Multicenter Interim Guidance on Use of Antivirals for Children With Coronavirus Disease 2019/Severe Acute Respiratory Syndrome Coronavirus 2.

BACKGROUND: Although coronavirus disease 2019 (COVID-19) is a mild infection in most children, a small proportion develop severe or critical illness. Data describing agents with potential antiviral activity continue to expand such that updated guidance is needed regarding use of these agents in children. METHODS: A panel of pediatric infectious diseases physicians and pharmacists from 20 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a set of guidance statements was developed and refined based on review of the best available evidence and expert opinion. RESULTS: Given the typically mild course of COVID-19 in children, supportive care alone is suggested for most cases. For children with severe illness, defined as a supplemental oxygen requirement without need for noninvasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO), remdesivir is suggested, preferably as part of a clinical trial if available. Remdesivir should also be considered for critically ill children requiring invasive or noninvasive mechanical ventilation or ECMO. A duration of 5 days is appropriate for most patients. The panel recommends against the use of hydroxychloroquine or lopinavir-ritonavir (or other protease inhibitors) for COVID-19 in children. CONCLUSIONS: Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For children with severe or critical disease, this guidance offers an approach for decision-making regarding use of remdesivir.

Injuries and injury risk factors among members of the United States Army Band.

BACKGROUND: This project documented injuries in the professional musical performers of the US Army Band and used a multivariate approach to determine injury risk factors. METHODS: Injuries were obtained from a medical surveillance database. Administrative records from the Band provided fitness test scores, physical characteristics, performing unit (Blues, Ceremonial, Chorale, Chorus, Concert, Strings), and functional group (strings, winds, keyboard, vocal, percussion, brass). A questionnaire completed by 95% of the Band (n=205) included queries on practice time, physical activity, tobacco use, and medical care. RESULTS: One or more injuries were diagnosed in 44 and 53% of Band members in the years 2004 and 2005, respectively. In univariate analysis, higher injury risk was associated with higher body mass index (BMI), less physical activity, prior injury, unit, functional group, and practice duration. In multivariate analysis, less self-rated physical activity, a prior injury, and functional group were independent risk factors. CONCLUSION: In the US Army Band, about half the performers had a medical visit for an injury in a 1-year period and injury risk was associated with identifiable factors.