BURDEN AND SEVERITY OF COVID-19 IN CHILDREN HOSPITALISED OVER FIVE COVID-19 WAVES IN SOWETO, SOUTH AFRICA

Intro There is sparse data on SARS-CoV-2 infection among paediatric patients from low-middle income countries (LMICs), including from sub-Saharan Africa. We describe the burden and severity of disease in children treated with SARS- CoV-2 infection at an academic hospital in Soweto, South Africa from 30 March 2020 through 30 June 2022. Methods SARS-CoV-2 was detected using reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal swab specimens. Clinical diagnoses, HIV status, admission C-reactive protein (CRP), blood culture results and clinical outcomes were captured. Epidemic waves were designated as follows: Wave 1 (01 March to 14 October 2020);Wave 2 (15 October 2020 to 17 May 2021);Wave 3 (18 May to 14 November 2021);Wave 4 (15 November 2021 to 14 March 2022);Wave 5 (15 March to 30 June 2022). Findings There were 797 SARS-CoV-2 positive paediatric hospitalisations in the study period. SARS-CoV-2 detection prevalence was 4.6% (77/1,673) in Wave 1, 3.9% (134/3,426) in Wave 2, 7.1% (187/2,618) in Wave 3, 12.5% (261/2,088) in Wave 4 and 5.9% (138/2,320) in Wave 5. Among SARS-CoV-2 positive cases, the prevalence of respiratory admission diagnoses increased over time (16.9% in Wave 1 to 42.8% in Wave 5). Conversely, the prevalence of multisystem inflammatory syndrom of childhood (MIS-C) and case fatailty ratios (CFRs) declined from Wave 1 to Wave 5 (MIS-C: 20.8% to 2.2%;CFR: 9.1% to 3.6%). Death was significantly associated with younger age (median age 3.4 versus 16.9 months), positive admission blood cultures (24.0% versus 8.4%), MIS-C (20.7% versus 6.5%), and HIV infection (21.1% versus 4.5%). Conclusion The omicron dominated fourth and fifth waves of SARS-CoV-2 infection were associated with a higher prevalence of respiratory admission diagnoses, but lower case fatality compared to the ancestral first wave in South African children. Optimisation of antenatal maternal SARS-CoV-2 vaccination and early HIV diagnosis may impact on paediatric SARS-CoV-2 CFR.

Choreoathetosis and dystonia in a child with COVID-19 and multisystem inflammatory syndrome

Neurological complications of COVID-19 or multisystem inflammatory syndrome in children (MIS-C) are well described. We report an unusual presentation in a 9-year-old girl presenting with status epilepticus, who thereafter developed choreoathetosis and dystonia. She was initially managed with intravenous immunoglobulins and methylprednisolone for presumed autoimmune encephalitis. However, she tested positive for SARS-CoV-2 and met the clinical and laboratory criteria for MIS-C. She remained encephalopathic with abnormal movements and dystonia for 8 days from presentation but was discharged home with complete clinical recovery after 2 weeks. © 2021, Health and Medical Publishing Group. All rights reserved.

Children caught in the long shadow of COVID-19

Despite the more transmissible delta variant being associated with higher rates of COVID-19 in unvaccinated adolescents, children have remained relatively spared from severe disease. Nevertheless, children are indirectly affected by the COVID-19 pandemic, which threatens to have far-reaching consequences. The effect of disruptions of seasonal patterns of circulation of respiratory pathogens on future immunity against such pathogens, childhood immunisation programmes, and HIV and tuberculosis treatment programmes poses a threat to the future wellbeing of children. Furthermore, the economic devastation caused by the pandemic, including an increase in unemployment, gives rise to numerous challenges, such as food insecurity, which is likely to worsen childhood nutritional status. Also, COVID-19 has ongoing effects on the mental wellbeing of children, driven in part by the interruption of schooling and other opportunities to socialise. An increase in psychological illnesses has manifested in children consequent to the stresses of the pandemic, lockdowns, caregiver deaths. In this article, we highlight the indirect effects of COVID-19 on children, and suggest solutions to mitigate against the long-term sequelae. A focused health, nutrition, education and child protection response is required from government and healthcare practitioners to safeguard the health and wellbeing of South African children. © 2021, Health and Medical Publishing Group. All rights reserved.

A blended learning and teaching model to improve bedside undergraduate paediatric clinical training during and beyond the COVID-19 pandemic

AFRICAN DEVELOPMENT Abstract: The 2020 COVID-19 pandemic has severely disrupted paediatric undergraduate bedside clinical training. Facing an uncertain future, we need to be able to adapt to the variable effects of the pandemic on bedside training. During severe conditions, no bedside training is possible, while limited bedside training is possible during less severe conditions. We propose a learning and teaching model for undergraduate paediatric clinical training during and beyond the COVID-19 pandemic to facilitate bedside clinical training in order to maximise students’ acquisition of clinical competencies

COVID-19 mass vaccination campaign for healthcare workers in a low-resource setting: A clinician-driven initiative.

COVID-19 vaccination has been globally accepted as a critical public health response measure to prevent severe disease and death, alleviate strain on healthcare systems, and prevent onward transmission of SARS-CoV-2. The South African Department of Health's plan to vaccinate 1.25 million healthcare workers through the Sisonke Early Access Vaccine Rollout for Healthcare Workers presented both opportunities and challenges in terms of designing and implementing a mass vaccination roll-out in the resource-limited state sector. We present our experiences and challenges from the largest hospital in Africa, and hope that this will assist other institutions with planning successful COVID-19 mass vaccination campaigns.