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PONE-D-21-02621

When months matter; modelling the impact of the COVID-19 pandemic on the UK diagnostic pathway of Motor Neurone Disease (MND)

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Reviewer #1: This very interesting paper explores the impact of the pandemic on the MND diagnostic pathway, suggesting that the COVID-19 pandemic will result in later-stage diagnoses and more emergency presentations of undiagnosed MND.

I would propose only minor changes:

1. Introduction section: The statement that “There are nearly 1100 people diagnosed with MND each year […]” appear to ben not clear. I would specify in which region.

2. Implications for secondary healthcare providers section: I would add in this section a small paragraph discussing the available opportunity to manage ALS patients remotely through telemedicine tools (suggested refences: Bombaci A, et al. Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail. Neurol Sci. 2021; Vasta R, et al. (2020) Telemedicine for patients with amyotrophic lateral sclerosis during COVID-19 pandemic: an Italian ALS referral center experience. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration)

Reviewer #2: In this manuscript, Burchill et al., considering that the COVID-19 pandemic has caused significant delays in NHS pathways, especially for caring disabling diseases needing multidisciplinary approaches, such as amyotrophic lateral sclerosis (ALS), and the majority of GP appointments occurred online with subsequent delays in secondary care assessment, applied a model to describe the pre-COVID-19 diagnostic pathway and then introduced plausible COVID-19 delays by using Monte Carlo simulation accounting for a wide range of delays. The pre-COVID model reproduced known features of the MND diagnostic pathway, with a median time to diagnosis of 399 days and predicting 5.2% of MND patients present as undiagnosed emergencies. COVID-19 resulted in diagnostic delays from 558 days when only primary care was 25% delayed, to 915 days when both primary and secondary care were 75%. The model predicted an increase in emergency presentations ranging from 15.4%-44.5%. The model suggests the COVID-19 pandemic will result in later-stage diagnoses and more emergency presentations of undiagnosed MND.

This is an interesting paper, focused on an innovative and crucial topic for clinical practice in the MND field. It is well written and well discussed. I have only a minor suggestion.

Among implications for secondary healthcare providers, the use of home-monitoring and services at home, such as through technological devices aimed at improving the assistance and quality of life of the monitored patients (i.e. telemonitoring respiratory function and telehealth services, such as TiM system by Hobson et al., 2018 DOI: 10.1080/21678421.2018.1440408), could be discussed in this regard, although considering the heterogeneity in healthcare services in UK, as well as in other countries.

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Reviewer #1: No

Reviewer #2: No

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When months matter; modelling the impact of the COVID-19 pandemic on the diagnostic pathway of Motor Neurone Disease (MND)

PONE-D-21-02621R1

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Luigi Lavorgna

Academic Editor

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