COVID-19 Scan for Aug 18, 2020

Poor COVID-19 website readability
COVID inflammatory syndrome in kids

Reading levels of US, global COVID-19 websites too high for many

A review of 18 US and international public health and governmental websites with COVID-19 information for the public—including those of the World Health Organization and the US Centers for Disease Control and Prevention (CDC)—has found that all exceeded the recommended reading level and used sentence structures and technical terminology that would hinder understanding.

The review, published today in JAMA Network Open, used five common readability formulas and health readability guidelines to evaluate the websites of three public health agencies and 15 official governmental sites of countries with English-language guidelines and at least 5,000 confirmed coronavirus cases as of Apr 5.

The American Medical Association, the National Institutes of Health, and the CDC recommend that public health information be written at an eighth-grade reading level or lower.

All 149 web pages evaluated were written at levels above the eighth grade by at least one metric, and 141 (95%) were written above that level by all five metrics. Of the 149 pages, 145 (97%) used sentence structures too complex to be understood by eighth-grade readers.

Of the CDC pages reviewed, the median Flesh-Kincaid grade level was 11, median syllables per word were 1.7, median words per sentence were 15.6, and 67 pages contained at least one difficult-to-understand term (median number of difficult terms, 11).

All US states' websites evaluated were written above the eighth-grade level and used substantially more difficult terms than those of the CDC. Nine of the 10 states with the highest illiteracy rates had information exceeding a 10th-grade reading level.

The authors said that CDC resources' lower level of complexity may reflect the influence of governmental oversight mandating that public information be easily understood.

"Nonadherence to readability standards may have a greater influence in communities with lower health literacy, potentially exacerbating the disparate effects of the pandemic," the researchers wrote. "As such, efforts should focus on the urgent development of plain-language COVID-19 resources that conform to established guidelines for clear communication and are more accessible to all audiences."
Aug 18 JAMA Netw Open research letter


Study: COVID-19 inflammatory syndrome in kids not Kawasaki disease

The multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 appears to be an abnormal immune response to the novel coronavirus, similar to but distinct from Kawasaki disease, according to a research letter published today in Nature Medicine.

Led by researchers at King's College London, the study evaluated the clinical characteristics and immune profiles of 25 UK children hospitalized for MIS-C from Apr 27 to May 25.

Seventeen of 25 children (68%) had antibodies against SARS-CoV-2, the virus that causes COVID-19, in their serum, suggesting previous coronavirus infection; they also had more severe illness than those without detectable antibodies. Of the 8 children without coronavirus antibodies, 6 had previous symptoms characteristic of COVID-19, infected household contacts, or parents who were healthcare workers or had attended a large gathering.

Children in the acute phase of MIS-C illness had elevated levels of interleukins, interferon-gamma, and lymphocytes, indicating inflammation and immune responses.

Eighteen of 25 children (72%) had gastrointestinal symptoms, 7 (28%) had pneumonia, 14 (56%) needed infusions of drugs to regulate blood pressure, and 7 (28%) had enlarged or weakened coronary arteries. Median age was 12.5 years.

Children in this cohort had few commonalities with those with Kawasaki disease, who are usually much younger (1 to 3 years) and don't often have the gastrointestinal symptoms or heart muscle dysfunction seen in children with coronavirus antibodies. Also, children with MIS-C had different immune profiles than those typically seen in Kawasaki disease.

"Based on our cohort characteristics and the immune cell changes we observed, MIS-C is likely to be a distinct immunopathogenic illness associated with SARS-CoV-2, with more severe illness in seropositive children," the authors wrote. "The mechanisms underpinning these immune abnormalities are of priority for further research."
Aug 18 Nature Med research letter

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