The COVID-19 pandemic came with strict public health guidelines for social distancing and infection control measures. Schools and daycare centres were closed for significant periods of time. The consequences of these measures for the epidemiology of transmissible paediatric disease are still unfolding. However, data 2 years into the pandemic indicate there has been a decrease in the incidence of at least one of the two most common causes of acquired heart disease in children, Kawasaki disease (KD). Japan, Korea, Singapore and Taiwan all reported decreased incidence of KD from 2020 to 2021.1–3 To the best of our knowledge, there have been limited and conflicting data published on the other most common cause of acquired heart disease in children, acute rheumatic fever (ARF). A major referral centre in Turkey reported decrease from 28 new cases of ARF in 2016–2017 to only 2 cases …