Varying numbers of acute wheezing cases presenting to paediatric emergency during the COVID-19 pandemic

Acute wheezing in children due to underlying asthma or airways hypersensitivity (including allergic rhinitis) can be exacerbated by infectious and non-infectious causes. Of the infectious causes, seasonal rhinoviruses are the most common. Particulate airborne pollutants (PM2.5, PM10) can also play a role. During the COVID-19 pandemic, we observed changes in the pattern of paediatric emergency department (PED) presentations for acute wheezing. In this retrospective observational cohort study, data was extracted for children (0-18 years) presenting to the PED during 2018-2021, whose illness episodes were coded as 'asthma' or 'viral induced wheeze', along with their age, ethnicity, gender, and clinical outcomes, from hospital databases. The Figure shows the number of PED presentations for acute wheezing during 2018-2021, with annotations to explain the changing patterns. The number of cases presenting during the pandemic years 2020-2021 were similar to those in 2018-2019 in the same months, except for April-June 2020, July-August 2020, November 2020 and January-March 2021. Decreases in PED presentations coincided with periods of enforced national and local lockdowns, likely due to parental reluctance to expose their children to SARS-CoV-2 in a hospital setting. In addition, fluctuations in the incidence of rhinovirus infections, as shown by national sentinel surveillance data, likely contributed to changes in case numbers. Higher and lower incidence of rhinovirus infections tended to increase and decrease the number of presentations, respectively. Surprisingly, the level of airborne particulates (PM2.5, PM10) showed no correlation with these PED presentations for acute wheezing.

Comparing impacts of the COVID-19 pandemic on training of public health Specialty Registrars starting before or after its onset.

Objectives: To capture and compare the differences in experiences of public health Specialty Registrars who commenced training prior to the COVID-19 pandemic (pre-pandemic Registrars) and those who commenced training during the pandemic (post-pandemic Registrars). Study design: This is a mixed methods study comprising a cross-sectional survey and participatory action research. Methods: A questionnaire of 10 open and 5 closed questions exploring participants experience of training during the pandemic was sent to East Midlands Specialty Registrars. Thematic analysis and double coding were undertaken, coded based on pre- or post-pandemic Registrar status. Participatory action research was then undertaken in 2 rounds with 2 groups, based on pre/post-pandemic status to consolidate themes. Results: The survey was completed by 17 Registrars (8 pre-pandemic, and 9 post-pandemic) and 19 Registrars took part in participatory action research. The findings showed pre-pandemic Registrars noted the importance of negative impacts on their mental health whilst post-pandemic Registrars were more positive and felt well supported in their training. Conclusions: There is a stark difference in the impact of the pandemic for Registrars who started training before compared to during the pandemic. The training programme was not resilient to the impact of the pandemic. Robustness could be increased by encouraging early leadership experience and providing wellbeing support, particularly for post pandemic Registrars now and in future.