Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Improved simulation of Indian summer monsoon in latest NCEP climate forecast system free run

Simulation of Indian summer monsoon features by latest coupled model of National Centers for Environmental Prediction (NCEPs) Climate Forecast System version 2 (CFSv2) is attempted in its long run. Improvements in the simulation of Indian summer monsoon as compared with previous version (CFSv1) is accessed and areas which still require considerable refinements are introduced. It is found that, spatial pattern of seasonal mean rainfall and wind circulations are more realistic in CFSv2 as compared with CFSv1. Variance and northward propagation of intraseasonal oscillation (ISO), which also contribute to the seasonal mean rainfall are remarkably improved. However, the central Indian dry bias still persists and amplified. Pervasive cold bias in surface (2m air temperature) as well as in the whole troposphere is further increased in CFSv2. These cold biases may be partly attributed to the lack of model's ability to realistically simulate the ratio of convective and stratiform rainfall. Sea-surface temperature (SST) over the Indian Ocean is underestimated in CFSv2. However, CFSv1 shows east-west dipole structure in the bias. The teleconnection of El Nino Southern Oscillation (ENSO) and Indian summer monsoon rainfall (ISMR) in terms of Niño3 SST and monsoon rainfall correlation is more realistic in the latest version of the model. Overall, there are substantial improvements in CFSv2 as compared with CFSv1, but it has to evolve further to realistically simulate the mean and variability of ISMR