Reduced Presentation of Biliary Atresia During the COVID-19 Lockdown: A Population Based Observational Study.

OBJECTIVE: The aim of this study was to assess whether there has been a change in presentations of biliary atresia (BA) in England and Wales during the first and second coronavirus disease 2019 (COVID-19) lockdowns (January-June 2020 and 2021). DESIGN: This population study assessed all confirmed cases of BA, from January 2020 to December 2021 across the 3 UK pediatric liver centers originating from England and Wales. Data was then compared to the incidence of confirmed BA cases from January to December 2017, 2018, and 2019. RESULTS: During January-June 2020 and 2021, there were only 8 and 12 presenting cases of BA in England and Wales, compared to 16, 13, and 18 for the same time periods in 2017, 2018, and 2019, respectively. This difference was significant in a two-sided t test for 2020 ( P = 0.035) but not for 2021 ( P = 0.385). There was no difference in the mean days to Kasai procedure in January-June 2020 and 2021 compared to 2017-2019; however average time to Kasai after the lockdown periods was significantly higher. CONCLUSIONS: There was a significant reduction in the presenting cases of BA during the first COVID-19 lockdown, with an increased time for BA referrals after the pandemic lockdowns were lifted in England and Wales.

Reduced presentation of biliary atresia during the COVID-19 lockdown – a population based observational study

BackgroundBiliary Atresia (BA) is the commonest surgical cause of cholestasis in infancy, affecting 1 in 1700 live births in England and Wales. Previous reports have demonstrated an average of 50 BA cases every year across the three UK centres, however observations from clinicians across these three centers have suggested a reduction in the number of presenting cases during the COVID-19 lockdown.ObjectivesThe aim of this study was to assess whether there has been a change in presentations of Biliary Atresia (BA) in England and Wales during the first COVID-19 lockdown (January – July 2020).MethodsThis population study assessed all confirmed cases of BA, from January 2020 to July 2020, across the 3 UK paediatric liver centers originating from England and Wales. Data was then compared to the incidence of confirmed BA cases from January - July 2017, 2018 and 2019, as documented within the Biliary Atresia National Registry.ResultsFrom January – July 2020, there were only 8 presenting cases of BA in England and Wales, compared to 24, 17 and 20 for the same time periods in 2017, 2018 and 2019 respectively. This difference was significant in a two-sided t-test (p = 0.0150). While the mean days to Kasai procedure was longer in 2020 compared to 2016–2019 (64.6 vs. 56.6), this difference was not observed to be significant (p=0.551).ConclusionsThere was a significant reduction in the presenting cases of BA during the first COVID-19 lockdown. This could either be due to a reduction in referrals or from a reduction in incidence of the condition, potentially due to an infectious cause being less prevalent during the national lockdown. If the former is correct there is potential for a significant number of BA babies with cholestatic jaundice remaining within the community. General practitioners and community paediatricians should be alert for these patients.

Obesity as a driver of international differences in COVID-19 death rates.

AIM: To determine what proportion of the inter-country variation in death rates can be explained in terms of obesity rates and other known risk factors for coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: COVID-19 death rates from 30 industrialized countries were analysed using linear regression models. Covariates modelled population density, the age structure of the population, obesity, population health, per capita gross domestic product (GDP), ethnic diversity, national temperature and the delay in the government imposing virus control measures. RESULTS: The multivariable regression model explained 63% of the inter-country variation in COVID-19 death rates. The initial model was optimized using stepwise selection. In descending order of absolute size of model coefficient, the covariates in the optimized model were the obesity rate, the hypertension rate, population density, life expectancy, the percentage of the population aged older than 65 years, the percentage of the population aged younger than 15 years, the diabetes rate, the delay in imposing national COVID-19 control measures, per capita GDP and mean temperature (with a negative coefficient indicating an association between higher national temperatures and lower death rates). CONCLUSIONS: A large proportion of the inter-country variation in COVID-19 death rates can be explained by differences in obesity rates, population health, population densities, age demographics, delays in imposing national virus control measures, per capita GDP and climate. Some of the unexplained variation is probably attributable to inter-country differences in the definition of a COVID-19 death and in the completeness of the recording of COVID-19 deaths.