Point-of-Care Ultrasound Diagnosis of Tetralogy of Fallot Causing Cyanosis: A Case Report.

INTRODUCTION: Tetralogy of Fallot (TOF) is a congenital heart defect with characteristic features leading to unique physical exam and ultrasound findings. In settings where there is limited prenatal screening, TOF can present with cyanosis at any time from the neonatal period to adulthood depending on the degree of obstruction of the right ventricular outflow tract. CASE REPORT: This case describes a pediatric patient who presented with undifferentiated dyspnea and cyanosis, for whom point-of-care ultrasound (POCUS) supported the diagnosis of TOF. We highlight the important role POCUS can play in a setting with limited access to formal echocardiography or consultative pediatric cardiology services. CONCLUSION: This report highlights the utility of POCUS as an inflection point in the diagnostic and management pathway of this patient, which is particularly important when working in a limited-resource or rural setting.

Surgical site infections during the COVID-19 era: A retrospective, multicenter analysis.

BACKGROUND: Surgical site infections (SSIs) are an undesired perioperative outcome. Recent studies have shown increases in hospital acquired infections during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to evaluate postoperative SSIs in the COVID-19-era compared to a historical cohort at a large, multicenter, academic institution. METHODS: A retrospective review of all patients who underwent National Health and Safety Network (NHSN) inpatient surgical procedures between January 1, 2018 and December 31, 2020. Patients from the COVID-19-era (March-December 2020) were compared and matched 1:1 with historical controls (2018/2019) utilizing the standardized infection ratio (SIR) to detect difference. RESULTS/DISCUSSION: During the study period, 29,904 patients underwent NHSN procedures at our institution. When patients from the matched cohort (2018/2019) were compared to the COVID-19-era cohort (2020), a decreased risk of SSI was observed following colorectal surgery (RR = 0.94, 95% CI [0.65, 1.37], P = .76), hysterectomy (RR = 0.88, 95% CI [0.39, 1.99], P = .75), and knee prothesis surgery (RR = 0.95, 95% CI [0.52, 1.74], P = .88), though not statistically significant. An increased risk of SSI was observed following hip prosthesis surgery (RR 1.09, 95% CI [0.68, 1.75], P = .72), though not statistically significant. CONCLUSIONS: The risk of SSI in patients who underwent NHSN inpatient surgical procedures in 2020 with perioperative COVID-19 precautions was not significantly different when compared to matched controls at our large, multicenter, academic institution.

A latent profile analysis of COVID-19 conspiracy beliefs: Associations with thinking styles, mistrust, socio-political control, need for closure and verbal intelligence.

Throughout the COVID-19 pandemic, attention has been drawn to conspiracy theories. To date, research has largely examined commonalities in conspiracy theory belief, however it is important to identify where there may be notable differences. The aim of the present research was first to distinguish between typologies of COVID-19 conspiracy belief and explore demographic, social cognitive factors associated with these beliefs. Secondly, we aimed to examine the effects of such beliefs on adherence to government health guidelines. Participants (N = 319) rated well known COVID-19 conspiracy theories, completing measures of thinking style, socio-political control, mistrust, verbal intelligence, need for closure and demographic information. Participants also rated the extent to which they followed government health guidelines. Latent profile analysis suggests three profiles of COVID-19 conspiracy beliefs with low, moderate, and high COVID conspiracy belief profiles and successively stronger endorsement on all but one of the COVID-19 conspiracy theories. Those holding stronger COVID-19 conspiracy theory beliefs are more likely to reason emotively, feel less socio-political control, mistrust others, have lower verbal ability and adhere less to COVID-19 guidelines. The social and health implications of these findings are discussed.

Lessons Learned-The Impact of the Third Wave of the COVID-19 Pandemic on German Waldorf Parents' Support Needs and Their Rating of Children's Health-Related Quality of Life: A Cross-Sectional Online Survey.

BACKGROUND: COVID-19-related lockdowns and homeschooling have imposed a substantial burden on school-aged children and parents. Waldorf education is a reform-educational concept. Little is known about the situation of German Waldorf families under pandemic conditions. METHODS: A cross-sectional, online, parent-proxy survey was conducted regarding the third pandemic wave. The primary outcome was parents' support needs, assessed with questions from the German COPSY (COVID-19 and PSYchological Health) study; the secondary outcome was children's HRQoL (KIDSCREEN-10, proxy version). RESULTS: We analyzed questionnaires from 431 parents of 511 Waldorf students aged 7 to 17 years. While 70.8% of Waldorf parents (WPs) reported a general need for support in dealing with their children, 59.9% of COPSY parents (CPs) indicated this need. WPs' support needs in dealing with their children's academic demands were similar to CPs' needs but relatively higher in terms of dealing with emotions and moods, behavior, and relationships within the family. WPs sought support mainly from school and teachers (65.6%). Support needs were high, although WPs rated their children's HRQoL higher than CPs. CONCLUSIONS: Our results underline the substantial pandemic-related burden on families across school types. WPs participating in this survey gave evidence that supports should focus on academic demands as well as psychosocial issues.

Children's Symptoms with a Febrile Illness and a Positive or Negative Test of SARS-CoV-2 during the Omicron Wave.

Febrile infections are common in childhood. Children can be infected with SARS-CoV-2, but their course is milder than in adults. So far, a comparison between febrile infections with a positive or negative Corona test with the Omicron variant is missing. The data used are from the FeverApp registry, which collects parent-reported data on febrile infections in children and informs about fever management. A comparison of symptomatic differences between episodes with a positive or negative Corona test was performed using Χ2-tests. During the Omicron wave, reported tests doubled and positive test results nearly 12-folded. In episodes with positive Corona saliva tests, more cough, fatigue, disturbed smell/taste, limb pain, sore throat, signs of serious sickness, and touch sensitivity were reported. Children with a negative Corona test show more tonsillitis, teething, any pain symptoms, earaches, and rashes. Thus, there are some significant differences between febrile infections with a positive or negative Corona test, but symptoms are present on both sides. The omicron variant seems to be more infectious than the alpha or delta variants in children, but the symptoms remain mild and do not differ much from other febrile infections.

Using Nighttime Lights Data to Assess the Resumption of Religious and Socioeconomic Activities Post-COVID-19

The COVID-19 pandemic greatly impacted socioeconomic life globally. Nighttime-lights (NTLs) data are mainly related to anthropogenic phenomena and thus have the ability to monitor changes in socioeconomic activity. However, the overglow effect is a source of uncertainty and affects the applicability of NTL data for accurately monitoring socioeconomic changes. This research integrates the NTL and fine bare-land-cover data to construct a novel index named the Bare Adjusted NTL Index (BANTLI) to lessen the overglow uncertainty. BANTLI was used to measure the post-pandemic resumption of religious rituals and socioeconomic activity in Makkah and Madinah at different spatial levels. The results demonstrate that BANTLI significantly eliminates the overglow effect. In addition, BANTLI brightness recovered during the post-pandemic periods, but it has remained below the level of the pre-pandemic period. Moreover, not all wards and rings are affected equally: wards and rings that are near the city center experienced the most explicit reduction of BANTLI brightness compared with the suburbs. The Hajj pilgrimage period witnessed a larger decrease in BANTLI brightness than the pandemic period in Makkah. The findings indicate that (i) BANTLI successfully mitigates the overglow effect in the NTL data, and (ii) the cultural context is important to understand the impact of COVID-19.

Mitigating co-circulation of seasonal influenza and COVID-19 pandemic in the presence of vaccination: A mathematical modeling approach.

The co-circulation of two respiratory infections with similar symptoms in a population can significantly overburden a healthcare system by slowing the testing and treatment. The persistent emergence of contagious variants of SARS-CoV-2, along with imperfect vaccines and their waning protections, have increased the likelihood of new COVID-19 outbreaks taking place during a typical flu season. Here, we developed a mathematical model for the co-circulation dynamics of COVID-19 and influenza, under different scenarios of influenza vaccine coverage, COVID-19 vaccine booster coverage and efficacy, and testing capacity. We investigated the required minimal and optimal coverage of COVID-19 booster (third) and fourth doses, in conjunction with the influenza vaccine, to avoid the coincidence of infection peaks for both diseases in a single season. We show that the testing delay brought on by the high number of influenza cases impacts the dynamics of influenza and COVID-19 transmission. The earlier the peak of the flu season and the greater the number of infections with flu-like symptoms, the greater the risk of flu transmission, which slows down COVID-19 testing, resulting in the delay of complete isolation of patients with COVID-19 who have not been isolated before the clinical presentation of symptoms and have been continuing their normal daily activities. Furthermore, our simulations stress the importance of vaccine uptake for preventing infection, severe illness, and hospitalization at the individual level and for disease outbreak control at the population level to avoid putting strain on already weak and overwhelmed healthcare systems. As such, ensuring optimal vaccine coverage for COVID-19 and influenza to reduce the burden of these infections is paramount. We showed that by keeping the influenza vaccine coverage about 35% and increasing the coverage of booster or fourth dose of COVID-19 not only reduces the infections with COVID-19 but also can delay its peak time. If the influenza vaccine coverage is increased to 55%, unexpectedly, it increases the peak size of influenza infections slightly, while it reduces the peak size of COVID-19 as well as significantly delays the peaks of both of these diseases. Mask-wearing coupled with a moderate increase in the vaccine uptake may mitigate COVID-19 and prevent an influenza outbreak.

Effects of hydrometeorological and other factors on SARS-CoV-2 reproduction number in three contiguous countries of Tropical Andean South America: a spatiotemporally disaggregated time series analysis.

Background: The COVID-19 pandemic has caused societal disruption globally and South America has been hit harder than other lower-income regions. This study modeled effects of 6 weather variables on district-level SARS-CoV-2 reproduction numbers (R t ) in three contiguous countries of Tropical Andean South America (Colombia, Ecuador, and Peru), adjusting for environmental, policy, healthcare infrastructural and other factors. Methods: Daily time-series data on SARS-CoV-2 infections were sourced from health authorities of the three countries at the smallest available administrative level. R t values were calculated and merged by date and unit ID with variables from a Unified COVID-19 dataset and other publicly available sources for May - December 2020. Generalized additive models were fitted. Findings: Relative humidity and solar radiation were inversely associated with SARS-CoV-2 R t . Days with radiation above 1,000 KJ/m2 saw a 1.3%, and those with humidity above 50%, a 0.9% reduction in R t . Transmission was highest in densely populated districts, and lowest in districts with poor healthcare access and on days with least population mobility. Wind speed, temperature, region, aggregate government policy response and population age structure had little impact. The fully adjusted model explained 4.3% of R t variance. Interpretation: Dry atmospheric conditions of low humidity increase, and higher solar radiation decrease district-level SARS-CoV-2 reproduction numbers, effects that are comparable in magnitude to population factors like lockdown compliance. Weather monitoring could be incorporated into disease surveillance and early warning systems in conjunction with more established risk indicators and surveillance measures. Funding: NASA's Group on Earth Observations Work Programme (16-GEO16-0047).

No delay in care of ambulatory orthopaedic fractures observed during the early Coronavirus-2019 pandemic: a retrospective cohort study

Background: The purpose of this study was to assess the impact of social distancing orders on ambulatory orthopaedic fracture care at a level 1 trauma center during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: All ambulatory orthopaedic fractures that presented to the author's Level 1 trauma center were analyzed retrospectively between December 2019 and June 2020. Patients were divided into prepandemic (n=377) and pandemic (n=224) groups based on the date of presentation. Primary outcomes included new ambulatory fracture volume, and time to presentation and surgery. Secondary outcomes included fracture type and clinic no-show rates. Results: In the first 8 wk after the pandemic began, there was a 60.8% decrease in new patients with ambulatory fractures (24.6/week pre-pandemic, 9.63/week during the first 8 wk, P =0.001). The presentation rate of patients with new ambulatory fractures returned to the prepandemic baseline after the first 8 wk of the pandemic. No significant difference in time to presentation or surgery was noted between groups. There was no statistically significant difference in the presentation rate of the most commonly treated fracture types (ankle, distal radius, hand, or foot) between groups. There was a statistically significant increase in overall clinic no-show rate during the pandemic period. Conclusions: An initial decrease in ambulatory fracture volume was seen during the first 8 wk of the COVID-19 pandemic. No delay in time to presentation or time to surgery was seen between groups. After the first 8 wk of the pandemic, a return to normal ambulatory fracture volume was seen. Level of Evidence: Level III.

Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19: JACC Review Topic of the Week.

Nirmatrelvir-ritonavir (NMVr) is used to treat symptomatic, nonhospitalized patients with coronavirus disease-2019 (COVID-19) who are at high risk of progression to severe disease. Patients with cardiovascular risk factors and cardiovascular disease are at a high risk of developing adverse events from COVID-19 and as a result have a higher likelihood of receiving NMVr. Ritonavir, the pharmaceutical enhancer used in NMVr, is an inhibitor of the enzymes of CYP450 pathway, particularly CYP3A4 and to a lesser degree CYP2D6, and affects the P-glycoprotein pump. Co-administration of NMVr with medications commonly used to manage cardiovascular conditions can potentially cause significant drug-drug interactions and may lead to severe adverse effects. It is crucial to be aware of such interactions and take appropriate measures to avoid them. In this review, we discuss potential drug-drug interactions between NMVr and commonly used cardiovascular medications based on their pharmacokinetics and pharmacodynamic properties.

Real-world comparative effectiveness of mRNA-1273 and BNT162b2 vaccines among immunocompromised adults identified in administrative claims data in the United States.

INTRODUCTION: Head-to-head studies comparing COVID-19 mRNA vaccine effectiveness in immunocompromised individuals, who are vulnerable to severe disease are lacking, as large sample sizes are required to make meaningful inferences. METHODS: This observational comparative effectiveness study was conducted in closed administrative claims data from the US HealthVerity database (December 11, 2020-January 10, 2022, before omicron). A 2-dose mRNA-1273 versus BNT162b2 regimen was assessed for preventing medically-attended breakthrough COVID-19 diagnosis and hospitalizations among immunocompromised adults. Inverse probability of treatment weighting was applied to balance baseline characteristics between vaccine groups. Incidence rates from patient-level data and hazard ratios (HRs) using weighted Cox proportional hazards models were calculated. RESULTS: Overall, 57,898 and 66,981 individuals received a 2-dose regimen of mRNA-1273 or BNT161b2, respectively. Among the weighted population, mean age was 51 years, 53 % were female, and baseline immunodeficiencies included prior blood transplant (8%-9%), prior organ transplant (7%), active cancer (12%-13%), primary immunodeficiency (5-6%), HIV (20%-21%), and immunosuppressive therapy use (60%-61%). Rates per 1,000 person-years (PYs; 95% confidence intervals [CI]s) of breakthrough medically-attended COVID-19 were 25.82 (23.83-27.97) with mRNA-1273 and 30.98 (28.93, 33.18) with BNT162b2 (HR, 0.83; 95% CI, 0.75-0.93). When requiring evidence of an antigen or polymerase chain reaction test before COVID-19 diagnosis, the HR for medically-attended COVID-19 was 0.78 (0.67-0.92). Breakthrough COVID-19 hospitalization rates per 1,000 PYs (95% CI) were 3.66 (2.96-4.51) for mRNA-1273 and 4.68 (3.91-5.59) for BNT162b2 (HR, 0.78; 0.59-1.03). Utilizing open and closed claims for outcome capture only, or both cohort entry/outcome capture, produced HRs (95% CIs) for COVID-19 hospitalization of 0.72 (0.57-0.92) and 0.66 (0.58-0.76), respectively. CONCLUSIONS: Among immunocompromised adults, a 2-dose mRNA-1273 regimen was more effective in preventing medically-attended COVID-19 in any setting (inpatient and outpatient) than 2-dose BNT162b2. Results were similar for COVID-19 hospitalization, although statistical power was limited when using closed claims only. STUDY REGISTRATION: NCT05366322.

Differences in lung function between major race/ethnicity groups following hospitalization with COVID-19.

BACKGROUND: Ethnic minorities have higher rates of infection, hospitalization, and death from COVID-19 compared to White Americans. RESEARCH QUESTION: Is race/ethnicity an independent predictor of lung dysfunction following hospitalization with COVID-19? STUDY DESIGN: and Methods: Patients hospitalized at the University of Virginia Medical Center with COVID-19 underwent a questionnaire within 30 days following discharge. Those who had persistent respiratory symptoms were invited to complete spirometry, lung volumes, and diffusion capacity of carbon monoxide. 128 completed pulmonary function testing at 6 months. RESULTS: Impairments in lung function were present in spirometry, lung volumes, and diffusion capacity of carbon monoxide at 6 months. The most prevalent impairments were noted in FVC (24.4%), FEV1 (20.5%), TLC (23.3%), and DLCO (20.8%). When compared between race/ethnicity groups three lung function parameters demonstrated statistically significant difference, including FEV1/FVC (p = 0.021), RV/TLC (p = 0.006) and DLCO % predicted (p = 0.002). The average difference between Hispanic and non-Hispanic Black patients with respect to DLCO % predicted was 13.09 (p = 0.01) and the average difference between non-Hispanic White and non-Hispanic Black patients was 9.46 (p = 0.04). Differences persisted when controlling for age, BMI, smoking status, history of chronic lung disease, ICU admission, treatment with corticosteroids, and socioeconomic status. INTERPRETATION: Long-term impairments in lung function following COVID-19 are common, occurring in roughly 22% of patients and across all three major domains of lung function. Non-Hispanic Black race/ethnicity was associated with a statistically significant lower DLCO % predicted when compared to non-Hispanic White and Hispanic patients.

Use of KROQI as a Level-2 Common Data Environment in the French Construction Industry

The implementation of a common data environment (CDE) in the construction industry appears to be crucial for organizing and managing the flow of important information within construction projects effectively. However, it is observed that the investments and the costs associated with setting up such environments are often dissuasive, particularly for small- and medium-sized enterprises (SMEs). By launching the Plan BIM 2022 in 2017, the French government aimed to combat the emerging digital divide between large and small construction companies. At the heart of this state-funded plan was the development of a CDE-like collaborative platform called KROQI. The work presented in this article proposes a three-level matrix to characterize common data environments based on computer-supported collaboration work theories. The paper demonstrates how KROQI can be characterized as a level-2 CDE solution. Based on a preliminary study, it explores the perception and satisfaction of practitioners with respect to the features proposed by KROQI. The results show that, among the large variety of features proposed, some are hardly ever used. Therefore, while KROQI appears to be an excellent industry-wide solution aimed at federating initiatives towards digital collaboration centered around BIM models, there is definitely room for improvement.

Estimating social contacts in mass gatherings for disease outbreak prevention and management: case of Hajj pilgrimage.

BACKGROUND: Most mass gathering events have been suspended due to the SARS-CoV-2 pandemic. However, with vaccination rollout, whether and how to organize some of these mass gathering events arises as part of the pandemic recovery discussions, and this calls for decision support tools. The Hajj, one of the world's largest religious gatherings, was substantively scaled down in 2020 and 2021 and it is still unclear how it will take place in 2022 and subsequent years. Simulating disease transmission dynamics during the Hajj season under different conditions can provide some insights for better decision-making. Most disease risk assessment models require data on the number and nature of possible close contacts between individuals. METHODS: We sought to use integrated agent-based modeling and discrete events simulation techniques to capture risky contacts among the pilgrims and assess different scenarios in one of the Hajj major sites, namely Masjid-Al-Haram. RESULTS: The simulation results showed that a plethora of risky contacts may occur during the rituals. Also, as the total number of pilgrims increases at each site, the number of risky contacts increases, and physical distancing measures may be challenging to maintain beyond a certain number of pilgrims in the site. CONCLUSIONS: This study presented a simulation tool that can be relevant for the risk assessment of a variety of (respiratory) infectious diseases, in addition to COVID-19 in the Hajj season. This tool can be expanded to include other contributing elements of disease transmission to quantify the risk of the mass gathering events.

Examination of Cutaneous Changes Among Patients Following SARS-CoV-2 Infection.

Individuals infected with SARS-CoV-2 have been found to develop a variety of cutaneous symptoms. This study sought to describe varying cutaneous manifestations of COVID-19 in individuals presenting to an inpatient healthcare facility. We screened individuals who presented with COVID-19 for skin changes throughout the illness and administered a survey regarding demographics, medical history, and their cutaneous findings. Three individuals reported varying skin findings including wheals, petechiae, ecchymosis, and papules. One individual reported a worsening skin condition, psoriasis, as well as a new skin condition, seborrheic dermatitis. In conclusion, cutaneous manifestations of patients suffering from COVID-19 are wide-ranging and worsening skin conditions amongst these patients should be further investigated.

Digitization in gynecology and obstetrics in times of COVID-19: Results of a national survey.

INTRODUCTION: In the COVID-19 pandemic, many consultations had to be cancelled, postponed, or converted to a virtual format. The use of telemedicine in the management of Women's Health Care could support doctors (tele-gynecology). This study analyses the use and perception of telemedicine applications among gynecologists in Germany. MATERIALS AND METHODS: This prospective cross-sectional study was based on a survey of gynecologists in Germany during the COVID-19 pandemic. Descriptive statistics were calculated, and regression analyses were performed to show correlations. RESULTS: The gynecologists expect telemedicine to be used in gynecology and obstetrics. 76.4% (365/478) of the respondents rated their knowledge of telemedicine as insufficient. The majority of respondents (437/478, 91.6%) said they did not currently use telemedicine, although 67.3% (321/478) would like to do so. Obstacles to the introduction of telemedicine include the purchase of technical equipment (325/478, 68.1%), administration (305/478, 64.0%) and poor reimbursement (233/478, 48.9%). Gynecologists surveyed would prefer telemedicine to communicate directly with other doctors (388/478, 81.2%) rather than to communicate with patients (228/478, 47.8%). In the treatment phases, 73.2% (349/478) of the respondents would use telemedicine during follow-up. Half of the respondents would choose tele counseling as a specific approach to improving care (246/478, 51.5%). CONCLUSION: Telemedicine in gynecology finds little use but high acceptance. The absence of a structured framework is an obstacle to effective implementation. Training courses should be introduced to improve the limited knowledge in the use of telemedicine. More research in tele-gynecology is needed. These include large-scale randomized controlled trials, economic analyses and the exploration of user preferences.

Probenecid Inhibits Respiratory Syncytial Virus (RSV) Replication.

RNA viruses like SARS-CoV-2, influenza virus, and respiratory syncytial virus (RSV) are dependent on host genes for replication. We investigated if probenecid, an FDA-approved and safe urate-lowering drug that inhibits organic anion transporters (OATs) has prophylactic or therapeutic efficacy to inhibit RSV replication in three epithelial cell lines used in RSV studies, i.e., Vero E6 cells, HEp-2 cells, and in primary normal human bronchoepithelial (NHBE) cells, and in BALB/c mice. The studies showed that nanomolar concentrations of all probenecid regimens prevent RSV strain A and B replication in vitro and RSV strain A in vivo, representing a potential prophylactic and chemotherapeutic for RSV.

Repurposing Probenecid to Inhibit SARS-CoV-2, Influenza Virus, and Respiratory Syncytial Virus (RSV) Replication.

Viral replication and transmissibility are the principal causes of endemic and pandemic disease threats. There remains a need for broad-spectrum antiviral agents. The most common respiratory viruses are endemic agents such as coronaviruses, respiratory syncytial viruses, and influenza viruses. Although vaccines are available for SARS-CoV-2 and some influenza viruses, there is a paucity of effective antiviral drugs, while for RSV there is no vaccine available, and therapeutic treatments are very limited. We have previously shown that probenecid is safe and effective in limiting influenza A virus replication and SARS-CoV-2 replication, along with strong evidence showing inhibition of RSV replication in vitro and in vivo. This review article will describe the antiviral activity profile of probenecid against these three viruses.

[Corona in Children: the Co-Ki Study]. / Corona bei Kindern: Die Co-Ki Studie: Relevanz von SARS-CoV-2 in der ambulanten pädiatrischen Versorgung in Deutschland.

BACKGROUND: In Germany over 80% of children and adolescents are in the ambulatory care of registered pediatricians. These have a specific perspective on the COVID-19 pandemic. METHODS: For this reason, this professional group initiated a central recording of case numbers, individual case descriptions and observations on infections and illnesses with SARS-CoV­2 (www.co-ki.de). RESULTS: So far 557 pediatricians have participated. Together they care for ca. 670,000 children. They reported 9803 children who presented as suspected cases. The pediatricians themselves had a clinical suspicion of SARS-CoV­2 infections in 3654 children. In 7707 children PCR tests were carried out using nose/throat swabs of which 198 (2.6%) were positive. In addition, 731 children were tested for SARS-CoV­2 antibodies with detection in 82 cases (11.2%). Despite initially positive PCR tests, 47 children had a negative antibody test at least 2 weeks later. Our query as to infections of adults by children yielded only one case, which a telephone enquiry revealed as unlikely. DISCUSSION: From an outpatient pediatric perspective COVID-19 is rare. There was no convincing evidence that children are a relevant source of infection for SARS-CoV­2 nor that they are relevantly at risk.