How worried should we be about #COVID19 in children?

Covid is a threat to children. But it’s not an extraordinary threat. In fact, it’s very ordinary.

In general, the risks from being infected are similar to the other respiratory viruses you probably don’t think much about

1/
In fact, for smaller children (pre school) viruses like RSV are much more likely to result in hospitalisation and severe disease

We are heaving with RSV and other viruses in children’s ED, but despite record numbers of community cases are still seeing very little #COVID19

2/
The children who are most likely to suffer from #COVID19 are those who suffer from other resp viruses, such as those with severe neurodisability or lung/heart disease

The risk is similar to that from other viruses, but can be significantly reduced by vaccination if available

3/
We obviously don’t want to see children infected. At very high numbers, we will see some rare, serious events, which we want to avoid if we can

But we must be aware that there are other, bigger risks to children (mental health, school loss) which should be prioritised

4/

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More from @apsmunro

30 Sep
The study we've all been waiting for

Using data from >50,000 #COVID19 contacts, vaccinated people are less infectious EVEN with Delta, and EVEN if CT count is the same

Also, kids appear less infectious and less susceptible, including with Delta

1/
medrxiv.org/content/10.110…
The effects of vaccination on reducing infectiousness are strongest earlier on and wane slightly with time

Somewhat less effective for Delta than Alpha

Effects on reducing susceptibility to infection appear stronger and remain quite well preserved, with some waning

2/
Data also clearly shows an age dependent effect

-Much lower rates of secondary infection from child index cases
-Mower secondary infection in child contacts

This remains true across settings including education, except "Events / activities" (?nature of contact)

3/
Read 7 tweets
24 Sep
It's over 3 weeks since schools reopened in England after summer - what's happening in the #COVID19 data?

I'll be honest with you, it's a mess

I've got no idea what's going on - the data is a bit baffling

Lets take a look... 🧵

1/
The headlines are mostly about PHE cases data

These have been increasing in most age groups since early August, with a slight flattening after reopening of schools, now rocketing in 10 - 15yo

Interestingly, sloping downwards in the <5s

Maybe a school effect on cases?

2/
We know the start of school based testing does botch the trends somewhat, which was always going to be difficult to disentangle

In contrast to case numbers, positivity is actually tanking, especially in people reporting symptoms

Increases in Rhinovirus etc boosting testing?

3/
Read 9 tweets
22 Sep
Proud our new analysis of the 2nd wave (mainly Alpha) of #COVID19 in children in the UK is now available!
Headlines:

- No evidence of increased severity
- Over 30% admissions <1y
- Over 40% admissions had comorbidities
- Over 20% incidental positives

assets.publishing.service.gov.uk/government/upl…

1/
Compared to wave 1, the acuity was lower - less unwell on admission, and less respiratory support

There were more admissions, likely representing a higher case count and lower threshold for admission

2/
Children with no comorbidity made up 60% of admissions, and of these >40% were <1yo, likely representing our lower threshold to admit infants

Indeed, children w/o comorbidities were less unwell and required much less support

3/
Read 7 tweets
16 Sep
The best data by far on #LongCovid is out from the ONS

For kids, the news is incredibly reassuring - parents minds should be put to rest

Rates of common symptoms after #COVID19 at 12 w for kids are extremely low (0% to 1.7%) compared to controls

ons.gov.uk/peoplepopulati…

1/
Previous ONS statistics have been widely misused, and difficult to interpret due to unavailable methods

This is all put to bed now. Excellent, transparent comparisons with a suitable control group.

Importantly, it includes COVID cases which would be missed by NHS testing

2/
One statistic stands out

At both 4 and 12 weeks, MORE children aged 2 - 11y in the control group were experiencing symptoms than in those who tested positive for #COVID19

3/
Read 9 tweets
14 Sep
Loads of people will now have heard of RSV for the first time

Here is a quick thread on the disease it causes (bronchiolitis) and why we DONT use salbutamol inhalers/nebulisers to treat it - they can even make it worse!

1/
Bronchiolitis does what is says on the tin

It’s infection with a virus (usually RSV, but can be others) affecting the small airways (“bronchioles”) causing inflammation (“itis”)

It causes wheezing, coughing, and difficulty breathing

2/
Usually it affects babies <1y of age (although in the US definitions are a bit different…) and is seasonal, coming in waves every winter

It is the most common cause of hospitalisation of children, usually for breathing support, extra oxygen, or help feeding

3/
Read 10 tweets
8 Sep
Amazing education settings outbreak data from the Delta #COVID19 outbreak in NSW 🇦🇺

Primary/Secondary schools mostly closed, so limited info to draw on (Attack rate v low, <2%)

BUT early years settings fully open with no masks!

What happened? 🧵

ncirs.org.au/covid-19-in-sc…

1/
There was secondary transmission in 16/32 settings

If the index was an adult, decent amounts of transmission - 17% AR to adults, only 8.1% to the kids

If the index was a child, minimal transmission - 1.3% to an adult, 1.8% to another child

Over 95% of contacts tested

2/
Once cases were back home, as you would expect with Delta, there was a lot of transmission

70% of all household contacts became infected

In 57% of households, everyone got infected (overdispersion in action)

3/
Read 6 tweets

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