Children First, a Debate on the Restrictions to Tackle COVID-19.

Sometimes, when a public health disaster strikes, mandatory freedom-limiting restrictions must be enforced in order to save lives. During the first waves of the COVID-19 pandemic, the customary and necessary exchange of ideas in academia drastically changed in most countries, and the absence of debate on the restrictions enforced became evident. Now that the pandemic seems to be drawing to an end, the aim of this article is to spark clinical and public debate on the ethical issues concerning pediatric COVID-19 mandates in an attempt to analyze what happened. With theoretical reflection, and not empirical inquiry, we address the mitigation measures which proved detrimental to children despite being beneficial to other segments of the population. We focus on three key points: (i) the sacrifice of fundamental children's rights for the greater good, (ii) the feasibility of cost-benefit analyses to make public health decisions and restrictions which affect children, and (iii) to analyze the impediments to allowing children's voices to be heard concerning their medical treatment.

A Preliminary Study on Acute Otitis Media in Spanish Children with Late Dinner Habits.

The timing of caloric intake plays an important role in the long-term process that leads to communicable diseases. The primary objective of this study was to analyse whether children who ate dinner early were at lower risks of acute respiratory infections than children who ate dinner late during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted from July to December 2020 on children attending Majorcan emergency services. Our survey on dinner time habits was carried out by using self-administered questionnaires. RESULTS: A total of 669 children were included in this study. The median dinner time was 8:30 pm. Late dinner eaters accounted for a higher proportion of acute otitis media (7% vs. 3%; p = 0.028) than early dinner eaters. Other infectious diseases were not associated with dinner time habits. CONCLUSIONS: We make a preliminary estimate of the link between late dinner habits and acute otitis media in children. However, no conclusions about causality can be established due to the observational design of the study, and further research is needed in order to confirm the different issues raised by our initial exploration of an emerging research area.

Can Breastfeeding Protect from Multi-System Inflammatory Syndrome in Children (MIS-C)? A Preliminary Study.

BACKGROUND: Breastfeeding prevents Kawasaki disease (KD), as well as several autoimmune disorders. Since there is an overlap between the Multi-System Inflammatory Syndrome in children following SARS-CoV-2 infection (MIS-C) and KD, this case series aims to analyze the association between breastfeeding and MIS-C. METHODS: A series of 16 cases of children with MIS-C admitted to three pediatric facilities between January 2021 and May 2022 were conducted. Breastfeeding rate was estimated through the Brief Breastfeeding and Milk Expression Recall Survey. RESULTS: Out of 16 children, 9 (56%) had been breastfed at birth. DISCUSSION: Our breastfeeding rate is below the median Spanish rate for initial breastfeeding. These findings do not clearly support the hypothesis that breastfeeding might prevent MIS-C. CONCLUSION: Contrary to the role of breastfeeding in KD prevention, our case series cannot answer with certainty the question about whether or not breastfeeding does protect children against MIS-C. These findings require confirmation in larger studies.

Re: "COVID-19: A Redox Disease-What a Stress Pandemic Can Teach Us About Resilience and What We May Learn from the Reactive Species Interactome About Its Treatment" by Cumpstey et al.

Cumpstey et al. (Antioxid Redox Signal 2021;10.1089/ars.2021.0017) have thoroughly reviewed the changes to the redox biology that determine individual resilience against COVID-19, and that hint at future treatment regimes. Verd and Verd question whether paracetamol, in the words of Cumpstey et al., "has the potential to overwhelm the body's ability to cope and maintain homeostasis" in COVID-19 patients. In response to this letter, the authors of Cumpstey et al. (Feelisch, Cumpstey, Clarka, Santolinic, and Jacksondargue) argue that what matters for human resilience against SARS-CoV-2 and other stressors is not simply determined by what is ingested/inhaled but also by how these substances can be handled by the body. The ability to cope with competing demands is determined by the extent to which the building blocks essential for cell/organ protection, function, adjustment, and healing can continue to be made available in sufficient quantities. To this end, dietary quality and nutrient status are fundamental determinants of the metabolic background against which all of these factors (including over-the-counter medications such as paracetamol) operate and either support or compromise the balanced functioning of the reactive species interactome.

Does breastfeeding protect children from COVID-19? An observational study from pediatric services in Majorca, Spain.

BACKGROUND: It has been demonstrated that children who had been breastfed remain better protected against various infections, and notably respiratory tract infections, well beyond infancy. Since the role of breastfeeding to explain why children are less affected by COVID-19 has not been studied until now, the aim of this study was to determine whether any history of breastfeeding reduces the incidence rate of COVID-19 in children. METHODS: This was a secondary analysis of an observational study on clinical and epidemiological characteristics of pediatric COVID-19 in Majorca. A total of 691 children were recruited during the 5 months of August-December 2020. Eligible participants were children under 14 who were tested for SARS-CoV-2 in pediatric emergency services. The independent explanatory variable was any breastfeeding. Bivariate analyses were conducted through the Chi-square test, the Fisher's Exact test or the Student's T test. All children had the same demographic, epidemiological and clinical data collected through a study team member interview and via the participants medical records. RESULTS: Within the sample of children who visited emergency services with symptoms of potential COVID-19, we found higher prevalence of positive SARS-CoV-2 RT-PCR test results among those who were exclusively formula fed compared with those who were ever breastfed (OR 2.48; 95% CI 1.45, 3.51; P = 0.036). CONCLUSIONS: The present study suggests that ever breastfeeding reduces the risk of COVID-19 among children, as documented for other infections.

Early dinner or "dinner like a pauper": Evidence, the habitual time of the largest meal of the day - dinner - is predisposing to severe COVID-19 outcome - death.

COVID-19 and metabolic syndrome are devastating pandemics. Effective control of metabolic parameters and their dysfunction may help prevent or minimize the acute and devastating effects of SARS-CoV-2 by reducing the local inflammatory response and blocking the entry of the virus into cells. With such consideration in mind, we gathered data from dietary surveys conducted in nine European countries to explore the relationship between actual clock hour of the large dinner meal and also interval in minutes between it and sunset in the respective countries and death rate above the median rate of per one million people as an index of mortality due to COVID-19 infection. Clock time of the dinner meal varied between 16:00 and 21:00 h across the European counties sampled, and the correlation between dinner mealtime and death rate was strongly correlated, R = 0.7991 (two-tailed p = 0.0098), with R2 explaining 63% of the variation within the data. This strong linear positive correlation indicates that the later the clock time of the dinner meal, the higher is the death rate (and vice versa). The relationship between meal timing in reference to sunset, utilized as a gross surrogate marker of the activity/rest synchronizer of circadian rhythms, and death rate was negative and even slightly stronger, R = -0.8025 (two-tailed p = 0.0092), with R2 explaining 64% of the variation within the data. This strong linear negative correlation indicates that the shorter the interval between the dinner meal and sunset, i.e., the closer the time of the largest meal of the day to bedtime, the greater is the death rate (and vice versa). Our preliminary approach to nighttime eating, in terms of the day's largest caloric intake, as a risk factor for the predisposing conditions of obesity, metabolic syndrome, type 2 diabetes, and other commonly associated comorbidities of being overweight, and death from COVID-19 infection reveals strong correlation with the time of the dinner meal, both in terms of its actual clock and circadian time.

Mothers’ masks should be improved or removed during pandemic as they inhibit bonding with neonates

Abstract Tran et al?s paper on appropriate care for neonates born to mothers with COVID-19, takes for granted that the coronavirus does not pass through breast milk (1). However, German clinicians detected virus ribonucleic acid in the milk of two infected nursing mothers on days 10 and 21 after birth, including one who wore a surgical mask (2). In addition, Tran et al reported that the 33 neonates in Zeng et al?s cohort were all formula fed, but the authors of that paper don?t mention the feeding method (3). Despite that small lapse, we agree with the paper (1), which adds to the mounting evidence on the unintended impact of the global response to COVID-19 on mothers and infants.