Parents want answers they can trust
What is COVID-19?
COVID-19 refers to disease (coronavirus disease 2019) that has gripped the world in a global pandemic in recent weeks and months. Coronaviruses are not new. They are one of the many viruses that cause common colds and other respiratory illnesses.
This novel (new) strain of coronavirus is much more severe. It has the potential to cause respiratory compromise requiring hospitalization and even death. It was first discovered last December in Wuhan, China, and has spread through Asia, Europe, and parts of Africa. It began to affect our country in the middle of February. To date, all 50 states have reported over 140,000 cases and over 2,000 deaths.
How is the disease spread?
COVID-19 is predominantly spread, through respiratory droplets. Human to human transmission occurs when someone coughs, sneezes, or even talks or laughs in the same vicinity as someone else.
In addition, the virus can live on hard surfaces for hours to days, depending on the surface type.This allows for transmission to occur when one person touches the same object that another person with the disease has coughed on or touched. This contaminated object could be doorknobs, elevator buttons, door handles, grocery carts, and especially our cell phones.
What are the symptoms of COVID-19?
At the beginning of the illness of COVD-19, symptoms are very similar to a common cold or seasonal flu. Patients can present with coughing, fever, body aches, and increased work of breathing. Pediatric patients are a bit of a mystery in some ways, as they do not always present with fever. These particular symptoms can be seen in dozens of other viruses, affecting the pediatric population such as RSV, rhinovirus, and adenovirus.
How can we prevent COVID-19?
While it sounds simplistic, frequent handwashing is the most important measure one can actively do to avoid the virus. Washing your hands for 20 seconds with soap and water can prevent the spread of the illness. The use of hand sanitizers with at least 60% ethyl alcohol is an acceptable alternative when soap and water are not readily available. We demonstrate the correct way to wash your hands in this video:
Resisting the urge to touch your face is key. The virus is spread when you touch a contaminated surface and later touch your eyes, nose, or mouth. It is also important to teach proper handwashing to children as well as “cough etiquette,” i.e., coughing into one’s elbow instead of his/her open palm.
It is also important to adjust the way we greet people. For now, at least we should do away with handshaking and employ elbow and fist bumps. Kids generally feel fist bumps are “cool” so they should have no problems adjusting.
Finally, cleaning grocery carts, personal work areas, keyboards, your devices like cell phones and tablets, and any hard surfaces you frequently touch with disinfectant wipes or alcohol swabs can help prevent virus spread. The same can be said for your child’s toys.
What treatment options are there for COVID-19?
While our infectious disease specialists and virologists are working hard to identify different therapies for this disease, there currently are no proven medications. There is no effective medical treatment or vaccines available to prevent COVID-19.
Treatment is generally supportive with fluids and rest. Unfortunately, more severe cases are treated in specialized hospital units with mechanical ventilation. The disease literally attacks the lungs so relentlessly that these patients find it difficult to breathe on their own. Without assistance from these mechanical ventilators, patients can have disastrous outcomes due to respiratory failure.
Are children immune from COVID-19?
The one silver lining that can be taken from the COVID-19 pandemic is that the pediatric population does not appear to be as severely affected as other segments of the population. This was not seen in previous pandemics like H1N1 flu (also known as swine flu). Typically, children present with cough, sore throat, and may have a fever. Generally speaking, they make full recoveries.
Several theories, as to why have been put forth including different cell receptors in the lungs of children and younger immune systems being more robust than that of the elderly. The honest truth is we do not know. The virus is new, and science is catching up.
It has been widely accepted that those with underlying chronic conditions and those over the age of 60 are more at risk for severe outcomes. Hence, children with significant histories of chronic conditions like asthma, heart disease, or diabetes could also be at risk. Very young infants under one year of age could also be vulnerable. In the newborn population, the signs of COVID-19 would be similar to other serious infections. These would include coughing, consistently fast breathing, excessive fussiness, and possibly fever (temperature of 100.4 or higher). All of these symptoms during the newborn period would require urgent evaluation, preferably in a facility specializing in pediatrics.
Still, in medicine, there are no absolutes. We have seen young adults in their 20s, 30s, and 40s have poor outcomes with COVID-19. Finally, as of the writing of this piece, an infant in Chicago has died after testing positive for coronavirus.
Are pregnant women more at risk?
Information is still fairly new, but again unlike H1N1 and even routine seasonal influenza, where pregnant women appeared vulnerable to horrible outcomes. Data from China and other countries that have been affected previously suggest that pregnant women are no more at risk for severe illness from COVID-19 than those in the general population. Breastfeeding can provide many health benefits. It can strenghten an infant’s immune system in general due to the secretory antibodies that can be passed along through breast milk.
For more information on Covid-19 in pregnancy check out this article by my colleague at Macarthur Medical Center.
Should I bring my children in for routine wellness visits?
Health maintenance visits are important during the first few years of life. Children’s immune systems are generally weaker in infancy. Because of this, children are at risk of severe infections caused by multiple classes of bacteria and viruses that can cause blood infections, brain infections, deafness, blindness, cognitive delays, and even death itself.
Also, identifying children at risk for developmental delays is another important reason for having well check-up appointments. The American Academy of Pediatrics has recommended younger children continue to receive wellness visits even during this time of social distancing, while postponing well check-up appointments for kids in middle childhood (ages 5 and up).
When should I call or bring my child in to make sure he/she does not have COVID-19?
The symptoms of COVID-19 and other viruses are quite similar. The recommendations for evaluation are also comparable. Children older than 3 months of age with cough and fever lasting more than 24 hours require at least a phone call to the pediatrician or primary care provider to gather information and see if further assessment in the office is necessary.
Children younger than three months of age with a cough and a temperature of 100.4 or higher should be seen urgently due to their age. If fever is not present in this age range, parents can breathe easier, but keep their child’s pediatrician or primary provider inform at least via phone.
Parents of children with underlying health issues should certainly be more conservative about reaching out to their child’s physician or advanced practice provider if respiratory symptoms emerge.
It is important to avoid going to the ER during the pandemic without first notifying your provider.
Can my child be tested for COVID-19?
This is the million dollar question. The answer changes daily and varies according to geographic location, even within North Texas.
As of today, there is very limited availability of the COVID-19 test. There are drive-through sites that can administer the test. One is located in the American Airlines Center, and there are others scattered throughout Dallas County. Children’s Medical Center also has limited tests available.
Shifting guidelines determine who is eligible to be tested. The list includes whether the patient has fever, cough, and shortness of breath. Patients generally need to satisfy each symptom on the list to be tested. MacArthur Medical Center currently does not have the COVID-19 test due to the nationwide limited availability, but we hope to have it in the future.
Again, though COVID-19 symptoms are similar to seasonal flu and other illnesses which can be tested by MacArthur Pediatrics including strep throat and RSV.
Is it safe to bring my child in to be evaluated?
MacArthur Medical Center has taken painstaking steps to ensure that a safe medical home is maintained for all of our patients. Recommendations from the Center for Disease Control have been followed diligently.
We take temperatures and interview all of our employees — including providers — daily for any possible respiratory symptoms. All visitors are pre-screened before entry to the complex, whether they are patients, delivery personnel, or sales representatives. We minimize office traffic by allowing only one caregiver to accompany each pediatric patient. We also have allocated morning appointments for well visits and sick visits in the afternoon.
We are also employing telemedicine to maintain social distancing by using technology to treat patients with rashes and less severe problems via phone and/or electronic media.
Moreover, the office is deep cleaned every evening to prevent infection from counters, chairs, reception, nursing stations, and other hard surfaces.
Photo by Perry Grone on Unsplash
Will we get through this?
Absolutely. West Nile, SARS, MERS, H1N1, Zika, and even Ebola. Viruses have impacted the United States as a whole and North Texas, specifically in the last 20 years. Yet, we have vanquished them from our great country one by one.
We have no doubt suffered some losses, but in the end, we emerged stronger and more advanced in our medical knowledge and understanding. We will do the same with COVID-19.
We need to buy our hospital systems, healthcare providers, scientists, and researcher’s time by “flattening the curve.” Practice social distancing, heed stay-at-home orders, and isolate yourself and members of your family if you or they feel ill.
By working together and focusing on our common goal of surviving this pandemic, we can tough this out until the number of cases eventually start to decrease nationally, and the world returns to normalcy. Until then, for the sake of our children and those close to us, remain vigilant.
Blog Author: Agboola O. Fatiregun, MD, FAAP