• systemic vasculitis
• granulomatosis with polyangiitis
• epidemiology

In our previous report on anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) during current COVID-19 pandemic, we described our observation of both an incidence-shift with a post-lockdown clustering and an increased incidence rate of AAV diagnoses between February and August 2020 compared with previous years.1

In correspondence to our article, Hakroush et al observed a similar incidence-shift with a post-lockdown increase of AAV diagnoses at their centre. This shift affected patients with less severe symptoms but not critically ill patients requiring intensive-care or intermediate-care treatment. In detail, four patients presented with biopsy-confirmed AAV in the stretch of April–June 2019 (one normal ward, three intensive/immediate care unit), while only one diagnosis was made in the same period in 2020.2 We agree that containment measures such as a lockdown and reduced attendance of hospitals due to fear of infection may delay diagnosis of less-severely affected patients. In contrast to the observations by Hakroush et al, our patients with new diagnosis and relapse were diagnosed either on the normal ward or in an outpatient setting. Estimation of the exact diagnostic delay in our cohort …