Risk of SARS-CoV-2 testing, PCR-confirmed infections and COVID-19-related hospital admissions in children and young people: birth cohort study

BackgroundThere have been no population-based studies of SARS-CoV-2 testing, PCR-confirmed infections and COVID-19-related hospital admissions across the full paediatric age range. We examine the epidemiology of SARS-CoV-2 in children and young people (CYP) aged <23 years. MethodsWe used a birth cohort of all children born in Scotland since 1997, constructed via linkage between vital statistics, hospital records and SARS-CoV-2 surveillance data. We calculated risks of tests and PCR-confirmed infections per 1000 CYP-years between August and December 2020, and COVID-19-related hospital admissions per 100,000 CYP-years between February and December 2020. We used Poisson and Cox proportional hazards regression models to determine risk factors. ResultsAmong the 1226855 CYP in the cohort, there were 378402 tests, 19005 PCR confirmed infections and 346 admissions, corresponding to rates of 770.8/1000 (95% confidence interval 768.4-773.3), 179.4 (176.9-182.0) and 29.4/100,000 (26.3-32.8) CYP-years respectively. Infants had the highest COVID-19-related admission rates. Chronic conditions, particularly multiple types of conditions, was strongly associated with COVID-19-related admissions across all ages. The hazard ratio for >1 chronic condition type was 12.2 (7.9-18.82) compared to children with no chronic conditions. 89% of admitted children had no chronic conditions recorded. ConclusionsInfants, and CYP with chronic conditions are at highest risk of admission with COVID-19, however the majority of admitted CYP have no chronic conditions. These results provide evidence to support risk/benefit analyses for paediatric COVID-19 vaccination programmes. Studies examining whether maternal vaccine during pregnancy prevents COVID-19 admissions in infants are urgently needed. FundingUK Research and Innovation-Medical Research Council

Long-Term Exposure to Outdoor Air Pollution and COVID-19 Mortality: an ecological analysis in England

There is an urgent need to examine what individual and environmental risk factors are associated with COVID-19 mortality. This objective of this study is to investigate the association between long term exposure to air pollution and COVID-19 mortality. We conducted a nationwide, ecological study using zero-inflated negative binomial models to estimate the association between long term (2014-2018) small area level exposure to NOx, PM2.5, PM10 and SO2 and COVID-19 mortality rates in England adjusting for socioeconomic factors and infection exposure. We found that all four pollutant concentrations were positively associated with COVID-19 mortality. The increase in mortality risk ratio per inter quarter range increase was for PM2.5:11%, 95%CIs 6%-17%), PM10 (5%; 95%CIs 1%-11%), NOx (11%, 95%CIs 6%-15%) and SO2 (7%, 95%CIs 3%-11%) were respectively in adjusted models. Public health intervention may need to protect people who are in highly polluted areas from COVID-19 infections.

Ultraviolet A Radiation and COVID-19 Deaths: A Multi Country Study

ObjectivesTo determine whether UVA exposure might be associated with COVID-19 deaths DesignEcological regression, with replication in two other countries and pooled estimation Setting2,474 counties of the contiguous USA, 6,755 municipalities in Italy, 6,274 small areas in England. Only small areas in their Vitamin D winter (monthly mean UVvitd of under 165 KJ/m2) from Jan to April 2020. Participants The at-risk population is the total small area population, with measures to incorporate spatial infection into the model. The model is adjusted for potential confounders including long-term winter temperature and humidity. Main outcome measuresWe derive UVA measures for each area from remote sensed data and estimate their relationship with COVID-19 mortality with a random effect for States, in a multilevel zero-inflated negative binomial model. In the USA and England death certificates had to record COVID-19. In Italy excess deaths in 2020 over expected from 2015-19. Data sourcesSatellite derived mean daily UVA dataset from Japan Aerospace Exploration Agency. Data on deaths compiled by Center for Disease Control (USA), Office for National Statistics (England) and Italian Institute of Statistics. ResultsDaily mean UVA (January-April 2020) varied between 450 to 1,000 KJ/m2 across the three countries. Our fully adjusted model showed an inverse correlation between UVA and COVID-19 mortality with a Mortality Risk Ratio (MRR) of 0.71 (0.60 to 0.85) per 100KJ/m2 increase UVA in the USA, 0.81 (0.71 to 0.93) in Italy and 0.49 (0.38 to 0.64) in England. Pooled MRR was 0.68 (0.52 to 0.88). ConclusionsOur analysis, replicated in 3 independent national datasets, suggests ambient UVA exposure is associated with lower COVID-19 specific mortality. This effect is independent of vitamin D, as it occurred at irradiances below that likely to induce significant cutaneous vitamin D3 synthesis. Causal interpretations must be made cautiously in observational studies. Nonetheless this study suggests strategies for reduction of COVID-19 mortality.