H5N1

Newborn triplets test positive for COVID-19 in Mexico

Via Globalnews.ca, a report by The Associated Press: Newborn triplets test positive for coronavirus in Mexico. Excerpt:

Mexico’s novel coronavirus cases mounted and added their youngest infections Monday, when triplets tested positive for the virus on the day they were born. 

Monica Rangel, the health secretary of the northern state of San Luis Potosi, said the triplets were born May 8 to a mother who was also positive but asymptomatic.

Rangel said the triplets are not believed to be in danger. She said the case was being studied to see whether the triplets were infected before or after birth was being conducted, but said it appeared improbable they could have been infected outside the womb so quickly. 

It is not the first time newborns have tested positive for the virus, but it is rare.

SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020

Via Eurosurveillance: SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020. The conclusion:

French surveillance data confirm the signal of the emergence of an inflammatory multisystem syndrome associated with SARS-CoV-2 infection in children. The actual risk of this disease is difficult to estimate, as reliable data on the incidence of COVID-19 infections in children are not yet available. COVID-19 cases in children younger than 15 years reported to The European Surveillance System (TESSy) represent only 2.1% of all laboratory-confirmed cases. Under the conservative estimate of no more than only 5% of French children under 15 years having been infected with SARS-CoV-2, the risk of PIMS, based on confirmed, probable and possible cases would be fewer than two per 10,000 children. 

In the short term, the risk of new cases of COVID- PIMS is likely to be very low in France, given the low circulation of the virus in France in the past few weeks. More data on this new syndrome will be collected through a research protocol that is currently being implemented. Countries with current high incidence of COVID-19 in the general population should consider this rare but severe delayed syndrome in children.

Strange symptoms, flare-ups, weeks-long illnesses for some COVID-19 survivors

Via CBC News: Strange symptoms, flare-ups, weeks-long illnesses for some COVID-19 survivors. Excerpt:

Chandra Pasma thought it was strange when she started feeling a burning sensation in her neck and ear canal. 

It was March 16, just days after COVID-19 had been declared a pandemic, and the 40-year-old Ottawa resident knew people were being infected across the country. But since her symptoms weren't among those listed for the virus, she didn't think much of it. 

Then every single member of Pasma's household started falling ill. 

First it was her husband, 44-year-old Matt Helleman, who suddenly felt exhausted. Just days later, the couple's three children — seven-year-old twins and a nine-year-old daughter — started experiencing fevers, sore throats, and fatigue. And around the same time, Pasma's own symptoms ramped up into chest pain and a cough. 

"I thought, oh crap," she recalls. "This is COVID."  

Like many people with milder forms of the illness, the whole family hunkered down, hoping to get better over a couple weeks at home — not knowing it would mark the start of a months-long recovery, with none of the family members feeling back to normal even now, more than 10 weeks later. 

So far, at least 90,000 Canadians have been infected with COVID-19. In some cases, the illness leads to a stay in intensive care or even causes death, with roughly 7,000 people dying to date.  

But in most other instances, those suffering from less-severe forms do recover outside the health care system. What's growing clear, both patients and clinicians agree, is that some of those people wind up facing a long, rocky road to recovery.  

'Constant cycle' of new symptoms 

A few months back, as the little-understood virus was first spreading around the world, health officials initially described it as a respiratory illness, even weaving that piece into its official name: SARS-CoV-2, referring to "severe acute respiratory syndrome." 

Since then, evidence and patient stories have emerged suggesting it actually impacts various parts of the body.  

One recent study published in the Canadian Medical Association Journal, for instance, determined that changes to someone's ability to taste and smell are likely a common feature of infection — a symptom first noticed anecdotally by doctors around the world. 

Similarly, early notions of a roughly two-week recovery period for mild cases — outlined in a February review of preliminary Chinese data from the World Health Organization — have been questioned by people who say their less-severe illnesses are still taking weeks, if not months, to fully clear up. 

Pasma first realized her family wasn't alone after joining a COVID-19 support group called Body Politic on Slack, an online communication platform. The group now includes more than 4,000 people.   

There, she met other global COVID-19 sufferers who were also documenting weeks-long illnesses with a strange mix of symptoms. 

In Pasma's home, multiple family members wound up having gastrointestinal issues, such as nausea and diarrhea, while she experienced inflammation in between her lungs and chest wall. Then, weeks later, a chicken pox-like rash broke out on her stomach and upper thigh. 

"It just went on like that: A constant cycle of new symptoms developing," Pasma said. "One symptom would get better, and I'd start to feel optimistic I was through it. Then something new would set in — something totally random and strange."  

She isn't sure where she caught the illness, but said it may have been during one of two business trips to Toronto for her job as a researcher at the Canadian Union of Public Employees in the weeks before her symptoms started. 

Like many Canadians early in the pandemic, she wasn't told to get tested by her family physician, who instead encouraged to just stay at home. It wasn't until after her symptoms worsened, flaring up a previous bout of pneumonia, that she went to a local hospital and got tested.  

The test came back negative. Pasma believes that's because it came so late in her illness — not that she wasn't infected.  

"There seems to be zero follow up," she said. "I don't know if there would be more follow up if we were acknowledged cases." 

Pasma also worries both the media and medical community have painted COVID-19 as far too black and white. "You get better in two weeks, or you die," she said. "There's no talk at all about what happens to the people who do not get better in two weeks."

'People are going to go hungry': COVID-19 pandemic effects could leave 54 million Americans without food

Via The Guardian: 'People are going to go hungry': pandemic effects could leave 54m Americans without food. Excerpt:

A record number of Americans face hunger this year as the catastrophic economic fallout caused by the coronavirus pandemic looks set to leave tens of millions of people unable to buy enough food to feed their families. 

Nationwide, the demand for aid at food banks and pantries has soared since the virus forced the economy to be shutdown, resulting in more than 40m new unemployment benefit claims, according to the latest figures. 

As a result, an estimated one in four children, the equivalent of 18 million minors, could need food aid this year – a 63% increase compared to 2018.  

Overall, about 54 million people across the US could go hungry without help from food banks, food stamps and other aid, according to an analysis by Feeding America, the national food bank network.  

Credit: Feeding America 

America’s food insecurity crisis was dire even before the Covid-19 pandemic, when at least 37 million people lived in households without adequate resources to guarantee consistent access to enough food for an active, healthy life.

Food insecurity varies vastly from state to state, and county to county, and had only recently fallen to pre-Great Recession levels. The current crisis will almost certainly reverse hard-fought for improvements, and exacerbate existing inequalities.  

It’s the deep south where the economic impact and food insecurity will probably penetrate deepest: more than 11 million people in the states of Louisiana, Arkansas, Alabama, Mississippi, New Mexico, Texas and Tennessee are projected to suffer food insecurity in 2020. 

The projections assume a national annual unemployment rate of 11.5% – 7.6 percentage points higher than 2018 – and a national annual poverty rate of 16.6% – 4.8 points higher than 2018. 

In Mississippi, proportionately the worst-affected state before and since the pandemic, almost three-quarters of a million people could need food aid this year, including one in every three children. 

Features of COVID-19 post-infectious cytokine release syndrome in children presenting to the emergency department

Via The American Journal of Emergency Medicine: Features of COVID-19 post-infectious cytokine release syndrome in children presenting to the emergency department. The highlights and abstract:

Highlights 

• COVID-19 post-infectious cytokine release syndrome is a novel disease in children. 

• This syndrome has similar features as Kawasaki Disease and Toxic Shock Syndrome. 

• Features include prolonged fever, gastrointestinal symptoms with or without rash. 

• These patients decompensate quickly and require admission to monitor for stability 

Abstract 

The 2019 coronavirus disease (COVID-19) has not appeared to affect children as severely as adults. However, approximately 1 month after the COVID-19 peak in New York City in April 2020, cases of children with prolonged fevers abruptly developing inflammatory shock-like states have been reported in Western Europe and the United States. 

This case series describes four previously healthy children with COVID-19 infection confirmed by serologic antibody testing, but negative by nasopharyngeal RT-PCR swab, presenting to the Pediatric Emergency Department (PED) with prolonged fever (5 or more days) and abrupt onset of hemodynamic instability with elevated serologic inflammatory markers and cytokine levels (IL-6, IL-8 and TNF-α). 

Emergency physicians must maintain a high clinical suspicion for this COVID-19 associated post-infectious cytokine release syndrome, with features that overlap with Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS) in children with recent or current COVID-19 infection, as patients can decompensate quickly.

Eurosurveillance: No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020

Eurosurveillance has published No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. The abstract:

As many countries begin to lift some of the restrictions to contain COVID-19 spread, lack of evidence of transmission in the school setting remains. We examined Irish notifications of SARS-CoV2 in the school setting before school closures on 12 March 2020 and identified no paediatric transmission. This adds to current evidence that children do not appear to be drivers of transmission, and we argue that reopening schools should be considered safe accompanied by certain measures.

Rethinking the role of the school after COVID-19

Via The Lancet Public Health: Rethinking the role of the school after COVID-19.

Closure of schools and the psychological impact on children and adolescents' health, resulting from staying at home for several weeks with uncertain perspectives for the near future, is a crucial issue. The worst consequences of this temporary shutdown are experienced by the most vulnerable children who already rely on school for educational, nutritional, and health needs due to their socioeconomic disadvantages or disabilities. In addition to the possible lack of parental support at home, major inequalities arise in the access to digital learning resources.

With the aim of ensuring continuity, inclusion, and equity for all students, the UN Educational, Scientific and Cultural Organisation (UNESCO) has launched the Global Education Coalition, calling for coordinated and innovative actions to support students through remote learning and to guide the school reopening phase, thanks to the involvement of public and private stakeholders. 

The COVID-19 crisis highlights that school fulfils not only an educational mission of knowledge acquisition, but it also satisfies the socialisation needs of young people. With students at home, the school community is absent and despite the virtual interactions and learning opportunities provided by the internet and social networks, a barrier is created in the educational relationship between pupils and teachers. Moreover, children are missing a physical space in which to share interests, thoughts, hopes, and emotions among peers. School provides a structured setting in which children can learn and develop social competencies, such as self-confidence, friendship, empathy, participation, respect, gratitude, compassion, and responsibility. 

Social and emotional learning is important for young people to become conscious members of a solidarity-based community. Learning objectives can be achieved remotely (and evaluated to some extent), but the core mission of any school system also comprises the promotion of students' wellbeing, which is closely related to school performance. 

The COVID-19 crisis gives us the opportunity to re-assess what type of school we want for the future. Paakkari and Okan recently highlighted the need to improve health literacy. Teachers should act as health promoters for their students from a young age, by actively fostering healthy habits (physical activity, good personal hygiene, and balanced diet) and raising awareness of the consequences of risky behaviours. 

For a more inclusive and student-centred education, didactic methodologies, such as cooperative learning (based on student collaboration), should be used to convey health topics among students, to encourage personal reconstruction of knowledge, and to engage them with adopting healthy lifestyles. A wide range of participatory activities can be used, including debates, small working groups, authentic learning activities (concerning real-life situations), storytelling, role playing, educational games and simulations, audio and visual laboratories, or arts, music, theatre, and dance. 

Health literacy should be integrated into school curricula, either within scientific subjects or as extracurricular matter. Medical professionals, pedagogists, and psychologists could support teachers in this task. Moreover, educational interventions that aim to promote children's wellbeing in the school setting might also represent the most effective anti-bullying strategy and are expected to facilitate the scholastic pathway of children belonging to the most disadvantaged socioeconomic groups. 

The UNESCO Chair on Health Education and Sustainable Development strongly believes that education is health. Wellbeing promotion in the school setting, resulting from a process of meaningful and transformative learning, can represent the lever for a knowledge-based health culture, impacting not only the behaviours of students, but also those of their families and communities.

Singapore reports 642 new COVID-19 cases, taking total past 31,000

Via Channel NewsAsia: Singapore reports 642 new COVID-19 cases, taking total past 31,000.

SINGAPORE: Singapore reported 642 new COVID-19 cases as of noon on Saturday (May 23), taking the national total to 31,068. 

The vast majority of the new cases are foreign workers living in dormitories, the Ministry of Health (MOH) said in its preliminary daily update. Six are either Singaporeans or permanent residents. 

Further updates will be announced on Saturday night, the ministry said.  

On Friday, updates from the authorities showed eight patients in critical condition in the intensive care unit – the smallest number since the start of the “circuit breaker” period.  

This is also the first time that the number of COVID-19 patients in the ICU fell to a single digit since the circuit breaker started on Apr 7. 

Singapore will exit the circuit breaker as planned on Jun 1, with measures to be progressively lifted in three phases. 

Under the first phase of the lifting of measures, patients warded in hospitals will be allowed to have visitors again but only if they are from the same or one other household, MOH said on Friday.  

In addition, dental procedures such as scaling and polishing, fillings, crowns, dentures and orthodontic treatment will also be allowed to resume with appropriate precautions.  

As part of an initiative by Temasek Foundation in partnership with the Early Childhood Development Agency and the Ministry of Education, pre-school and primary school students will each be given a face shield and hand sanitisers as they prepare to head back to the classroom from Jun 2.

MMWR: High COVID-19 attack rate among attendees at events at a church — Arkansas, March 2020

MMWR has published High COVID-19 Attack Rate Among Attendees at Events at a Church — Arkansas, March 2020. The summary:

What is already known about this topic? 

Large gatherings pose a risk for SARS-CoV-2 transmission. 

What is added by this report?

Among 92 attendees at a rural Arkansas church during March 6–11, 35 (38%) developed laboratory-confirmed COVID-19, and three persons died. Highest attack rates were in persons aged 19–64 years (59%) and ≥65 years (50%). An additional 26 cases linked to the church occurred in the community, including one death.  

What are the implications for public health practice? 

Faith-based organizations should work with local health officials to determine how to implement the U.S. Government guidelines for modifying activities during the COVID-19 pandemic to prevent transmission of the virus to their members and their communities.

Filling in the blanks: National research needs to guide decisions about reopening schools in the US

An email from Johns Hopkins: New Report: Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US. Excerpt:

Today (Friday, May 15, 2020), the Center for Health Security at Johns Hopkins Bloomberg School of Public Health has released a new report calling for a national mandate to prioritize and fund research about children and COVID-19 so that governors, school districts, teachers, parents and guardians can make informed decisions about reopening schools in the US.     

According to the report, “Filling in the Blanks: National Research Needs to Guide Decisions about Reopening Schools in the US,” there is an urgent need to generate additional evidence to better assess the potential risks of students and teachers returning to school classrooms in the fall. While published studies to date indicate that children with COVID-19 are less likely to suffer severe illness than adults, there is only limited scientific evidence to gauge whether children with COVID-19 in school can transmit the virus to other children, teachers, school staff and family members.   

New research would help answer key questions including: 

• How vulnerable to severe illness are students who have underlying health conditions, such as asthma, diabetes, or severe obesity? 

• How safe is it for adults with serious underlying health conditions to send their children back to school without fear of those children bringing the virus home and infecting others in the family? 

• How safe is it for teachers, administrators, and other school staff, especially those who are medically vulnerable, to return to school and interact with students who may be asymptomatic but infectious? 

While some research relevant to these questions has begun, the authors say, the U.S. government (as well as other national governments, non-governmental organizations and philanthropies) should fund additional studies aimed at understanding the role of children in transmission of COVID-19. 

The report also includes a summary of other countries’ approaches to school reopenings. The authors recommend tracking these various efforts closely to monitor whether any result in increased community transmission, and whether successful approaches could be translated to the US education landscape.