Note: This thread is related to #Coronavirus #COVID19

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Alasdair Munro+ Your Authors @apsmunro Paediatric Registrar | Clinical Research Fellow Paediatric Infectious diseases @southamptonCRF | @DFTBubbles #COVID19 evidence review lead | Husband and dad Aug. 03, 2020 2 min read + Your Authors

OK I'm busy trying to catch up with what I've missed on #COVID19 in children, which looks like a lot!

People seem to be making a big deal out of some new papers, but frankly there's not a huge amount of new information here - quick run down

1/13

This paper examines a big outbreak at an overnight camp in Georgia (USA) during a period of high community transmission

Lots of kids infected, including young children

2/13

 https://www.cdc.gov/mmwr/volumes/69/wr/mm6931e1.htm?s_cid=mm6931e1_w#T1_down 

Over such a brief period of time, likely kids didn't actually have time to transmit to each other. Mainly got infected by staff

Good break down here by @DiseaseEcology (although I disagree with the take on household transmission studies!)

3/13

We've known for some time children can get infected in mass spreading events, albeit has mostly been demonstrated in older children (see study from France)

Attack rate is pretty high though!

4/13

 https://www.medrxiv.org/content/10.1101/2020.04.18.20071134v1 

Next an outbreak in a high school in Israel

We cannot tell direction of transmission, but to me this looks like too many cases too fast to all be spread between children; I imagine multiple sources of entry

Secondary schools do seem higher risk

5/13

 https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.29.2001352 

Next a surprising study showing higher viral loads in younger children than adults?! At odds with previous studies showing similar, or lower VL

6/13

 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2768952 

See here (L'Huillier)

 https://wwwnc.cdc.gov/eid/article/26/10/20-2403_article 

Here (Jones)

 https://www.medrxiv.org/content/10.1101/2020.06.08.20125484v1 

Here (Kawasuji)

 https://www.medrxiv.org/content/10.1101/2020.06.02.20120014v1 

Confused? Me too.

7/13

We already known children have transmissible virus, so this isn't new information

It's nice that they targeted ONLY symptomatic individuals, so at least we have a consistent denominator

Shame we still don't know how many children are asymptomatic...

8/13

Next a study suggesting school closures in the USA may have prevented infections/deaths

Sadly it's impossible to tell from these studies the true effect as school closures are never adopted in isolation

Not sure it's helpful

9/13

 https://jamanetwork.com/journals/jama/fullarticle/2769034 

On which note, this study from Japan on the same topic found it made no difference

Not sure we've gotten any further

10/13

 https://www.ijidonline.com/article/S1201-9712(20)30598-1/fulltext 

Finally, 2 excellent pre-print review articles to highlight

The first by @mugecevik @mlipsitch and @EdwardGoldste16 (a veritable A team of #COVID19) on age and transmission

 https://www.medrxiv.org/content/10.1101/2020.07.19.20157362v2 

11/13

The next also by @mugecevik et al. on viral dynamics of #COVID19

Includes interesting findings on duration of viral shedding according to age (although kids data poor, might explain apparent reduced infectivity of children despite similar VL?)

12/13

 https://www.medrxiv.org/content/10.1101/2020.07.25.20162107v2 

Quick whistle stop tour there - hope to come back to some of these when (or if!) I have more time!

Hoping to get the @DFTBubbles #COVID19 in children review up to date soon too!

 https://dontforgetthebubbles.com/evidence-summary-paediatric-covid-19-literature/ 

13/13


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