Impact of Home Confinement Due to COVID-19 Pandemic on Mental Health in Young Children: A Natural Experiment (preprint)

Background: The outbreak of coronavirus disease in 2019 (COVID-19) has had an enormous impact on people’s health, and profoundly changed our lives and society. However, the impact of pandemic-related home confinement on children’s life and their mental health remains unknown. We took advantage of a natural experiment due to the onset of COVID-19 and examined this issue in two consecutive cohorts. Methods: This study compared mental health, family environment and lifestyles of two representative cohorts of young children in Shanghai, China. Both prospective cohorts recruited children at entry to kindergarten. Surveys were conducted at both entry and graduation of kindergarten using the same assessment instruments. Children in the non-exposed cohort experienced a normal period of kindergarten study and graduated in June, 2019; those in the exposed cohort were under confinement for five months and graduated in June, 2020. Findings: Compared with the non-exposed cohort, the exposed cohort had a significant increased percentage of children classified as “at-risk for mental health problems”, with an adjusted absolute risk difference of 3·1% (95% CI, 1·9% to 4·4%) for total difficulties as measured by the Strength and Difficulty Questionnaire. The effect of pandemic related confinement on mental health was larger in children with lower parental education. The exposed cohort had longer media time, sleep duration and a less favorable home environment. Interpretation: The pandemic related confinement negatively affected children's mental health and home environment. Strategies and actions are urgently needed to improve parenting skills and mitigate the negative impact by strengthening the family environment.Funding Statement: National Natural Science Foundation of China, Shanghai Committee of Science and Technology, Shanghai Municipal Health Commission, Shanghai Education CommitteeDeclaration of Interests: We declare no competing interests.Ethics Approval Statement: The study was approved by the Institutional Review Board of the Shanghai Children’s Medical Center, the Shanghai Jiao Tong University School of Medicine (SCMCIRB-K2016022-01)

Identification of a super-spreading chain of transmission associated with COVID-19 (preprint)

BackgroundSuper-spreading events were associated with the outbreaks of SARS and MERS, but their association with the outbreak of COVID-19 remains unknown. Here, we report a super-spreading transmission chain of SARS-CoV-2 involving an index patient, seven cancer patients, 40 health care workers and four family members. MethodsWe conducted a retrospective study to identify the index patient and the exposed individuals linked to a chain of transmission associated with COVID-19. We collected and analyzed the data on demographic features, exposure history, clinical presentation, laboratory investigation, radiological examination, and disease outcome of these patients. ResultsWe identified the index patient and another presumptive "super-spreader", who initiated and amplified a super-spreading transmission chain associated with COVID-19, respectively. There were 31 female and 21 male patients in this cohort, and the median age was 37 years (range: 22-79 years). Each of them had an exposure history with the index patient or his close contacts. Approximately 87% (45/52) of the patients had fever or other symptoms, 96% (50/52) had abnormal chest CT-scan findings, 86% of the tested patients (39/45) were positive for SARS-CoV-2 in the nasopharyngeal or throat swab specimen, 85% of the tested patients (29/34) were positive for SARS-CoV-2-specific IgM and/or IgG, 15% of the RT-PCR positive patients were tested negative for the specific IgM and/or IgG at the convalescent phase, and 15% of the RT-PCR negative patients were tested positive for the specific IgM and/or IgG. The severe patients experienced a significant decrease in oximetry saturation, lymphocyte, and platelet counts, along with a significant increase in C-reactive protein, D-dimer, and lactate dehydrogenase. All six fatal cases had comorbidities and five of the seven cancer patients (71%) died within 2-20 days of the disease onset. ConclusionsThe super-spreading events were associated with the outbreak of COVID-19 in Wuhan and its impact on disease transmission warrants further investigation. Cancer patients appeared highly vulnerable to COVID-19. The finding that a significant portion of SARS-CoV-2 infected patients were tested negative for the serum specific IgM and IgG at the convalescent phase should be addressed by additional studies.