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Introduction: Since the beginning of the COVID-19 pandemic, a worldwide significant decrease in Emergency Department (ED) visits has been documen- ted. Despite the significant decrease in ED visits, it remains unclear whether this resulted in an increase in severity of ED visits. The objective of this study is to analyze epidemiologic data of ED visits and assess the collateral damage due to the COVID-19 pandemic. Methods: This retrospective, observational, single center study examined daily ED visits, hospital admis- sions following ED presentation and mortality rates following hospital admission from March to June 2020, i.e. the first wave of the COVID-19 pandemic in Belgium. These data were appointed as cases. Data were compared with data from a 2-year period prior to these months (January 2018 till February 2020), which were considered as controls. Data were col- lected from a large hospital located in the province of West-Flanders. Primary endpoint was mortality rates after admission following ED presentation. Secondary endpoints were disease severity, reflected as hospital admission rates following ED presentation, number of STEMI (ST elevation myocardial infarction) and number of CVA (cerebrovascular accident) presentations in the ED. Results: A total amount of 74 992 ED visits was reviewed from January 2018 till June 2020. During the months of March to June 2020, a significant decrease in number of ED presentations was seen compared to the 2-year period prior to these months (2213 ± 349.7 vs. 2544 ± 108 (p < 0.001)). The total number of hospital admissions was significantly less during the first wave of COVID-19 pandemic compared to the previous 2-year period (p < 0.001). The mortality rates following hospital admissions after ED presenta- tion did not significantly differ during COVID-19 pan- demic compared to 2018 and 2019 (p = 0.29). The amount of STEMI’s was significantly less during the first wave of COVID-19 (p < 0.05) as was the amount of CVA’s (p < 0.05). Discussion: Our data showed a significant decrease in ED visits and hospital admissions after ED presenta- tion during the first wave of the COVID-19 pandemic in Belgium. It did not show a difference in mortality rates after hospital admission following ED presentation. The decrease in ED visits is probably multifactorial. One of the possible explanations is the decrease in traffic and daily activities, decreasing the amount of minor and major trauma. People’s fear of possible exposure to COVID-19 in the ED could also explain the decrease in ED presentations. Secondly, we observed a decrease in number of admissions following ED pre- sentation. Third, there was no significant difference in mortality rates following hospital admission. This sug- gests the absence of significant collateral damage dur- ing the first wave of the COVID-19 pandemic. The amount of STEMI’s and CVA’s was both significantly lower during COVID-19 pandemic compared to the previous 2 years. It remains unclear if fear for exposure to COVID-19 kept severely ill patientsaway from the ED department, and if there was a difference in mortality rates at home. To conclude, there was seen a decrease in ED pre- sentations and hospital admissions during the first wave of the pandemic, but no difference in hospital mortality after ED presentation. This suggests there is no significant collateral damage regarding mortality rates. During the first wave of COVID-19 pandemic, there were also significant less CVA’s and STEMI’s com- pared to the two-year period before. It remains unclear if mortality rates at home were different.

Maternal transfer of organohalogenated pollutants (OHPs) was investigated through comparisons of the levels and profiles of organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) between female blue tits (Cyanistes caeruleus) and their eggs. Mean egg concentrations decreased significantly in relation to the laying order from 342 ± 24 ng/g lw to 235 ± 17 ng/g lw for the sum OCPs, from 1623 ± 148 ng/g lw to 1040 ± 47 ng/g lw for the sum PCBs and from 49 ± 5 ng/g lw to 27 ± 5 ng/g lw for the sum PBDEs. The egg/female lipid concentration ratios for the sum OCPs, sum PCBs and sum PBDEs decreased significantly in function of the laying order from 1.1 ± 0.1 to 0.7 ± 0.02, 1.0 ± 0.09 to 0.7 ± 0.003 and 1.2 ± 0.14 to 0.8 ± 0.05, respectively. Furthermore, our results suggest that maternal transfer in blue tits seems to be selective for the more bioaccumulative and persistent congeners/compounds. Differences in reproductive strategies among species are suggested to be important in the processes of maternal transfer of OHPs.