Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network-the Paediatric Tuberculosis Network European Trials Group (ptbnet)-that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5•0 years (IQR 0•5-12•0) and a sex ratio of 1•15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2-11, range 1-34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5•06, 95% CI 1•72-14•87; p=0•0035), male sex (2•12, 1•06-4•21; p=0•033), pre-existing medical conditions (3•27, 1•67-6•42; p=0•0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10•46, 5•16-21•23; p<0•0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir-ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0•69%, 95% CI 0•20-1•82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs...

Situation Report-65 HIGHLIGHTS • Two new countries/territories/areas from the Western Pacific Region [1], and Eastern Mediterranean Region [1] have reported cases of COVID-19. • OpenWHO released its introductory video on COVID-19 in Indian sign language yesterday, which is the first sign language resource on the platform. The video already has nearly 900 enrolments. Courses in additional languages can be found here. Western Pacific Region 97 766 confirmed (1186) 3518 deaths (16) European Region 220 516 confirmed (25 007) 11 986 deaths (1797) SouthEast Asia Region 2344 confirmed (354) 72 deaths (7) Eastern Mediterranean Region 29 631 confirmed (2416) 2008 deaths (131) Region of the Americas 60 834 confirmed (11 390) 813 deaths (248) African Region 1664 confirmed (359) 29 deaths (3)

A recent large cohort of 1733 patients from Wuhan found persistent symptoms in 76% of patients 6 months after initial diagnosis. 2 To date, data on Long COVID in children are scarce, with the exception of an earlier description of five children with Long COVID in Sweden. 3 We assessed persistent symptoms in paediatric patients previously diagnosed with COVID-19. | ME THODSThis cross-sectional study included all children ≤18 year old diagnosed with microbiologically confirmed (PCR analysis on nasopharyngeal swab) COVID-19 (through a nasopharyngeal swab from March 2020 to October 2020) in Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy). Only children with a SARS-CoV-2 infection diagnosed 30 days before the assessment were included.Patients >18 years old or with severe neurocognitive disability were excluded, since this would have not allowed a proper assessment of signs and symptoms included in the survey. Caregivers were interviewed about their child's health using a questionnaire (Appendix S1) developed by the Long COVID ISARIC study group, 4 for evaluation of persisting symptoms. Participants were interviewed by two paediatricians, either by phone or in the outpatient department, from 1 September 2020 to 1 January 2021. For those assessed in the outpatient settings, the same survey was used and symptoms reported were collected even if not present at the moment of the visit (eg tachycardia). Also, investigations were not performed at the moment of the assessment, in order to rule-out other causes, although the survey has a section to ask whether other possible causes have been detected in the meantime. Participants were categorised into groups according to symptoms status during the acute phase (symptomatic/ asymptomatic), need for hospitalisation and time from COVID-19 diagnosis to follow-up evaluation (<60, 60-120, >120 days). Numerical variables were compared using t test or ANOVA and categorical variables with chi-square or Fisher's exact test where appropriate.All analyses were performed using R version 4.0.3 (R Foundation).