Time for a quick round up of the bizarre world of #COVID19 epidemiology in children in England right now

Hold on to your hats, it's an interesting picture and despite what you might have heard, it's not all bad news! 🧵

1/
Firstly @UKHSA clinical cases

Case ballooned in secondary school age children after a blip on school opening, and after a slight dip (?) now up again

Primary children appeared to continue summer trend upwards, with small school re-entry blip. Now maybe oscillating or up?

2/
This trend is matched by school ages in the @ONS population sampling data

Huge prevalence last week in secondary school age (>8%!), and less than half of this in primary school age

Remember we've been saying for 18m young children are different to older children?

3/
What's particularly interesting is via @ONS there is very little sign of spill-over from teenagers into older ages (small lift in the 35-49yo?), in spite of more suggestion of this in case data (? increased testing)

Vaccines holding up well - let's hope this continues!

4/
Now it gets a bit weird. With all these children infected what's happening with hospitalisations?

Not much!

Lowest rates since before "freedom day" for <5s, and after falling on school opening (?) back up to average summer levels for school age (6-17y) and flat

5/
And just for some context on these rates of admissions, here is what RSV is doing to the <5s compared to #COVID19

On the frontline in ED, #COVID19 fortunately still isn't making a dent on what we see in hospital for kids

6/
I get asked about PIMS-TS/MIS-C and sadly we don't have current surveillance data - however I can report we are seeing a small trickle of cases, WAY below previous peaks, despite much higher community covid numbers

Same reported in US and Europe - no current explanation

7/
Summary:

-Cases WAY up in teens
-Little spill over to parents
-Cases remain surprisingly low in primary children
-Hospitalisations low
-PIMS-TS/MIS-C surprisingly low

If anyone has explanations for the weird parts I'd love to hear them!

8/

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More from @apsmunro

15 Oct
We know health workers are high risk for #COVID19

High quality PPE can protect us, but filtration masks hurt like hell, cost £££ and are bad for the environment

What's the answer?

We show PAPR like @PeRSoPPE are well tolerated, sustainable and safe

1/
frontiersin.org/articles/10.33…
After rolling out @PeRSoPPE at @UHSFT we asked HCWs about their experience, and it was much preferred for comfort and feeling of safety over other forms of PPE

Patients (particularly the elderly) preferred it too

(thanks Paul Elkington MBE for being such a glamorous model)

2/
An economic analysis found that they are more cost efficient than filtration masks, or a mix of filtration + surgical masks over almost all scenarios

Also significantly reducing waste (we can be safe and not kill the turtles🐢)

3/
Read 6 tweets
11 Oct
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/
Read 4 tweets
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

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