The coronavirus disease 2019 (COVID-19) outbreak raises unique ethical dilemmas because it makes demands on society from all sectors of life, nationally and across the globe. Health professionals must deal with decisions about the allocation of scarce resources that can eventually cause moral distress and may affect one's mental health.Everybody must deal with restrictions on freedom of movement that have shut down whole economies in an attempt to flatten the epidemic curve. Moving forward, there will be questions of when and how it will all end? In due course, some will question the ethics behind the search for effective treatments and the development of vaccines in a time of uncertainty and distress. These sorts of predicamentsand the people that they effect-are very different. While the lasting implications of the pandemic are yet to become apparent, we here outline some of the potential lessons and address its ethical dilemmas.

Introduction.Emotional exhaustion is an important component of burnout. Burnout is common among doctors. It affects the physical and mental health of doctors, their performance and the quality of care they provide. This study aimed to investigate the level and factors associated with emotional exhaustion among doctors in pediatric practice in Malaysia. Population and methods. A self-administered questionnaire was used in this multicenter cross-sectional study. It included questions on the socio-demographics, work characteristics, Emotional Exhaustion, Perceived Stress Scale and sources of job stress. Descriptive, univariate and multivariate analysis were conducted using the SPSS software. Results. A total of 197 doctors working in the Pediatric department in eight hospitals returned complete questionnaire. High and moderate emotional exhaustion was reported by 25.4% and 24.4% doctors, respectively. In bivariate analysis, 29 out of the 38 items of sources of stress showed significant association with emotional exhaustion (p <0.05).The significant predictors of emotional exhaustion in the multivariate analysis were: scoring higher on the Perceived Stress Score, dealing with patient's psychosocial problems, disrespectful interactions with colleagues/ subordinates, lack of appreciation from supervisors, lack of incentives and promotions, time pressures and deadlines to meet, and setting unrealistic goals of having them imposed on oneself (p <0.05). The most common source of stress was dealing with difficult parents (80.2%). Conclusions. Emotional exhaustion is associated with sources of stress in the workplace but not with socio-demographic factors.

Objectives We describe the clinical and epidemiological characteristics of children with COVID-19 in the state of Negeri Sembilan, Malaysia in the setting of mandatory hospital isolation and quarantine for all confirmed cases. Methods A multicentre, retrospective observational study was performed among children aged 12 years and below with laboratory-proven COVID-19 between 1 February to 31 December 2020. Results A total of 261 children were included, 48.7% were males with a median age of 6 years (interquartile range, IQR: 3-10). 151 children (57.9%) were asymptomatic on presentation. Among those symptomatic, fever was the most common presenting symptom. 241 (92.3%) cases were close contacts of infected household or extended family members. 21 (8.4%) had abnormal radiological findings. All cases were discharged alive without requiring supplemental oxygen therapy or any specific treatment throughout hospitalisation. The median duration of hospitalisation was 7 days (IQR 6-10 days). One (2.1%) of the uninfected guardians accompanying the child in quarantine was tested positive for SARS-CoV-2 upon discharge. Conclusions COVID-19 in children was associated with mild symptoms and a good prognosis. Familial clustering was an important epidemiologic feature in the outbreak in Negeri Sembilan. Transmission risk of SARS-CoV-2 from children to guardians in hospital isolation was minimal despite close proximity.

Aim Households are a significant venue for the transmission of SARS‐CoV‐2. We conducted a study to characterise the transmission dynamics and identify risk factors for household transmission of SARS‐CoV‐2 in Negeri Sembilan, Malaysia. Methods This retrospective observational study included 185 families of paediatric COVID‐19 cases from 1 February 2020 to 31 December 2020. We identified the index case for each household and gathered the socio‐demographic, epidemiological investigation results and risk factors for household transmission from medical case records. The secondary attack rate was calculated, and logistic regression analyses were used to identify risk factors associated with secondary household transmission of SARS‐CoV‐2. Results Of the 848 household contacts, 466 acquired secondary infections, resulting in a secondary attack rate of 55%. The median age of the secondary cases was 12 years. Female household contacts and household contacts who slept in the same room with the index case were significantly associated with increased risk for COVID‐19. Other independent risk factors associated with higher transmission risk in the household included an index case who was symptomatic, a household index case aged greater than 18 years and a male household index case. Conclusions High rates of household transmission of COVID‐19 were found, indicating households were a major setting of transmission of SARS‐CoV‐2. Our data provide insight into the risk factors for household transmission of SARS‐CoV‐2 in Malaysia.

ObjectivesWe described the etiology of severe pneumonia in children during the height of the COVID-19 pandemic in Malaysia and compared the clinical features of severe SARS-CoV-2 to other respiratory viruses.MethodsThis retrospective study included all children aged 12 years and below hospitalized with severe pneumonia in Negeri Sembilan, Malaysia, between 1 April 2021 and 31 October 2021. We extracted demographic and clinical data and used logistic regression to examine risk factors associated with severe SARS-CoV-2 or other viral pneumonia.ResultsA total of 111 children were included. The median age was 15 months. Human rhinovirus/enterovirus, SARS-CoV-2 and respiratory syncytial virus were the most common etiology of severe pneumonia. Codetection of &gt;1 viral pathogen was present in 14 (12.6%) patients. Children with severe COVID-19 presented early in the course of illness and had lower rates of pediatric intensive care admission. The presence of sick contact with an adult was a predictor for SARS-CoV-2, whereas adventitious breath sounds were predictive of other respiratory viruses.ConclusionsThe etiology of severe pneumonia in children evolved with the epidemic curve of COVID-19 and school closures. Children with severe pneumonia due to SARS-CoV-2 experienced a milder clinical course when compared to other respiratory viruses.