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1.
CMAJ ; 194(14): E513-E523, 2022 04 11.
Article in English | MEDLINE | ID: covidwho-2089467

ABSTRACT

BACKGROUND: SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS: We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement. RESULTS: Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13-17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6-12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 µg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI -0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%). INTERPRETATION: We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.


Subject(s)
COVID-19 , Connective Tissue Diseases , COVID-19/complications , COVID-19/epidemiology , Canada/epidemiology , Child , Child, Preschool , Cohort Studies , Ferritins , Humans , Male , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
2.
Infection ; 2022 Aug 29.
Article in English | MEDLINE | ID: covidwho-2014586

ABSTRACT

PURPOSE: The objective of this study was to describe the clinical course and outcomes in children with technology dependence (TD) hospitalized with SARS-CoV-2 infection. METHODS: Seventeen pediatric hospitals (15 Canadian and one each in Iran and Costa Rica) included children up to 17 years of age admitted February 1, 2020, through May 31, 2021, with detection of SARS-CoV-2. For those with TD, data were collected on demographics, clinical course and outcome. RESULTS: Of 691 children entered in the database, 42 (6%) had TD of which 22 had feeding tube dependence only, 9 were on supplemental oxygen only, 3 had feeding tube dependence and were on supplemental oxygen, 2 had a tracheostomy but were not ventilated, 4 were on non-invasive ventilation, and 2 were on mechanical ventilation prior to admission. Three of 42 had incidental SARS-CoV-2 infection. Two with end-stage underlying conditions were transitioned to comfort care and died. Sixteen (43%) of the remaining 37 cases required increased respiratory support from baseline due to COVID-19 while 21 (57%) did not. All survivors were discharged home. CONCLUSION: Children with TD appear to have an increased risk of COVID-19 hospitalization. However, in the absence of end-stage chronic conditions, all survived to discharge.

3.
Topics in Antiviral Medicine ; 30(1 SUPPL):246, 2022.
Article in English | EMBASE | ID: covidwho-1880203

ABSTRACT

Background: Randomized COVID-19 trials provide opportunities to describe post-acute sequelae of SARS-CoV-2 (PASC)-related symptom burden longitudinally and assess the impact of early use of antivirals on PASC prevalence. Methods: ACTIV-2 evaluates safety and efficacy of investigational agents for non-hospitalized adults with mild to moderate COVID-19 in a Phase II/III trial. In Phase II, participants were randomized within 10 days of symptom onset and a positive SARS-CoV-2 virologic test to receive bamlanivimab (BAM) or placebo as a single infusion at 7000mg (n=94) or 700mg (n=225). In a subsequent single-arm open-label study, 1059 participants received 700mg BAM. Participants completed a 13-symptom daily diary from enrollment through Day 28. A long-term (LT) diary (14 additional symptoms) introduced after the study was underway was completed by a subset of individuals every 12 weeks. We report Week 24 findings. Results: Between Aug 2020 to Feb 2021 605 participants enrolled and completed LT diary at Week 24 [Phase II: 7000mg vs. placebo (n=25);700mg vs. placebo (n=68);single-arm open-label cohort: 700mg (n=512)]. Median age was 50 years, 51% female sex, 99% identified as cis-gender, 5% Black/African American, and 35% Hispanic/Latino. At enrollment, 53% reported ≥1 high-risk comorbidity and 0.3% were vaccinated against COVID-19. By Week 24, 14% (87/605) had not returned to their pre-COVID-19 health by self-report, with 57% (50/87) reporting ≥3 PASC symptoms. The most common symptoms were fatigue (45% of 87), smell disorder (36%), breathing difficulties (30%), taste disorders (25%), musculoskeletal pain (26%) or weakness (23%), and cognitive complaints: difficulty concentrating/thinking (30%), difficulty reasoning and solving problems (21%), memory loss (25%) and insomnia (23%). Most reported symptoms as "mild". Participants who reported acute viral illness symptoms between Days 22-28 were more likely to report PASC symptoms at Week 24 than those who did not report symptoms at Days 22-28 [51% (164/320) vs. 27% (76/285);p<0.0001]. Conclusion: In outpatients with mild to moderate COVID-19, 14% had not returned to pre-COVID-19 health by 24 weeks post infection, with generally mild but multiple symptoms. Presence of acute viral illness symptoms at 3-4 weeks was associated with an increased risk of PASC symptoms months later. Larger placebo-controlled studies within ACTIV-2 will assess the potential for early antiviral therapies to mitigate or prevent PASC.

5.
CALICO Journal ; 39(1):26-52, 2021.
Article in English | Scopus | ID: covidwho-1599414

ABSTRACT

This study focuses on the social presence framework (Rourke et al., 2001), in order to examine the ways that university-level international students develop social interaction and support in a virtual asynchronous learning community in an online class during the COVID-19 pandemic. English language learners (ELLs) participated in weekly online exchanges on a video discussion platform called Flipgrid in the form of oral dialogue journals for reflection on their academic learning and experiences during these disruptive times. These ELLs’ video journals and peer responses (N = 198) were collected for content analysis, in order to investigate how the use of video-based asynchronous computer-mediated communication (ACMC) can establish positive social and emotional support and a sense of community. The findings of the study indicate that ACMC was successful in establishing interconnectedness in terms of high levels of self-disclosure, positive facial expressions, and other indicators of social and emotional support, demonstrating social presence. Implications of the findings are discussed in terms of how social presence is expressed and fostered in video-based ACMC communities during emergency remote teaching. © 2022, equinox publishing.

7.
Mult Scler Relat Disord ; 58: 103468, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1586959

ABSTRACT

BACKGROUND: Children with neuroinflammatory disorders have high rates of anxiety and depression, alongside low rates of physical activity. Given general concerns for mental and physical health in children during the COVID-19 pandemic lockdown, here we sought to understand how sleep, anxiety, depression, and physical activity changed with the lockdown in children with neuroinflammatory disorders. We hypothesized that outcomes would worsen during the lockdown, and that they would differ by underlying disorder category and age. METHODS: Patients attending a specialized neuroinflammatory clinic (n = 314) completed questionnaires (n = 821 responses; Jan 2017-Aug 2020) assessing sleep, anxiety, depression, and physical activity. Respondents had either: childhood-onset chronic or recurrent neuroinflammatory disorders (CRNI), a history of Autoimmune Encephalitis (AE) or Monophasic Acquired Demyelinating Syndromes (monoADS). We performed linear mixed models to examine the association between our outcome measures (sleep, anxiety, depression, and physical activity) and categories of disorder type, sex, age, physical activity, relapses, and time (pre- vs. post- COVID-19 lockdown). Participant ID acted as a random effect, to account for repeated measures. RESULTS: Sleep significantly increased in the first 6 months of the COVID-19 lockdown (F(1, 544)=56.85, P<0.001,). Across the whole group, anxiety and depression did not change with the pandemic, but we found differing trends by age category. Anxiety decreased in teenagers (≥13y) (Z = 3.96, P<0.001), but not for pre-teens. Depression remained higher in teenagers than preteens across both timepoints (F(1, 597)=6.30, p = 0.012). Physical activity levels did not change with the pandemic in comparison to pre-pandemic (F(1, 629)=1.92, P = 0.166). Anxiety was higher in inactive individuals regardless of timing (F(2, 547)=3.74, p = 0.024). CONCLUSION: For youth with neuroinflammatory disorders, the COVID-19 pandemic lockdown resulted in increased hours of nighttime sleep but did not result in significant overall changes in self-reported anxiety or depression. Pre-lockdown, teenagers had higher depression and anxiety scores than preteens. Post-lockdown, anxiety and depression scores decreased in teenagers compared to pre-teens. Physical activity was low both pre- and post-lockdown, and rates of anxiety were higher for inactive participants at both timepoints. Differences based on age suggest that younger children (<13 years) were more negatively affected by the pandemic than older children (≥ 13 years).


Subject(s)
COVID-19 , Pandemics , Adolescent , Anxiety/epidemiology , Anxiety/psychology , COVID-19/epidemiology , Child , Communicable Disease Control , Depression/epidemiology , Depression/psychology , Humans , Mental Health , SARS-CoV-2
8.
Multiple Sclerosis Journal ; 27(2 SUPPL):172, 2021.
Article in English | EMBASE | ID: covidwho-1496005

ABSTRACT

Introduction: Despite better characterization of the spectrum of MOG IgG-associated disorders (MOGAD) in children, the role of infection in its pathophysiology remains unclear. Objectives: The goal of this study was to evaluate if public health measures put in place to prevent the spread of SARS-CoV-2 in March 2020 in Ontario (Canada) have been associated with a change in the incidence of MOGAD and other neuroinflammatory disorders in children. Methods: We reviewed a single-centre cohort of children referred for a suspicion of neuroinflammatory disorder between 2015-2020. Age, date, sex, diagnosis, MOG IgG antibodies status and detected pathogens at presentation were identified. Comparative statistical analysis was performed between years and seasons using Pearson's Chi-squared test or Fisher's exact test for categorical variables and using ANOVA or Kruskal-Wallis test for continuous variables, as appropriate. Post-hoc pairwise comparisons between 2020 and previous years were performed on significant results. The analyses were repeated twice including either complete data from 2020 (January 1st to December 31st, 2020) or only data acquired after the spring lockdown (March 17th to Dec 31st, 2020). A false discovery rate adjustment with an adjusted p-value (q-value) < 0.05 was computed. It was hypothesized that the number of new MOGAD would be significantly lower in 2020 compared to previous years due to decreased regional pathogen transmission. Results: Among 479 referred cases, we identified 364 confirmed new cases of neuroinflammatory disorder between 2015 and 2020. The number of new neuroinflammatory disorder diagnoses did not change between years. We noted significantly fewer new MOGAD diagnoses in 2020 compared to previous years (q=0.003), with no MOGAD patient presenting in 2020 after the spring lockdown. Parallelly, there were significantly fewer parainfectious neuroinflammatory cases (q=0.038) and pathogen detected (q=0.045) in the post-lockdown period. The number of new multiple sclerosis (MS) and aquaporin-4 neuromyelitis optica spectrum disorders (AQP4-NMOSD) cases remained stable despite the lockdown (q-value=0.237 and 0.505 respectively). Conclusions: Enhanced population-based infection control strategies may have a role in modulating the incidence of MOGAD and parainfectious neuroinflammatory disorders, but not MS or AQP4-NMOSD.

9.
Mult Scler Relat Disord ; 56: 103286, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1440270

ABSTRACT

BACKGROUND: Despite better characterization of the spectrum of MOG-IgG-associated disorders (MOGAD) in children, the role of infection in its pathophysiology remains unclear. The goal of this study was to evaluate if public health measures put in place to prevent the spread of SARS-CoV-2 in March 2020 in Ontario (Canada) have been associated with a change in the incidence of MOGAD and other neuroinflammatory disorders in children. METHODOLOGY: We reviewed a single-centre cohort of children referred for a suspicion of neuroinflammatory disorder between January 2015 and March 2021. Age, date, sex, diagnosis, MOG-IgG antibodies status and detected pathogens at presentation were identified. Comparative statistical analysis was performed based on diagnosis between years and seasons using Pearson's Chi-squared test or Fisher's exact test for categorical variables and using ANOVA or Kruskal-Wallis test for continuous variables, as appropriate. We compared the post-lockdown period (March 17th, 2020, to March 31st, 2021) to previous calendar years (2015 to 2019) alone and to previous calendar years and the pre-lockdown 2020 period (January 1st, 2020, to March 16th, 2020). A p-value of < 0.05 was considered significant. Post-hoc pairwise comparisons between the post-lockdown period and previous years were performed on significant results. A false discovery rate adjustment with an adjusted p-value (q-value) < 0.05 was computed. We hypothesized that the number of new MOGAD would be significantly lower in the post-lockdown period compared to previous years due to decreased regional pathogen transmission. RESULTS: Among 491 referred cases, we identified 415 new cases of neuroinflammatory disorder between January 2015 and March 2021. The number of new neuroinflammatory disorder diagnoses did not change between years. We noted significantly fewer new MOGAD diagnoses in 2020 compared to previous years, with no MOGAD patients presenting in 2020 after the spring lockdown (q=0.0009). In addition, there were significantly fewer parainfectious neuroinflammatory cases (q=0.04) and pathogen detected (q=0.04) in the post-lockdown period. The number of new multiple sclerosis (MS) and aquaporin-4 neuromyelitis optica spectrum disorders (AQP4-NMOSD) cases remained stable despite the lockdown (q=0.185 and 0.693 respectively). INTERPRETATION: Enhanced population-based infection control strategies may have a role in modulating the incidence of MOGAD and parainfectious neuroinflammatory disorders, but not MS or AQP4-NMOSD.


Subject(s)
COVID-19 , Communicable Disease Control , /epidemiology , Aquaporin 4 , Autoantibodies , COVID-19/prevention & control , Child , Humans , Immunoglobulin G , Myelin-Oligodendrocyte Glycoprotein , Neuromyelitis Optica/epidemiology , Ontario/epidemiology , Public Health
10.
Neurology ; 96(15 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1407875

ABSTRACT

Objective: To assess changes in anxiety, fatigue, depression, physical activity, and sleep associated with the COVID-19 pandemic in youth with neuroinflammatory disorders. Background: Children with neuroinflammatory disorders have high rates of anxiety, depression, and fatigue, plus reduced physical activity compared to healthy counterparts. We examined whether patients with neuroinflammatory disorders would show changes in the above domains associated with COVID-19, hypothesizing poorer outcomes in patients with chronic/recurrent disease. Design/Methods: Children with neuroinflammatory disorders completed questionnaires from March-August 2020 (n=129): Screen for Childhood Anxiety and Related Disorders, Centre for Epidemiologic Studies Depression scale for Children, Pediatric Quality of Life Multidimensional Fatigue Scale, Godin Leisure-Time Exercise Questionnaire, and Children's Sleep Habits Questionnaire. Clinical/demographic data were collected via standardized Case Report Form. We used pre-pandemic data for paired analysis where available (n=87). Results: Participants were 57% female (mean age: 13±4 years). Children with monophasic Acquired Demyelinating Syndrome (monoADS) engaged in moderate/vigorous physical activity a mean of 6±4 times/week pre-pandemic (n=61), and 5±4 during the pandemic (n=62). Children with chronic/recurrent neuroinflammation (crNI;Multiple Sclerosis (MS) and neuroinflammation with systemic involvement) exercised 4±3 times/week pre-pandemic (n=21 (14 MS)), and 4±2 during (n=25 (15 MS)) (monoADS vs crNI: p=0.076). Across all groups, the pandemic brought a rise in sleep time (9±1 versus 10±2 hours, p<0.001), and improved sleep-rest fatigue (p=0.05). Despite this, children with MS reported more sleep-rest fatigue compared to monoADS (p=0.043). Average rates of depression and anxiety were similar pre/post-pandemic (29%/31%, p=0.507;16%/17%, p=0.857). During the pandemic, however, rates of depression/anxiety were significantly different by disease type: systemic involvement (60%/50%), MS (33%/27%), monoADS (22%/16%)(Chi-square, p=0.048/0.049). Conclusions: With the pandemic, despite increased sleep, youth with neuroinflammatory disorders continued to display high rates of depression/anxiety and reduced physical activity. There were significantly different rates of depression/anxiety between disease types. Individuals with recurrent disease had more fatigue than those with monophasic disease.

12.
Topics in Antiviral Medicine ; 29(1):140-141, 2021.
Article in English | EMBASE | ID: covidwho-1250022

ABSTRACT

Background: Due to the substantial morbidity but low rates of hospitalization and death among outpatients with COVID-19, symptom outcome measures should be considered for primary efficacy assessment in phase 3 treatment trials. We analyzed potential measures utilizing the ACTIV-2 participant diary. Methods: Data from the first 95 participants in ACTIV-2 were included. All had symptomatic SARS-CoV-2 infection and received blinded bamlanivimab 7000 mg/placebo. The symptom diary was completed by participants prior to treatment (Day 0) and then daily for 28 days. It included 13 targeted symptoms scored as absent, mild, moderate, or severe, and a question about whether they had returned to pre-COVID-19 health. Without unblinding, 3 candidate symptom outcome measures were assessed: A) time to confirmed (2 consecutive days) absence of all targeted symptoms, B) time to all targeted symptoms confirmed to be mild or absent, and C) time to confirmed improvement in all targeted symptoms. Median time to outcome was estimated by Kaplan-Meier methods. Results: Of the 95 participants, 53% were female, 82% white, and 33% Latinx. Median age was 44 years;46% were age ≥55 years and/or had protocol-defined comorbidities. Median time from COVID-19 symptom onset to randomization was 6 days. Prevalence of each targeted symptom on Day 0 ranged from 6% vomiting to 87% fatigue. Candidate outcome B was met in median 2 days due to 29% of participants having only mild symptoms at Day 0. For candidate outcomes A and C, median time was 11 and 8 days, with 26% and 16%, respectively, not meeting the outcome by 28 days. These candidate outcomes (A and C) were associated with a participant's confirmed assessment of return to pre-COVID-19 health (Figure). For all measures, increasing the consecutive days required for confirmation from 2 to 3 or 4 had a modest impact on median time to the outcome being met, consistent with few participants experiencing relapsing symptoms. Conclusion: Outcomes based on symptom resolution (A) or improvement (C) are promising for evaluating COVID-19 treatment response, with good internal validity with self-assessment of return to pre-COVID-19 health. A valid symptom outcome measure may be preferred over hospitalization/death as a primary outcome for outpatient COVID-19 treatment trials as most participants achieve the outcome, increasing power to compare treatments, especially among participants who are at low risk for hospitalization/death.

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