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OK, time for a tweet summary of what we know from the paediatric literature about #COVID19 in kids SO FAR

Given the disease has only existed for 3 months, it's quite a lot...

#FOAMPed #PedsICU #IDTwitter

1/7
Kids get MUCH less severe disease than adults. Mortality AND critical illness v. low (close to 0%), confirmed from both China and Italian data

pediatrics.aappublications.org/content/pediat…

jamanetwork.com/journals/jama/…
2/7
Kids PROBABLY acquire the disease less often than adults. Low rates seen in symptomatic cohorts, and in S Korea which had higher rates of population screening.

statista.com/statistics/110…

Japanese contact tracing found lower attack rates in children

medrxiv.org/content/10.110…

3/7
Kids get slightly different symptoms. Many asymptomatic (unknown N, but 30% of 6-10yr olds in Chinese data). Cough and fever most common, followed by sore throat, rhinorrhoea, and some children only get diarrhoea or vomiting.

pediatrics.aappublications.org/content/early/…

nejm.org/doi/full/10.10…
4/7
Childrens bloods and radiology are different too. Lymphopaenia is rare. Inflammatory markers are rarely raised. CXR/CT have much milder findings, often ground glass changes but peripheral predominance is rarer.

onlinelibrary.wiley.com/doi/full/10.10…
5/7
Neonates don't seem to get severe disease, and it doesn't appear to be vertically transmitted.

No evidence of SARS-CoV-2 in amniotic fluid, plancental swabs, cord blood, or babies (one tested positive aged 36hrs though...)

doi.org/10.1093/cid/ci…

thelancet.com/lancet/article…

6/7
What don't we know?

The role of asymptomatic children in transmission is unclear

Children have detectable virus in stool for up to 4w post symptoms, but we don't know if it's viable or transmittable

We don't know why children are less affected.

END
7/7
And how could I forget to link to our review of ALL the paediatric COVID-19 literature @DFTBubbles

dontforgetthebubbles.com/evidence-summa…
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#COVID19 #FOAMPed #PedsICU #IDTwitter

More from @apsmunro see all

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Alasdair Munro
@apsmunro
There’s a lot of magical thinking about IV antibiotics 🧙‍♂️

The fact is, the bug doesn’t care how the drug got in. It only cares how much drug gets to it!

There’s actually only a few reasons you ever have to give them IV over oral. Let’s take a look at some #FOAMed 1/4
1. Speed. If you have a life/limb threatening infection and need peak plasma levels in seconds/minutes, not minutes to hours (Sepsis, nec fasc etc)

2. Absorption. If there are concerns about poor gut function and not absorbing oral drugs properly (enteropathy, sepsis etc) 2/4
3. No gut access. Patient is nil by mouth (duh)

4. Coverage. There are no oral options to sufficiently cover a particularly resistant bacteria (e.g. Pseudomonas, ESBLs)

5. Dose. You need to give such a whopping dose it wouldn’t be tolerated orally 💊 3/4
Read 4 tweets
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Alasdair Munro
@apsmunro
1/15 #Fever #tweetorial

Parents and paediatricians alike are obsessed with fever

We've all got fever fever 🔥 But it is SO misunderstood

Let's take a look at what fever actually is, and finish off with some myth busting!

#FOAMPed #FOAMed #IDTwitter #PedsICU #PedsID
2/15
Fever (pyrexia) is an elevated core body temperature as part of a physiological response to infection controlled by the hypothalamus

This is opposed to hyperthermia, a pathological elevated temperature

This is important, as your body is IN CONTROL. Fever happens on purpose
3/15
What temperature counts as a fever?

There's no strict definition (there's no really good data on what a "normal" temperature is...), but an arbitrary cut of off 38C is often used.

Its better taken in context; 37.8C following temps >38.5C is probably still a fever.
Read 15 tweets
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Alasdair Munro
@apsmunro
1/8 #FOAMPed #PEM #FOAMed

Another chat in CED last night about using Ibuprofen in chickenpox, and thought it would make a nice tweetorial! (for more detail check out end of thread for link to blog and podcast!)

Ever heard you shouldn't given ibuprofen to kids with chickenpox?
2/8
 The concern is about increased risk of severe skin infections, in particular the dreaded necrotising fasciitis (nec fasc) with group A Strep (GAS).

This first popped up in the 60's with case reports of a GAS outbreak associated with ibuprofen.

journals.lww.com/pidj/Abstract/…
3/8
 A few case control studies have been done since, with small sample sizes (Nec fasc is rare!) which seemed to confirm an association.

But, as you all know, correlation does not equal causation!

adc.bmj.com/content/102/10…
Read 8 tweets

Related threads

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Josh Wolf
@Joshuawolf
First reported case of an immunocompromised child with #COVID-19 infection suggests risk for severe disease. (1/12)@PIDSociety @IDSAInfo #TxID #IDtwitter
Most descriptions of children with #COVID-19 have been reassuring, few have had severe disease and most recover rapidly. However, there is some concern that immunocompromised children will fare much worse. (2/12)
This case in the Chinese Journal of Hematology is reportedly the first case of documented COVID-19 infection in an immunocompromised child. It’s in Chinese and I had a lab colleague read it to me – apologies for any errors. (3/12)
Read 15 tweets
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Antonio
@AGarciaPascual
(1/9)

@ECB has to react this week to #COVIDー19 as EA heads into a recession

There is more limited fire-power at the ECB than at the Fed, but it does not mean the ECB won't act

Targeted support for SMEs is crucial

Time to learn about the reaction function of ECB's new owl
(2/9)
1. While there is far more limited fire-power at the ECB than at the Fed, it does not mean the ECB won't act; it will

2. The ECB will try to support SMEs through TLTRO possibly introducing full-allotment

3. It will also signal more QE

4. It won't cut the depo
(3/9)
EA is heading into recession in H1 2020.

Financial conditions have tightened materially:

1) European equities are down along with the growth outlook and as part of de-risking by investors
Read 9 tweets
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LSMOH
@LSMOH
PRESS RELEASE

                       COVID-19: SUSPECTED CHINESE PATIENT TESTS NEGATIVE

The Chinese man who arrived Lagos yesterday aboard an Ethiopian Airline and suspected for COVID-19 has tested negative for the disease, Commissioner for Health, @ProfAkinAbayomi has said
@ProfAkinAbayomi who disclosed this today while giving an update on the management and control of COVID-19 outbreak in Lagos State said the patient who arrived yesterday aboard an Ethiopian Airline was taken into isolation after exhibiting symptoms of #COVIDー19.
According to him, samples were collected from the patient and the test which turned out negative was carried out the Lagos State Bio-security Level 3 laboratory located within the premises of the Mainland Hospital.
Read 11 tweets
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Ali
@aliostad
I will start today's thread on #COVID in Iran, following up from yesterday's #irancorona
DISCLAIMER:

The GOOD
- Government in a complete reversal taken #COVID seriously
- As per contacts, many stay indoors if they can

The BAD:
- Explosion of cases in new cities
- Tehran seems to be next
- Extreme shortage of basic hygiene supplies
- Street collapses continue
#irancorona
Read 37 tweets
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mRr3b00t @ planet earth
@UK_Daniel_Card
ok time to live tweet my quick glance review and analysis of: GOVERNMENT SECURITY! Image
I'm listneing to James Bond tunes whilst doing this :p
after cool but very high level video lets read this! Image
Read 115 tweets
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Anna makes vestments🇻🇦
@notabananaanna
Ok. Time for a rant

As some of you know... my family fostered 3 little ones for several years. We were about to adopt them and then at the last minute the judge gave them back to their mother.
It was devastating. It absolutely devastated my family... not to mention the harm it did to the kiddos. We had them longer than their mother did. We were their FAMILY.
Most people say to us “oh you should be happy for the kids, they’re back with their mother and that’s most important.” “You did your job, they’re back where they belong” Etc.
That couldn’t be further from the truth.
Read 7 tweets

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