ABSTRACT
BACKGROUND: The burden of the COVID-19 pandemic is often enumerated in lives lost, but the strain on health care resources and mobility limitations contributed to the burden of non-COVID related disease. In this study, we evaluated the impact of the pandemic through a time series review of cytology samples. METHODS: Pathology reports for all cytology specimens received from January 2019 through April 2021 at our institution were reviewed. Time series analysis was performed using moving averages, time trend analysis, cross-correlation, and tests of homogeneity. RESULTS: During the first peak of the pandemic (March-June 2020), breakpoint analysis showed a downward shift in the number of gynecologic (-89.4%) and non-gynecologic (-70.4%) cytology specimens within a week of declaration of an emergency. Cross-correlation analysis showed a relationship between sample numbers and COVID-19 cases during the initial phase of the pandemic (April-June 2020). During the second surge (October 2020-April 2021), despite the higher incidence of COVID-19, there was a smaller impact on cytology samples (-20.1% and - 24.8% for gynecologic and non-gynecologic samples, respectively). During the first 3 months of the pandemic, 154 fewer malignant cases were identified compared with the prior year. Although specimen numbers slowly returned to baseline following the first wave of the pandemic, the earlier decline in malignant diagnoses was not offset during the study period. CONCLUSIONS: The deleterious effects of COVID-19 extend beyond direct mortality attributed to the disease. The significant decrease in diagnostic cytology specimens during this period has profound implications including delayed care and missed disease.