Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK #covid19rftlks

The Lancet Child & adolescent Health | 9th July 2020

In April, 2020, clinicians in the UK observed a cluster of children with unexplained inflammation requiring admission to paediatric intensive care units (PICUs).

This paper aims to describe the clinical characteristics, course, management, and outcomes of patients admitted to PICUs with this condition, which is now known as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS).

Full document: Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study.

Young carers and young adult carers: providing care during coronavirus #covid19rftlks

Guidance and information for people under the age of 25 who are providing care for someone during the coronavirus (COVID-19) outbreak | Department of Health and Social Care 

This guidance is for anyone under 25 who cares for a family member who cannot cope without their support. This may be because they have a lifelong condition, illness, disability, serious injury, a mental health condition or an addiction.

The information and advice provided here is designed to help young carers understand the changes they need to make and signposts the help available during the coronavirus (COVID-19) outbreak.

It builds on previously published guidance for those who provide unpaid care to friends or family and is also available as an easy read version.

Full guidance: Guidance for those under 25 who provide care for someone

Coronavirus (COVID-19): Keeping children safe from abuse and harm #covid19rftlks

Home Office, Public Health England, Department for Digital, Culture, Media & Sport, and Department for Education | June 2020 | Coronavirus (COVID-19): Keeping children safe from abuse and harm

This guidance brings together sources of information about the main risks children may be particularly vulnerable to during the coronavirus (COVID-19) pandemic and signposts you to help and support available.

Advice to parents and carers on keeping children safe from abuse and harm

Royal College of Physicians: First UK study of COVID-19 neurological and psychiatric complications warns of mental health problems in younger patients #covid19rftlks

Royal College of Physicians | June 2020| First UK study of COVID-19 neurological and psychiatric complications warns of mental health problems in younger patients

Abstract

A study of 153 patients treated in UK hospitals during the acute phase of the COVID-19 pandemic describes a range of neurological and psychiatric complications that may be linked to the virus.

The research carried out by the CoroNerve Studies Group, including the Royal College of Psychiatrists, and published today in The Lancet Psychiatry journal reveals that while stroke was the most commonly reported neurological complication in hospitalised COVID-19 patients, many younger patients developed an altered mental state such as psychosis or catatonia.

 To investigate the breadth of COVID-19 complications that affect the brain, researchers set up a secure, UK-wide online network for specialist doctors to report details of specific cases. These portals were hosted by professional bodies representing specialists in neurology, stroke, psychiatry and intensive care. Data was collected between 2 April and 26 April 2020, during the exponential phase of the pandemic

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Varatharaj, A. et al. (25 June 2020). Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study| The Lancet Psychiatry|

Summary

Background

Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.

Methods

During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.

Findings

The ABN portal was launched on April 2, 2020, the BASP portal on April 3, 2020, and the RCPsych portal on April 21, 2020. Data lock for this report was on April 26, 2020. During this period, the platforms received notification of 153 unique cases that met the clinical case definitions by clinicians in the UK, with an exponential growth in reported cases that was similar to overall COVID-19 data from UK Government public health bodies. Median patient age was 71 years (range 23–94; IQR 58–79). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.

Interpretation

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

COVID-19 in children and adolescents in Europe #covid19rftlks

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study | The Lancet Child & Adolescent Health | 25th June 2020

To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic.

The study found that COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed.

Full article: COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Advice to parents and carers on keeping children safe from abuse and harm #covid19rftlks

Advice for parents and carers about the main risks children may be particularly vulnerable to at this time and information about available help and support | Home Office | Public Health England |Department for Digital, Culture, Media & Sport

The essential measures to control coronavirus can potentially increase risks to children and this can cause concern for parents and carers.

This guidance brings together sources of information about the main risks children may be particularly vulnerable to during the coronavirus (COVID-19) pandemic and signposts you to help and support available.

This guide also includes information on the support providers who can help you have effective conversations with a young person, especially if you are concerned for their safety.

Full guidance: Advice to parents and carers on keeping children safe from abuse and harm

Childhood Trust report warns of serious mental health conditions in children due to COVID-19 #covid19rftlks

The Childhood Trust | June 2020 | Childhood Trust report warns of serious mental health conditions in children due to COVID-19

This report draws on emerging evidence from available studies highlighting some of teh most pressing concerns that government and third sector organisations need to address to mitigate this crisis for children. These include the risk of emotional and physical abuse, mental health concerns, educational learning loss, hunger and food insecurity, homelessness and temporary housing, and lack of outdoor physical activity.

Read the report from The Childhood Trust

In the news:

BBC News Coronavirus: Children ‘developing post-traumatic stress’ from pandemic

Push to reopen schools risks new wave of infections, says Independent SAGE #covid19rftlks

It is not safe enough for all schools to reopen on 1 June and in pushing ahead the government is risking a new surge in cases of covid-19 in some communities, an independent committee of experts has warned | via BMJ | 28th May 2020

The Independent Scientific Advisory Group for Emergencies (Independent SAGE) has now published its full report on schools reopening after a public consultation with parents and teachers in association with The BMJ and the online forum Mumsnet.

The report concluded that the government was ignoring the advice of its own scientists who carried out modelling showing the reproduction rate R rising above 1 if schools reopened.

Full editorial: Push to reopen schools risks new wave of infections, says Independent SAGE

See also: Covid-19: Delaying school reopening by two weeks would halve risks to children, says iSAGE | BMJ

[NICE COVID-19 rapid guideline] Children and young people who are immunocompromised #covid19rftlks

NICE  |  May 2020 |COVID-19 rapid guideline: children and young people who are immunocompromised NICE guideline [NG174]

The purpose of this guideline is to maximise the safety of children and young people who are immunocompromised during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The guideline covers children and young people (aged 17 and under). It may also be relevant for newborn babies under 72 hours, and 18 to 24 year olds using healthcare services.

Children and young people who are immunocompromised include those with:

  • primary immunodeficiencies
  • secondary or acquired immunodeficiencies because of their condition
  • secondary or acquired immunodeficiencies because of immunosuppressive treatment
  • chronic disease associated with immune dysfunction (such as organ dysfunction or failure or severe inflammatory disease).

This guideline focuses on what you need to stop or start doing during the pandemic. Use it alongside your usual professional guidelines, standards and laws (including equalities, safeguarding, communication and mental capacity).

This guideline is for:

  • health and care practitioners
  • health and care staff involved in planning and delivering services
  • commissioners

The recommendations bring together

    • existing national and international guidance and policies
    • advice from specialists working in the NHS from across the UK. These include people with expertise and experience of treating children and young people who are immunocompromised during the current COVID-19 pandemic.

See NICE for further details

 

Children in lockdown: What coronvairus means for UK children #covid19rftlks

Unicef | May 2020 | Children in lockdown: What coronvairus means for UK children

Unicef UK reaches 2 million children in the UK every year through its work with schools, hospitals and local authorities.. The charity, has produced a briefing paper which lays out the complex issues facing children and their rights, and the multi-layered way in which the coronavirus presents a growing crisis for the worst affected families.

The risks to children’s health, wellbeing and futures are profound:

  • Education: 700 million days of education could be lost this school year
  • Nutrition: More children in the UK will face food insecurity as job losses take their toll on family finances
  • Health: A stretched health system means children have less access to healthcare and other essential services
  • Protection: Thousands of children are at greater risk of abuse in their homes and online
  • Participation: Across the board, the voices of children and young people have been absent from decisions made about their lives. (Source: Unicef)

Summary report: Children In Lockdown