Thread by @Williams_T_C

our study on the indirect effects of the COVID-19 pandemic on children now out @ADC_BMJ adc.bmj.com/content/early/…

many positives, in terms of our findings and how the paper came together

but also raises serious considerations for clinicians, researchers and government 🧵 1/n

first of all, the findings

at the start of the pandemic, we were concerned that radical shake-ups to health-care seeking behaviour and provision

might lead to delayed presentations & higher risk of injuries, accidental & non-accidental

& increased harm to children 2/n

(a reminder of the timeline for the first few months of the pandemic in Scotland) 3/n

we found a dramatic reduction in health-care seeking in emergency primary and secondary care, for medical but not surgical presentations 4/n

the biggest fall in PICU admissions requiring emergency mechanical ventilation was for respiratory conditions

probably to be expected

measures taken to interrupt SARS-CoV-2 transmission are, as it turns out, also highly effective in preventing transmission of any pathogen 5/n

we didn't find evidence of increased severe harm:

no change in severity score of sickest children on admission to PICU

no change in overall mortality rates for children 6/n

some caveats to our findings

even though we looked at data covering healthcare for almost a million children

as in any high income country, the number of PICU admissions and deaths was relatively small, and the risk of type II error remains 7/n

in addition, we couldn't examine many types of harm, & in particular the impact of this pandemic on mental health

which from my clinical practice & listening to colleagues, appears to have hit teenagers in particular hard @rcpsych @RCPsychScot @rcpsychEDFac @rcpsychTrainees 8/n

what are positives in terms of methods?

first of all, hats off to @ADC_BMJ to publishing what is essentially an (important) negative finding & for making it free to read at no cost to the authors

(data for paper also #OpenAccess git.ecdf.ed.ac.uk/twillia2/indir… @gitlab) 9/n

I've been genuinely impressed and heartened by @P_H_S_Official 's & @NatRecordsScot 's commitment to #OpenData

thank you to @JulieRamsay, Marie Kay, Jaime Villacampa, Kathy McGregor and Rachael Wood for the time they spent on this project with us 10/n

was great also to work with enthusiastic early career researchers (@TheLucyGarner) including Clare MacRae, Haris Haseeb

we need clinicians who are passionate about child health

AND research oriented 11/n

coming on to the most serious part of this thread, what do we need to learn ? 12/n

every child death is a tragedy

rates in the UK are amongst the highest in Western Europe and twice as high as in Sweden thelancet.com/journals/lance…).

we need to learn everything we can from every child death, to do our best to bring these rates down 13/n

1) England now has a Child Mortality Database which gathers information on all children who die @NCMD_England ncmd.info/2020/07/09/sui…

Scotland should have the same, or join England's @scotgov 14/n

2) interventions implemented to reduced SARS-CoV-2 transmission have had a dramatic reduction on the burden of childhood morbidity

what can we learn from this in terms of reducing risk to, in particular infants, of hospitalisation? 15/n

we managed to crush the curve for COVID-19 (at least initially) and (so far) have crushed the curve for RSV this winter @PHE_uk 16/n

couldn't we do this every year by washing our hands, minimising social contacts, and paying attention to infection risk in babies? 17/n

3) a constant tension in clinical research looking at rare events is balancing patient confidentiality with public good

as clinicians we rightly prize patient autonomy

however, in this pandemic in the UK we have privileged individual rights above societal good 18/n

successfully eliminating COVID-19 has required restricting people's right to free movement and to privacy (in Taiwan, NZ, Australia) 19/n

of course there is the risk of mission creep

but I believe we should think about ways to make detailed data on important issues like child deaths and hospitalisations available quickly and openly 20/n

so that clinicians, researchers, government and probably most importantly parents can contribute towards discussions on making quick and decisive (if not perfect @DrMikeRyan) decisions 21/n

to conclude

let's learn from this pandemic

let's use what we've learnt to protect the most vulnerable in our society, but also our future : children and young people

(END)