% of all ED attendances, compared to 1.5% in the previous year, despite the overall decrease in total number of burn injuries (n = 83) by 24%. This could be due to a combination of the closure of some local and minor injury facilities, reduced faceto-face consultations with general practitioners and the advice given to the general public that even minor burn injuries still require medical attention for adequate treatment. This instruction is crucial for the well-known potentially lifethreatening complications of burns in children [1]. Concerns were raised by the Royal College of Paediatrics and Child Health that children may be coming to harm from delayed presentation to emergency departments for fears of contracting COVID-19 in hospital. In our cohort of burns patients, only 2 were deemed to have come to harm by delaying presentation. We also noted that the number of referrals to children social care increased from 4% (5/123) in the control period to 12% (12/ 95) in the lockdown period. The reduced opportunity to liaise with allied health professionals and education settings to share information and concerns and to finally agree on a plan for follow up might have been due to a more vigilant approach for the fear of missing child protection concerns. The mean age of patients presenting with burns increased from 2.9 to 4.8 years. School-age children are now spending more time at home due to school closures, and UK statistics have suggested that most burns happen at home [2]. Gender distribution is similar in both periods. The number of inpatients in our centre decreased by 37%. All patients required COVID-19 testing prior to admission to

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