Respiratory admissions during COVID-19 pandemic restrictions-a single centre experience

Introduction: Respiratory tract diseases are a major cause of morbidity and mortality in children. This study aimed to compare respiratory illness rates and aetiology requiring hospitalization in 2019 (pre-COVID lockdown in Ireland) and 2020 (during COVID lockdown in Ireland). Methodology: Data from medical admissions were retrospectively collected from the emergency department admissions record of a Tertiary Paediatric Hospital in Dublin, Ireland. This study focused on September, October and November in 2019 and 2020. The documented reason for admission in each case was noted;these were transcribed and grouped into categories. Reasons for admission under the category of respiratory included: bronchiolitis, lower respiratory tract infection, upper respiratory tract infection, wheeze, stridor and exacerbation of asthma. Rates of admission in this category were compared from 2019 versus 2020. Rates of investigative nasopharyngeal swabs for these admissions were documented, as well as the resultant viruses isolated. The results were compared across 2019 and 2020. Results: 1040 admission were included in the study. Of these, 620 were in 2019 and 420 in 2020. This alone shows a decrease of 32% in the admissions rate to Temple Street Children's hospital during COVID-19 restrictions. Of the 620 admissions across September, October and November 2019, 265 were attributed to respiratory illnesses (42.77%). In the same time period of 2020, only 67 admissions were attributed to respiratory causes (15.95%). This shows a dramatic decrease in the number of paediatric respiratory illnesses requiring hospital admission. There was a decrease in the number of respiratory panel nasopharyngeal swabs taken in 2020 compared to 2019, although 89% of respiratory admissions were swabbed for Sars-CoV-2 in 2020. Respiratory syncytial virus accounted for 54.60% of respiratory admissions swabbed in 2019 versus a 0% isolation rate in 2020. The table below further outlines virology differences between 2019 and 2020. (table) Conclusion: SARS-CoV-2 pandemic related social restrictions dramatically interfered with the seasonality of childhood respiratory illnesses. This was reflected in the unexpected reduction in the number of hospitalizations in the paediatric population during this period. There is also an obvious stark contrast in the viruses isolated in children presenting with respiratory illnesses in 2019 and 2020. This study raises serious questions and concerns regarding paediatric immunity to respiratory illnesses and begs the question: will we experience a more severe respiratory season in 2021?

Patient and caregiver satisfaction with novel en masse oral food challenge performance

Background: Oral food challenge (OFC) is the gold standard for the diagnosis of food allergy. OFC are traditionally performed in hospital, as a day ward procedure, with a high medical caregiver to patient ratio. This is likely to enhance communication and patient satisfaction. Despite the high incidence of adverse reactions, families generally report a positive experience . In Sep-Oct 2020 a novel, high throughput, OFC initiative was carried out by a cross-hospital, multidisciplinary Irish paediatric allergy team. Up to 25 OFCs were performed each day at an offsite, COVID-19 stepdown facility. The unique model was designed in response to the impact of the pandemic, on provision of ambulatory allergy services. It was essential to evaluate the patient experience of this unique, alternative OFC model, compounded by COVID related distancing. Method: An anonymised survey was conducted of randomised cross-section of patients attending. The survey was completed by the primary caregiver of the child attending for the OFC. 178 survey responses were collected from a total of 474 families and included for analysis. The survey was designed to assess patient satisfaction across a number of parameters. Results: 81% of respondents were highly satisfied with ease of use of a non-hospital facility. 81% reported that the site was “child friendly”. Patient experience was scored as “excellent” 82.9% of the time with a further 12.35% reporting it as above average. Communication was effective with 89% of carers reporting good understanding of the results of the OFC. 94.7% stated that their questions were answered by the Allergy Team present. Conclusion: Our results are remarkable for enhanced patient satisfaction despite a reduced medical caregiver to patient ratio. The patient's overall satisfaction was rated overwhelmingly as “excellent” despite almost 30% of patients experiencing allergic reactions. The pandemic has forced health services to seek new ways of doing things. This data reassures, that OFC models can be changed without sacrificing patient experience.

Mass food challenges in a vacant COVID-19 stepdown facility: The children's health Ireland food challenge initiative 2020

Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi elective procedures. For allergic children in Ireland, already waiting to 4yr for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative there were approx 900 children on the Chidren's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short term (6wk) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive Ireland (HSE). The aim was to the achieve rapid rollout of an off-site OFC service, delivering high throughput of long waiting patients, while aligning with hospital existing policies and quality standards, international allergy guidelines and national social distancing standards. Method: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant Paediatric Allergists, Consultant Paediatricians, trainees and Allergy Clinical Nurse Specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, Pulse, Oxygen saturation) bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardised food challenge protocols were created. Access to onsite hotel chef facilitated food preparation. A risk register was established. Results: After 6wks planning, the remote centre became operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges were commenced, 465 (98%) were completed, 9(2%) were inconclusive. 135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusion: OFCs remain a vital tool in the care of allergic children, with their cost saving and quality of life benefits negatively affected by delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy in -even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID- 19 era.

Babies born in the 1st 2020 lockdown: Early data from the CORAL study

Background: The CORAL study is a cross-sectional study of the impact of the Coronavirus pandemic on allergic and autoimmune dysregulation of infants born in March, April and May 2020, during Ireland's 1 st COVID-19 pandemic Lockdown. Method: Invitations were sent to families of 3065 term, singleton babies. Exclusion criteria were ante-natal PCR-proven SARSCoV-2 in a parent or co-dwelling person, IV antibiotics in neonatal period, multiple births and major congenital anomalies. At 6 months babies were invited to attend CHI Connolly for point-of-care SARSCoV-2 antibody testing. Results: Of the 3065 letters sent 353 babies were enrolled.53.7% of enrolled infants were male, 78.4% were white-Irish, average birth weight was 3.506kg. 45% were first-born and 95.5% of mothers were educated at 3 rd level or higher. Babies' average number of close contacts other than household members was 2.3 during lockdown and 5.6 afterwards. 42.5% were reported to be currently breast-fed at enrolment. By 6 months, 97% of infants had solid foods introduced but only 24.5% had tried egg and 9.6% had tried peanut. Complete primary immunisation uptake at 6 months was 99%. Lastly, 3 babies out of 200 (1.3%) tested showed presence of IgM & IgG SARSCoV-2 antibodies;2 were PCR negative, the other PCR positive. Conclusion: Initial breastfeeding and immunisation uptake to 6 months are reassuringly high in this self-selected, highly-educated cohort. The rare positive antibody tests suggest recent or current infection, so newborn babies appear to have been protected from SARSCoV-2 exposure during the 1 st COVID Pandemic lockdown.

Satisfactory implementation of paediatric virtual clinics and the perspectives of parents

Aim To assess whether virtual clinics result in a reduction in unnecessary clinic appointments, whilst maintaining a high parental satisfaction rate. Methods Parents of children waiting greater than 36 months were called about the continued need for their appointment. Clinic outcome data was quantified and a phone survey of a random sample of participating parents was undertaken to assess their virtual clinic experience. Results 66% (154 children) no longer required appointments. 20 parents participated in the phone survey. 90% (18) agreed/strongly agreed that they had enough time to speak to the Consultant/CNS. 80% (16) reported they were satisfied with the telephone consultation. 35% (7) highlighted their frustration at not being contacted sooner. Positive remarks included the personal nature of the phone consultations, and reassurance that their children hadn’t been removed from the waiting list. The main disadvantage voiced was the lack of warning for the phone call. Conclusion Virtual clinics lead to a reduction in required face-to-face appointments, whilst maintain parental satisfaction. However, it is important to note, our study referenced patients waiting greater than 36 months. Introducing this new type of effective consultation is more important than ever given the need to reduce social interactions during this COVID-19 Pandemic.

A note on blind contact tracing at scale with applications to the COVID-19 pandemic

The current COVID-19 pandemic highlights the utility of contact tracing, when combined with case isolation and social distancing, as an important tool for mitigating the spread of a disease [1]. Contact tracing provides a mechanism of identifying individuals with a high likelihood of previous exposure to a contagious disease, allowing additional precautions to be put in place to prevent continued transmission. Here we consider a cryptographic approach to contact tracing based on secure two-party computation (2PC). We begin by considering the problem of comparing a set of location histories held by two parties to determine whether they have come within some threshold distance while at the same time maintaining the privacy of the location histories. We propose a solution to this problem using pre-shared keys, adapted from an equality testing protocol due to Ishai et al [2]. We discuss how this protocol can be used to maintain privacy within practical contact tracing scenarios, including both app-based approaches and approaches which leverage location history held by telecoms and internet service providers. We examine the efficiency of this approach and show that existing infrastructure is sufficient to support anonymised contact tracing at a national level. © 2020 ACM.