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The COVID-19 pandemic caused by SARS-COV-2 virus fortunately resulted in few children suffering from severe disease. However, the collateral effects on the COVID-19 pandemic appear to have had significant detrimental effects on children affected and young people. There are also some positive impacts in the form of reduced prevalence of viral bronchiolitis. The new strain of SARS-COV-2 identified recently in the UK appears to have increased transmissibility to children. However, there are no large vaccine trials set up in children to evaluate safety and efficacy. In this short communication, we review the collateral effects of COVID-19 pandemic in children and young people. We highlight the need for urgent strategies to mitigate the risks to children due to the COVID-19 pandemic.What is Known:• Children and young people account for <2% of all COVID-19 hospital admissions• The collateral impact of COVID-19 pandemic on children and young people is devastating• Significant reduction in influenza and respiratory syncytial virus (RSV) infection in the southern hemisphereWhat is New:• The public health measures to reduce COVID-19 infection may have also resulted in near elimination of influenza and RSV infections across the globe• A COVID-19 vaccine has been licensed for adults. However, large scale vaccine studies are yet to be initiated although there is emerging evidence of the new SARS-COV-2 strain spreading more rapidly though young people.• Children and young people continue to bear the collateral effects of COVID-19 pandemic

BackgroundThe SARS-Cov2 pandemic impacts postgraduate medical training in all specialties, including paediatrics. However, those advised to ‘shield’ or stringently socially distance have been particularly affected personally and professionally. Despite the emerging situation, trainee voices must be heard to provide valuable contributions to local and national processes affecting them.ObjectivesWe describe the model used and outcomes from the Supported Return to Training programme (SuppoRTT) Shielding Trainee Advisory Group (S-STAG) in collaboration with Health Education England (HEE) to design and implement pathways and resources for these trainees.MethodsLed by HEE fellows, the group was recruited from varied specialties, providing broad representation of community and hospital-based, medical and craft specialties, including paediatrics. The group met virtually fortnightly during the first wave of the pandemic. Collaborative work was completed using shared documents online.Trainee challenges and experiences raised within the group and via wider trainee networks allowed a targeted approach to providing resources and guidance. Good practice from different regions, Royal College guidance and advocacy of displaced trainees was shared across multiple platforms.Results272 live attendees of four webinar episodes represented all HEE regions and Northern Ireland. 96% found the series ‘useful’ with 86% rating the psychological support sessions as ‘useful’ or ‘very useful’. Recorded sessions continue to be viewed.ResourcesA pathway was designed to help trainees and supervisors navigate their new circumstances and identify learning contributing to training progression despite significant changes to clinical roles. We designed a nationally available toolkit, freely available via the national/regional HEE SuppoRTT websites including: suggested activities, resource signposting, peer-support models, trainers guidance and advice on returning to face-to-face working.Four recorded webinars were delivered with country-wide involvement of professionals including a clinical psychologist, exploring the impact of shielding on identity and purpose. Bringing people experiencing similar challenges together developed support and a framework to understand the emotional impact of shielding and negotiate the challenges of abrupt changes. Peer-support groups were set up in many regions.Collaboration continues to inform further guidance as the situation evolves.Information DisseminationStrong connections developed with SuppoRTT Regional offices and HEE national communication teams assisted in identifying, receiving feedback from and disseminating information to affected trainees whilst maintaining confidentiality. Utilising social media, formal publication in journals and digital media facilitated rapid dissemination of resources.ChallengesThe pandemic presents unique challenges: Trainee occupational health is provided by the employer, not HEE or a training body, resulting in potential disconnect and lack of institutional awareness. Each trainee has individual circumstances requiring a bespoke approach. Formal national guidance and resources were not immediately available, constantly changing case rates in different geographies impaired making guidance universally available and appropriate. S-STAG is aware that for some, these resources were not prompt enough, despite best efforts. In future, these resources could be adapted and earlier advocacy initiated.ConclusionsOur group has successfully demonstrated a collaborative approach between trainees from a broad range of specialties and educational leaders with an interest in welfare and trainee support, working in a rapidly changing environment to produce a range of relevant resources.

ObjectiveExamine admissions for bronchiolitis, comparing centres with oxygen saturation thresholds for admission of 90% versus 92%.DesignProspective multi-centre service evaluation, all admissions for bronchiolitis during 4-week period, November 2018.SettingPaediatric departments across 12 hospitals in the West Midlands, UK.Patients320 patients aged 6 weeks–1 year, diagnosis of bronchiolitis, exclusions: chronic illness or high dependency/intensive care admission.Main outcome measuresReason for admission, admission saturations and length of stay.ResultsInadequate feeding was the the most common reason for admission (80%). Only 20 patients were admitted solely because of low saturations. Median peripheral oxygen saturation in this group was 88%. Median length of stay in 90% centres was 41 hours, against 59 hours for 92% centres (p=0.0074).ConclusionsFew patients were admitted solely due to low oxygen saturations, only one had a potentially avoidable admission if thresholds were 90%. Length of stay was significantly reduced in the 90% threshold centres.