Thread by @dgurdasani1

Interesting the takes from some scientists/clinicians that because most kids are exposed to SARS-CoV-2, it's meaningless to evaluate past exposure in an outbreak of acute fulminant hepatitis. Some thoughts:

It's our policies of mass infection that led to children being mass infected. Maybe it's then worth looking at evidence from other countries where this didn't happen. Israel & Austria both had fewer cases, & were able to show recent COVID-19 infection in most/all cases. How?

Excellent surveillance in kids. We never prioritised this. We limited symptom eligibility criteria, our contact tracing was done by centralised private companies with little experience, we disincentivised testing by having very low support for isolation.

https://twitter.com/NuritBaytch/status/1536217549154680833?s=20&t=hFTdAt8XIeeHMsTzDMpgYA

A comparison of ONS (random community survey) results with test-based results shows consistent underascertainment of infection, especially in young children. They didn't have access to rapid tests either. Or saliva testing, which was introduced by Austria.

And we stopped testing for the majority of the population in April altogether. And got rid of contact tracing in Feb when we ended isolation (all steps that added to mass infection but without detection). So, sadly ascertaining recent infection is going to be problematic here.

However, so far the data released by UKHSA suggest seropositivity in under 5s was ~47% up to Feb 2022. We don't know what's happened since, but I don't think we can assume that the expectation is that its near 100%. We need UKHSA to release more recent estimates.

I think it's important to keep in mind that a lot of this is down to the failed policies implemented in the UK, and the poor surveillance especially in young children. Rather than saying 'there's no point evaluating for past exposure' - maybe do better going forward.

We *need* good surveillance. This is a novel virus, and every day we're seeing new report of how it affects people- both children and adults. If we don't surveil it- we won't know what's going on. We know it's been associated with higher risk of many chronic conditions now.

So if/when we see young people coming in with diabetes, pulmonary embolisms, strokes, cognitive effects- how will we evaluate for these being post covid complications? If we have little record of infections/re-infections and when these happened.

So - rather than saying 'it's useless to evaluate', perhaps consider how we got here (other countries didn't!), and how we can do better in the future. And also look at evidence from other countries that *have done better* rather than dismissing evidence from them.

It's disingenuous to be part of a process of dismissing impacts on children, ending the means to diagnose people with COVID-19, mass infected children - to then say
'we can never know now because everyone had infection (that we didn't even bother ascertaining when it happened)'.

How on earth are we going to understand the impact of re-infections for example, if we've stopped surveilling infection? Serology isn't going to help with that. We know this. So do better- instead of later saying 'we can't say' when you designed this!

or at least became part of a narrative that normalised this...