ABSTRACT
Objective: Similarities in clinical, laboratory, and cytokine responses have been demonstrated in Dengue Fever and COVID-19 diseases. This study aims to determine a geographical correlation between COVID-19 mortality and the prevalence of dengue fever. Design and Methods: This is a geographical ecological study among 16 Caribbean islands. Using secondary online data sources, we compared COVID-19 and dengue mortality, with dengue incidence rates among Caribbean islands. To minimize the impact of vaccination on outcomes, data from 2020 was used. The percentage of the population > 65 years, income level, hospital beds/1000 people, physicians /1000 people, and nurses/1000 people were assessed for correlations with mortality outcomes. Pearson correlations were calculated using SPSS version 20 Results: Demographic, health system indicators, and COVID-19 mortality varied among islands with the widest disparity in dengue incidence rates. Dengue mortality and dengue incidence rate were found to be moderately positively correlated, r(14) = .528 , p = .036. There was no correlation with dengue incidence rate and COVID mortality, r(14) = .1, p = .713. COVID-19 and dengue mortality were not associated with percentage population > 65 years or health system indicators Conclusion(s): There was no ecological link in islands with high dengue incidence rates and COVID mortality. Dengue mortality correlated with high dengue incidence rates. This study did not demonstrate disease synergism. Further evaluation of cases of dengue COVID coinfections can provide additional insight into the dengue COVID-19 syndemic. A high index of suspicion should be maintained in dengueendemic countries to avert delayed diagnoses.
ABSTRACT
Objective: To identify factors associated with the need for supportive hospitalised care among children admitted for COVID-19. Design and Methods: A multicentre retrospective descriptive cohort of children <17 years , hospitalized with COVID- 19 in nine hospitals in Barbados, The Bahamas, and Jamaica from September 2020 to July 2021. The need for supportive therapy was explored by age, and among children with and without a range of comorbidities. Result(s): Among 238 hospitalized children, 56% were < 5 years of age. Comorbidities were present in 107 (45%), with proportionately more comorbidities among older children (> 5 years of age, p < 0.001). Comorbidities included asthma 21(9%), sickle cell disease 20 (8%), neurological 12 (5%) or cardiac 11 (5%) diseases, and diabetes 11 (5%). Multisystem Inflammatory Syndrome (MISC) was present among 32 (13%) children, and of these the largest proportion 12 (29%) were between 5 and 9 years of age (p = 0.04). All diabetic children had diabetic ketoacidosis (DKA), and 83% of neurology cases had seizures. Oxygen use was common among children with asthma (50%), obesity (75%) and MIS-C (40%). Blood products were required among children with MISC (40%), or with malignancy (50%). Almost three-quarters of children with MISC had additional complications, including liver dysfunction, acute kidney injury, and anaemia, and these children regularly required inotropes (22%), non-invasive ventilatory support (12%), or ICU admission (34%). Conclusion(s): Children with asthma, obesity, malignancy, diabetes and neurological disease require additional support with more ICU support needed in MISC cases. Care of vulnerable groups and early recognition and intervention for severe MISC should be prioritized.
ABSTRACT
Objective: The objectives are to determine the incidence of malnutrition and anemia and evaluate the association of nutritional status and COVID-19-related clinical outcomes in children hospitalized for COVID-19. Method(s): This multi-island inpatient survey presents data from nine hospitals in three Caribbean islands in children from birth to 17 years from September 2020 to July 2021. We explore statistical associations with inpatient characteristics and potential differences between malnourished and well-nourished children. Result(s): Among children hospitalized for COVID-19, 6.8% were stunted, 6.6% were underweight, 13.6% were overweight/ obese, and 30% had anemia. Anemia was associated with multi-system inflammatory syndrome (MIS-C) in children but not with malnutrition. The prevalence of underweight children exceeded the 4.4% prevalence in the general pediatric population in islands and there was a greater-than-expected prevalence of overweight children hospitalized with COVID-19. No clear associations were detected between malnutrition and indicator outcomes. There were two deaths in children with severe malnutrition, COVID and septicemia identified after the study window. Conclusion(s): Hospitalizations exceeded baseline population rates of undernutrition but no significant associations were detected possibly due to small numbers. T cell activity is associated with less disease severity in SARS-CoV-2 infection and the diverse repertoire of naive T lymphocytes in children may confer protection to undernourished children. The deaths in two children with severe malnutrition and sepsis may suggest a compound effect on immunity by nutrition severity and COVID-19 disease. Overweight children in this cohort may reflect an increased prevalence of overweight children in the general population that requires further evaluation and intervention.
ABSTRACT
Objective: There are few published reports concerning the impact of the COVID-19 pandemic on children in the Caribbean. The specific impacts of COVID-19 on Caribbean children aged 0-19 are examined. Method(s): Using standardized online questionnaire , primary data and published reports the burden of COVID-19 among children is evaluated. Result(s): Most islands have pediatric specialists, but few have designated pediatric hospitals. The higher number of cases among children is notable in islands with large populations such as Cuba, Jamaica, Trinidad, the Dominican Republic, and Haiti. The proportion of children among all cases in these islands range from 0.6%- 16.9% compared with a global case rate of 20.2%. As of August 2021, there were 33 cumulative deaths among children in Haiti, Jamaica, in Trinidad and Barbados. The case fatality rates (CFR) for 0-9-year-old and 10-19-year-old were 2.8 and 0.7 for Haiti, 0.1 and 0.2 for Jamaica, and 0 and 0.14 for Trinidad compared with and globally. Higher CFRs in Haiti may be related to the testing strategy, which may not identify all cases. However, low socioeconomic status and a poor healthcare system may have had an impact. Conclusion(s): Overall COVID-19 prevalence and mortality in children were consistent with global estimates. A standardized regional assessment and the multidimensional impact of the COVID-19 pandemic among children warrants further examination in light of limited resources and the potential lifelong impact of secondary effects.