COVID: Schools & Age-Related Morbidity and Mortality

JF Ludvigsson et al NEJM 2021; 384: 669-671. Full text: Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden In this letter to the editor, the authors report on outcomes in Sweden, which kept schools open during the pandemic; time period: from March 1-June 30, 2020 (schools end around June 10th). Key findings:

  • Among 1-16 years of age (~1.95 million in total), 15 required ICU admission; there were no deaths in this age group
  • “Fewer than 10 pre-school teachers [1-6 years] and 20 schoolteachers received ICU care up to June 30, 2020.” Excluding health care workers, the occupational risk was similar to other occupations, with relative risk of 1.10 (0.49-2.49, 95% CI) and 0.43 (0.28-0.68, 95% CI) for preschool and school teachers respectively.

My take: This study suggests that school teachers are at similar risk for COVID-19 infection as other essential workers. In Sweden, during this timeframe, distancing but not masking was recommended. Thus, transmission rates could be lowered further.

Related article: SR Kadire et al. NEJM 2021; 384: DOI: 10.1056/NEJMclde2101987. Full text: Delayed Second Dose versus Standard Regimen for Covid-19 Vaccination This article provides rationale for both vaccine options.

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Does Gastrostomy Tube Placement Lower Rates of Hospitalization?

Yes. But maybe for the reasons one might expect.

In this retrospective study from Australia (P Jacoby et al J Pediatr 2020; 217: 131-8.), the authors analyzed two cohorts with total of 673 children with disabilities who had undergone gastrostomy tube (GT) placement.

Key findings:

  • All-cause hospitalizations declined at 5 years after procedure with combined (both cohorts) incidence rate ratio of 0.63
  • Admissions for lower respiratory tract infections did not change appreciably
  • Admissions for epilepsy were generally decreased (see Table V) –this drop is mainly what accounts for the lower hospitalization rates.
  • Fundoplication (which occurred in ~30% with GT insertion) “seemed to decrease the relative incidence of acute LRTI admissions in the combined cohort”
  • The specific numbers for hospitalizations are listed in Table V.

In their discussion, the authors noted that in the year prior to GT placement, there had been an elevated number of hospitalizations.  With regard to fundoplication, the authors note uncertain benefit for respiratory complications.  In previous studies of neonates and children with neurologic impairment and GT placement, there was similar gastrointestinal and respiratory related admissions with or without fundoplication.

My take: GT placement facilitates care for children with disabilities including provision of medication and nutrition.  This study confirms subsequent improvement in hospitalization rates but does not show a clear benefit with regard to respiratory infections.

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Do Anti-TNF Agents Reduce Surgeries and Hospitalizations?

Briefly noted:

A recent study (http://dx.doi.org/10.1136/gutjnl-2019-318440; SK Murthy et al. BMJ indicates that anti-TNF therapy has not been effective in significantly lowering CD-related hospitalizations or surgeries.

Full Text Link (from Eric Benchimol twitter feed): Introduction of anti-TNF therapy has not yielded expected declines in hospitalisation and intestinal resection rates in inflammatory bowel diseases: a population-based interrupted time series study)

My take: While big changes in the frequency of these outcomes were not demonstrated in this large study, prior studies, including the RISK study, have shown that anti-TNF therapy can be disease-modifying and reduce the risk of penetrating disease in Crohn’s disease.

Related blog post: CCFA Updates in IBD