Primary care coronavirus disease 2019 (COVID-19) clinics were rapidly introduced across the UK to review potentially infectious patients. Evaluation of these services is needed to guide future implementation. This mixed-methods study evaluates patient demographics, clinical presentation, co-morbidities, service usage, and outcomes for the Islington COVID-19 service (London, UK) and from April to May 2020 and thematically analyses survey responses from 29 service clinicians and 41 GP referrers on their service experience. Of the 237 patients booked into the service, a significant number of referrals (n = 91; 38.6%) were made after the presumed infectious period of 14 days. Almost half of all adult referrals (49%) were dealt with remotely (via telephone/video consultation +/− remote oxygen saturation monitoring). The service was perceived to provide a safe way to see patients; it developed local expertise, learning, and empowerment; and it was a positive teamworking experience. These findings suggest that the management of many patients with COVID-19 symptoms is possible in routine general practice with minimal risk through the implementation of remote consultation methods and in patients who present after the post-infectious period. Additionally, the use of remote saturation monitoring and local GP COVID-19 “experts” can support practices to manage COVID-19 patients. Future primary care COVID-19 services should act as empowerment tools to assist GPs to safely manage their own patients and provide support for GPs in this process.

Children are unlikely to get sick, need hospitalisation, or die from COVID-19. 1 This is a demonstrable fact that has been well known since the very first data sets to come out of China. 2 Infrequently is data so clear cut. Medicine and disease, however, are rarely so simple. Schools reopening combined with the approaching winter viral season will inevitably lead to an increase in paediatric infections. In the current climate new barriers to health care, namely fear of COVID-19 and the lack of easily accessible face-to-face GP appointments, are likely to result in late presentations with non-COVID-19 illnesses and increased harm. We need to start planning to prevent this. FEAR OF THE VIRUS The media and, to a certain extent, the medical profession have increased anxiety both among parents and GPs about the dangers of COVID-19 in children. The media's publication 3 of a very small number of children developing PIMS-TS, a multisystem inflammatory disorder similar to Kawasaki disease, 4 has caused understandable anxiety among parents. Similarly the relentless focus on concerns about opening schools has led some parents to conclude it is not safe, resulting in poor attendance. 5 During previous viral outbreaks, such as the H1N1 scare, evidence showed that presentations to medical services went up when the initial 'fear' was publicised. 6 During this pandemic, however, the opposite has happened. A&E attendances in the UK have significantly reduced; by 33% in June 2020 compared to the previous year. 7 The climate of fear has had severe consequences. A group of increased deaths and significant harm were reported in North London recently, many of these caused by a delayed presentation to hospital. 8

IntroductionResearch into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation.MethodsSingle centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital.ResultsSix patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients.InterpretationThe results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.

histological inflammatory response and scored according to the Amniotic Fluid Infection Nosology Committee of Perinatal Section, the Society for Pediatric Pathology, and reported by Redline et al. in 2003. Results Chorioamnionitis was seen in 42/101(41.6%) placentae and this occurred significantly more often in newborn babies with probable or proven EONS (p < 0.05). No features of chorioamnionitis were seen in 51/61(83.6%) of newborn babies with suspected EONS (p<0.05). Conclusions Histological examination of the placenta for acute chorioamnionitis has statistically significant correlation with probable and proven EONS and can be a potential tool to guide clinical decision-making and thereby antibiotic use if report is made available within 24 hours as in frozen section study.

No abstract