SARS‐CoV‐2 testing and outcomes in the first 30 days after the first case of COVID‐19 at an Australian children's hospital

Abstract

Objective: International studies describing COVID-19 in children have shown low proportions of paediatric cases and generally a mild clinical course. We aimed to present early data on children tested for SARS-CoV-2 at a large Australian tertiary children's hospital according to the state health department guidelines, which varied over time. Methods: We conducted a retrospective cohort study at The Royal Children's Hospital, Melbourne, Australia. It included all paediatric patients (aged 0-18 years) who presented to the ED or the Respiratory Infection Clinic (RIC) and were tested for SARS-CoV-2. The 30-day study period commenced after the first confirmed positive case was detected at the hospital on 21 March 2020, until 19 April 2020. We recorded epidemiological and clinical data. Results: There were 433 patients in whom SARS-CoV-2 testing was performed in ED (331 [76%]) or RIC (102 [24%]). There were four (0.9%) who had positive SARS-CoV-2 detected, none of whom were admitted to hospital or developed severe disease. Of these SARS-CoV-2 positive patients, 1/4 (25%) had a comorbidity, which was asthma. Of the SARS-CoV-2 negative patients, 196/429 (46%) had comorbidities. Risk factors for COVID-19 were identified in 4/4 SARS-CoV-2 positive patients and 47/429 (11%) SARS-CoV-2 negative patients. Conclusion: Our study identified a very low rate of SARS-CoV-2 positive cases in children presenting to a tertiary ED or RIC, none of whom were admitted to hospital. A high proportion of patients who were SARS-CoV-2 negative had comorbidities.

Adverse Childhood Experiences Should Be Priority in Global Response to Covid‐19

“…Children are at low risk of novel coronavirus disease 2019 (COVID-19) infection and tend to experience a milder clinical course and a very low risk of death. 3 Despite the low risk of COVID-19 to children, their risk of exposure to adverse childhood experiences (ACEs), such as childhood maltreatment, household dysfunction, maladaptive parenting, violence and economic adversity, has substantially increased due to the social, financial and psychological consequences of the ongoing COVID-19 pandemic. Mass unemployment has an adverse impact on the health, financial and social circumstances of workers, families and communities.…”

“…The rates of domestic violence and alcohol misuse have increased substantially during the lockdown. 4 ACEs are linked with an increased risk of unhealthy life-style behaviours, obesity, suicidality and chronic diseases, including mental disorders and cardiometabolic outcomes across the life course. 5 About 30% of all mental disorders are attributable to ACEs, including 30% of cases of anxiety, 40% of cases of depression and 67% of lifetime suicide attempts.…”

“…2 The most commonly used treatment in emergency department (ED) is high-dose inhaled salbutamol with or without ipratropium. 3 We investigated whether a novel use of burst Ventolin therapy (BVT) at home can be safely given during an exacerbation to prevent ED and hospital admissions in a pilot study.…”

COVID‐19 in health‐care workers: Testing and outcomes at a Victorian tertiary children's hospital

“…This is consistent with early data at our institution that showed a low proportion of children testing positive at <1%. 6 Measures were taken when an outbreak was identified to reduce, contain and limit nosocomial infection including temporarily closing the neonatal unit to admissions (diverted to the paediatric intensive care unit), allocating single-rooms for all patients, widespread testing and furloughing of all potentially exposed staff. Our current positive test rate of 0.4% is similar to the overall Victorian rate (0.7%).…”

Re: SARS‐CoV‐2 testing and outcomes in the first 30 days after the first case of COVID‐19 at an Australian children's hospital

“…Dear Editor, Ibrahim et al highlighted a very low number of SARS-CoV-2 positive cases in their tertiary paediatric setting. 1 We congratulate the authors on encompassing the whole presenting cohort of children who were tested, and would like to make a contribution from the vantage point at our hospital trust, providing emergency and urgent primary care in London, UK, where the incidence of COVID-19 has been high and community transmission is well established.…”