SARS-CoV-2 infections in children: Understanding diverse outcomes.

SARS-CoV-2 infections mostly lead to mild or even asymptomatic infections in children, but the reasons for this are not fully understood. More efficient local tissue responses, better thymic function, and cross-reactive immunity have all been proposed to explain this. In rare cases of children and young people, but very rarely in adults, post-infectious hyperinflammatory syndromes can develop and be serious. Here, I will discuss our current understanding of SARS-CoV-2 infections in children and hypothesize that a life history and energy allocation perspective might offer an additional explanation to mild infections, viral dynamics, and the higher incidence of rare multisystem inflammatory syndromes in children and young people.

Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance.

BACKGROUND: Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS: A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS: The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. CONCLUSION: Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.

Comparison of deliberate self-harm incidents attended by Helicopter Emergency Medical Services before and during the first wave of COVID-19 in the East of England.

INTRODUCTION: There is significant interest in the mental health impact of the COVID-19 pandemic. Helicopter Emergency Medical Services (HEMS) attend the most seriously unwell and injured patients in the community; their data therefore present an early opportunity to examine self-harm trends. The primary aim was to compare the incidence of deliberate self-harm incident (DSH-I) encounters by HEMS before and during the first wave of COVID-19. METHODS: Data were obtained from all three East of England HEMS: total number of activations and stand-downs, number of DSH-I activations and stand-downs, self-harm mechanism and number of 'severe' DSH-I patient encounters, in two 61-day periods: 1 March to 30 April in 2019 (control) and 2020 (COVID-19). Severe DSH-I was defined as cardiac arrest and/or died prehospital. Proportions were compared with a Fisher's exact test. RESULTS: There were a total of 1725 HEMS activations: n=981 (control) and n=744 (COVID-19), a decrease of 24.2% during COVID-19. DSH-I patient encounters increased by 65.4%: n=26 (control) and n=43 (COVID-19). The proportion of encounters that were DSH-I and severe DSH-I both significantly increased during COVID-19: p=0.002 and p=0.001, respectively. The absolute number of hangings and falls from height both approximately tripled during COVID-19, whereas the number of other mechanisms remained almost constant. CONCLUSION: Despite a reduction in overall HEMS patient encounters, there were significant increases in both the proportion of DSH-Is and their severity attended by HEMS during the first wave of the COVID-19 pandemic in the East of England.

"Safer at home": The effect of the COVID-19 lockdown on epidemiology, resource utilization, and outcomes at a large urban trauma center.

BACKGROUND: The COVID-19 pandemic has affected the entire global health care system. In California, because of a high burden of cases, a lockdown order was announced on March 19, 2020. This study investigated the impact of the lockdown on the epidemiology and outcomes of trauma admissions at the largest trauma center in Los Angeles. METHODS: A retrospective study comparing epidemiological and clinical characteristics and outcomes of trauma admissions during the lockdown period (March 20, 2020, to June 30, 2020) to a similar period in the previous year (March 20, 2019, to June 30, 2019) was performed. Data collection included demographics, mechanism of injury, prehospital transportation, substance use, injury severity, resource utilization, and outcomes. FINDINGS: There were 1,202 admissions during the lockdown period in 2020 and 1,143 during the same calendar period in 2019. Following the lockdown, there was a reduction in the automobile versus pedestrian admissions by 42.5%, motorcycle injuries by 38.7%, and bicycle accidents by 28.4% but no significant effect on the number of motor vehicle accident admissions. There was an increase in ground level falls by 32.5%, especially in the elderly group. The absolute number of gunshot wounds increased by 6.2% and knife injuries by 39.3%. Suicides increased by 38.5%. Positive testing for substance use increased by 20.9%. During the lockdown, patients suffered less severe trauma, with Injury Severity Score of <9 (p < 0.001), as well as less severe head (p = 0.001) and severe chest trauma (p < 0.001). Trauma deaths were reduced by 27.9%, and the crude overall mortality was significantly lower during the lockdown period (4.1% vs. 5.9%, p = 0.046). Intensive care unit admission rates, mechanical ventilation, and intensive care unit length of stay were all reduced. CONCLUSION: The COVID-19 lockdown in 2020 had a significant effect on the epidemiology, clinical characteristics, and critical care resource utilization of trauma admissions in a large academic trauma center. These findings may help in planning and optimization of hospital resources during the pandemic. LEVEL OF EVIDENCE: Epidemiological study, level III; Retrospective observational, level III.

The impact of COVID-19 lockdown on acute trauma patients seen at the National Hospital Trauma Centre Abuja, Nigeria.

INTRODUCTION: trauma is the leading cause of mortality in individuals less than 45 years. The principles of Advanced Trauma Life Support (ATLS) which is used around the world in resuscitation of trauma patients have been considered to be safe. However, the outbreak of corona virus disease 2019 (COVID-19) has affected the processes and characteristics of acute trauma patients seen around the world. This study is intended to determine the impact of COVID-19 lockdown on the acute trauma patients seen in a Nigerian trauma centre. METHODS: this is a cross-sectional observational study of trauma patients seen in the resuscitation room of the National Hospital trauma centre in Abuja, Nigeria, from 24th February,2020 to 3rd May, 2020. The participants were consecutive acute trauma patients who were grouped into two: five weeks preceding total lockdown and five weeks of total lockdown. Statistical analysis was done using the statistical package for social sciences (SPSS) version 24.0 while results were presented in tables and a figure. RESULTS: a total of 229 patients were recruited into the study with age range 1 to 62 years, mean age of 28 ± 13 and male to female ratio of 3.87. The patient volume reduced by 41.31% during the lockdown. Though motor vehicular crash (MVC) was the predominant mechanism of injury in both groups making up 37.65% and 23.88% respectively, penetrating assault was more during the lockdown period (17.91% versus 6.17%). The lockdown was further associated with more delayed presentation (52.24% versus 48.15%), more referrals (53.73% versus 32.72%), less severe injury score (29.6% versus 56.7%) and no death in the resuscitation room (0% versus 1.85%). CONCLUSION: despite the reduction in the volume of trauma presentations by 41.31%, patients got the required care with less mortality. Efforts should be directed at sustaining access to acute trauma care in all circumstances to reduce preventable trauma deaths.

Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center.

PURPOSE: In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. METHODS: All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. RESULTS: During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. CONCLUSION: This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

The ICON Trauma Study: the impact of the COVID-19 lockdown on major trauma workload in the UK.

BACKGROUND: The global pandemic caused by SARS-CoV-2 has impacted population health and care delivery worldwide. As information emerges regarding the impact of "lockdown measures" and changes to clinical practice worldwide; there is no comparative information emerging from the United Kingdom with regard to major trauma. METHODS: This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020-18/05/2020) to a historical cohort of patients admitted during a similar time period in 2019 (11/03/2019-20/05/2019). Differences in demographics, Clinical Frailty Scale, SARS-CoV-2 status, mechanism of injury and injury severity were compared using Fisher's exact and Chi-squared tests. Univariable and multivariable logistic regression analyses examined the associated factors that predicted 30-days mortality. RESULTS: A total of 642 patients were included, with 405 in the 2019 and 237 in the 2020 cohorts, respectively. 4/237(1.69%) of patients in the 2020 cohort tested positive for SARS-CoV-2. There was a 41.5% decrease in the number of trauma admissions in 2020. This cohort was older (median 46 vs 40 years), had more comorbidities and were frail (p < 0.0015). There was a significant difference in mechanism of injury with a decrease in vehicle related trauma, but an increase in falls. There was a twofold increased risk of mortality in the 2020 cohort which in adjusted multivariable models, was explained by injury severity and frailty. A positive SARS-CoV-2 status was not significantly associated with increased mortality when adjusted for other variables. CONCLUSION: Patients admitted during the COVID-19 pandemic were older, frailer, more co-morbid and had an associated increased risk of mortality.

The Impact of Immunosuppression and Autoimmune Disease on Severe Outcomes in Patients Hospitalized with COVID-19.

Immunosuppression (IS) and autoimmune disease (AD) are prevalent in patients with severe coronavirus disease 2019 (COVID-19), but their impact on its clinical course is unknown. We investigated relationships between IS, AD, and outcomes in patients hospitalized with COVID-19. Data on consecutive admissions for COVID-19 were extracted retrospectively from medical records. Patients were assigned to one of four cohorts, according to whether or not they had an AD (AD and NAD) or were immunosuppressed (IS and NIS). The primary endpoint was development of severe acute respiratory distress syndrome (ARDS); secondary endpoints included death, and a composite of mechanical ventilation (MV) or death. A total of 789 patients were included: 569 (72.1%) male, 76 (9.6%) with an AD, and 63 (8.0%) with IS. Relative to the NIS-NAD cohort, patients in the IS-AD cohort had a significantly reduced risk of severe ARDS (adjusted hazard ratio [aHR] 0.42; 95% confidence interval [CI] 0.23-0.80; p = 0.008). No significant relationships between IS or AD status and either death or the composite of MV and death were identified, although a trend towards higher mortality was identified in the IS-NAD cohort (aHR vs NIS-NAD 1.71; 95% CI 0.94-3.12; p = 0.081). Patients in this cohort also had higher median serum levels of interleukin-6 compared with IS-AD patients (98.2 vs 21.6 pg/mL; p = 0.0328) and NIS-NAD patients (29.1 pg/mL; p = 0.0057). In conclusion, among patients hospitalized with COVID-19, those receiving immunosuppressive treatment for an AD may have a reduced risk of developing severe ARDS.

Increasing Traumatic Brain Injury Incidence during COVID-19 Pandemic in the Emergency Department of Cipto Mangunkusumo National General Hospital-A National Referral Hospital in Indonesia.

OBJECTIVE: Evaluating the TBI incidence during the COVID-19 pandemic era compared with similar period in previous year. BACKGROUND: The emergence of SARS-CoV2 influenced the evolution of governmental and hospital policy worldwide, which might eventually impact many aspects. The incidence of many diseases in the Emergency Department (ED), especially traumatic brain injury (TBI), has been an area of interest. DESIGN/METHODS: Retrospective study comparing TBI incidence before and during COVID-19 pandemic era starting from the declaration of national pandemic date (March 16, 2020) until June 14, 2020 with the comparison of the same period in the previous year. RESULTS: There was an increase in admission rate due to TBI during COVID-19 pandemic compared with the previous year (157/752 (20.9%) vs 106/766 (13.8%), p < 0.001, respectively). While the range of age was similar between COVID-19 and non-COVID-19 era (37.9 ± 14.8 vs 38.6 ± 15.4 years, p = 0.712), male was higher in percentage to experience the injury (131/157 (83.4%) vs 67/106 (63.2%), p < 0.001). During the pandemic era, road traffic injury (97/157 (61.8%) vs 56/106 (52.8%), p = 0.149) as well as moderate-to-severe brain injury tended to increase (30/157 (19.1%) vs 17/106 (16.0%) p = 0.524) albeit statistically insignificant. Although the mortality rate was similar (12/157 (7.6%) vs 9/106 (8.5%), p = 0.804), higher hospitalization rate was observed in the pandemic era (81/157 (51.2%) vs 37/106 (34.9%) p = 0.008). CONCLUSIONS: TBI incidence remained increasing despite entering the COVID-19 era. These phenomena required further investigation and analysis that may possibly be unrelated with the COVID-19, but due to the change of the government policy and its impact, such as the more quiet road after national social distancing.

Comparison of Psychological Distress and Demand Induced by COVID-19 during the Lockdown Period in Patients Undergoing Peritoneal Dialysis and Hemodialysis: A Cross-Section Study in a Tertiary Hospital.

BACKGROUND: Since the outbreak of COVID-19 in December 2019, it has spread rapidly and widely, bringing great psychological pressure to the public. In order to prevent the epidemic, traffic lockdown was required in many areas of China, which led to inconvenience of treatment for dialysis patients. This study was conducted to explore the psychological distress and the psychological demand induced by CO-VID-19 in the patients undergoing dialysis and compare the difference between hemodialysis (HD) and peritoneal dialysis (PD) patients during the traffic lockdown period. METHODS: Questionnaires were given to the dialysis patients in the West China Hospital of Sichuan University. The Impact of Event Scale (IES) was used to investigate the patients' trauma-related distress in response to COVID-19. RESULTS: 232 eligible respondents were enrolled in this cross-section study, consisting of 156 PD patients and 76 HD patients. The median IES score for all the enrolled patients was 8.00 (2.00-19.00), which belonged to the subclinical dimension of post-traumatic stress symptoms (PTSS). HD patients had a significant higher IES score than PD patients (11.50 vs. 8.00) (p < 0.05). HD patients already got more psychological support from the medical staff. According to IES scores, 22.4% HD patients and 13.4% PD patients were classified as having moderate or severe PTSS, which need psychological support (p < 0.05). But more patients of both groups considered psychological support was necessary (HD: 50%, PD: 45.5%) (p > 0.05). In the multivariate regression analysis, we found that dialysis vintage, the impact of COVID-19 on the severity of illness and daily life, and confidence in overcoming the disease contributed to IES score (p < 0.05). CONCLUSIONS: HD patients had more severe trauma-related stress symptoms than PD patients. When major public healthy events occurred, careful psychological estimate and sufficient psychological support should be provided to the dialysis patients, especially to the HD patients.

Epidemiology of trauma presentations to a major trauma centre in the North West of England during the COVID-19 level 4 lockdown.

PURPOSE: The COVID-19 pandemic has impacted healthcare systems globally, little is known about the trauma patterns during a national lockdown. The aim of this study is to delineate the trauma patterns and outcomes at Aintree University Teaching Hospital level 1 Major Trauma Centre (MTC) during the COVID-19 lockdown imposed by the U.K. government. METHODS: A retrospective cohort study data from the Merseyside and Cheshire Trauma Audit and Research Network database were analysed. The 7-week 'lockdown period' was compared to a 7-week period prior to the lockdown and also to an equivalent 7-week period corresponding to the previous year. RESULTS: A total of 488 patients were included in the study. Overall, there was 37.6% and 30.0% reduction in the number of traumatic injuries during lockdown. Road traffic collisions (RTC) reduced by 42.6% and 46.6%. RTC involving a car significantly reduced during lockdown, conversely, bike-related RTC significantly increased. No significant changes were noted in deliberate self-harm, trauma severity and crude mortality during lockdown. There was 1 mortality from COVID-19 infection in the lockdown cohort. CONCLUSION: Trauma continues during lockdown, our MTC has continued to provide a full service during lockdown. However, trauma patterns have changed and departments should adapt to balance these alongside the COVID-19 pandemic. As the U.K. starts its cautious transition out of lockdown, trauma services are required to be flexible during changes in national social restrictions and changing trauma patterns. COVID-19 and lockdown state were found to have no significant impact on survival outcomes for trauma.

Trends in Pediatric Emergency Department Utilization after Institution of Coronavirus Disease-19 Mandatory Social Distancing.

We conducted a descriptive time-series study of pediatric emergency healthcare use during the onset of severe acute respiratory syndrome coronavirus 2 pandemic after a state-wide stay-at-home order. Our study demonstrated decreased volume, increased acuity, and generally consistent chief complaints compared with the prior 3 years (2017 through 2019). Ingestions became a significantly more common chief complaint in 2020.

COVID-19 Pandemic among Latinx Farmworker and Nonfarmworker Families in North Carolina: Knowledge, Risk Perceptions, and Preventive Behaviors.

(1) Background: The COVID-19 pandemic poses substantial threats to Latinx farmworkers and other immigrants in food production and processing. Classified as essential, such workers cannot shelter at home. Therefore, knowledge and preventive behaviors are important to reduce COVID-19 spread in the community. (2) Methods: Respondents for 67 families with at least one farmworker (FWF) and 38 comparable families with no farmworkers (nonFWF) in North Carolina completed a telephone survey in May 2020. The survey queried knowledge of COVID-19, perceptions of its severity, self-efficacy, and preventive behaviors. Detailed data were collected to document household members' social interaction and use of face coverings. (3) Results: Knowledge of COVID-19 and prevention methods was high in both groups, as was its perceived severity. NonFWF had higher self-efficacy for preventing infection. Both groups claimed to practice preventive behaviors, though FWF emphasized social avoidance and nonFWF emphasized personal hygiene. Detailed social interactions showed high rates of inter-personal contact at home, at work, and in the community with more mask use in nonFWF than FWF. (4) Conclusions: Despite high levels of knowledge and perceived severity for COVID-19, these immigrant families were engaged in frequent interpersonal contact that could expose community members and themselves to COVID-19.

The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown.

PURPOSE: In February 2020, the federal state of Tyrol in Austria has become one of the epicenters of the COVID-19 pandemic. Tyrol is known for numerous skiing areas. Thus, winter sport resorts became a starting point for COVID-19 infections spreading towards the rest of the state, Austria and other countries, leading to a mandatory quarantine for almost a million people, who were placed under a curfew and restrictions in daily life. Additionally, all ski resorts and hotels were closed. We aimed to analyze the influence of the COVID-19 quarantine on traumatic brain injury (TBI) cases in Tyrol. METHODS: We retrospectively compared demographical and injury characteristics from all TBI patients within the 2020 strict quarantine period with the respective time periods from 2016 to 2019. As our department is the only neurosurgical unit in Tyrol, all patients with moderate or severe TBI are transferred to our hospital. RESULTS: During 3 weeks of the full quarantine period, the weekly TBI cases load decreased significantly in comparison to the same time periods in the years 2016-2019. Furthermore, concomitant skull fractures decreased significantly (p < 0.016), probably reflecting different causative mechanisms. The other demographical and injury characteristics and particularly falls at home stayed relatively unchanged. CONCLUSION: TBI remained an important contributor to the neurosurgical workflow during the COVID-19 pandemic. Strategies to ensure neurosurgical care also under pandemic-induced lockdown are important.