Earlier this week, infectious disease expert Anthony Fauci, M.D., observed: “One interesting feature of this novel coronavirus pandemic is that very few children have become sick with COVID-19 compared to adults.” Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, made the statement while announcing a new national study into the incidence of novel coronavirus infection in U.S. children.
It isn’t always easy for parents to get answers to their questions about coronavirus and children, says Jonathan Fialkow, M.D., deputy medical director, chief of cardiology and a certified lipid specialist at Miami Cardiac & Vascular Institute.
“We’ve all been reading and hearing reports that increasing age appears to be the most significant risk factor towards a more symptomatic and more deadly course,” explains Dr. Fialkow. “While this is true, it might be perceived as COVID-19 only being risky for older people. Concerns as parents and grandparents for our children’s safety are often not met with information provided by news and other medical reports.”
To address that information gap, “Coronavirus and Kids” is the subject of the latest Baptist HealthTalk podcast, hosted by Dr. Fialkow, with guest Fernando Mendoza, M.D., chief of pediatrics and medical director of pediatric emergency, Baptist Hospital. You can access Baptist HealthTalk on your computer or smartphone, or via Apple Podcasts and Google Podcasts. Here are some Q&A highlights from their discussion about what parents need to know.
Dr. Fialkow: “Can kids get COVID-19? Is the coronavirus something that we should be aware of and concerned about with regards to children?”
“The short answer is yes. Kids can get coronavirus and kids have been getting coronavirus. I think the big differentiator here is that it does affect kids a bit differently and we’re not seeing the severity of disease over the past few months that we’ve seen with elder adults or even adults in general.”
Dr. Fialkow: “Are kids getting tested in any situations like adults would be?”
“In the pediatric emergency room, which is the most likely area where we’re going to test a kid, the kids are presenting. And when they have fever, they’re screened at a front triage area in most ERs, especially the Baptist pediatric ER, and we’re basically screening for fever. If fever or any kind of upper respiratory symptoms tend to be present, we’ll then further evaluate them for testing. Most of the time, the kids that get tested are going to come back negative. Actually, we have about a 95 percent negative test rate at Baptist Children’s emergency room, which is very consistent, and which is what’s happening around our community in the South Florida region … We think the kids are just maybe not as much in a carrier state or getting infected as frequently as adults, and that’s emerging research that we’re trying to really figure out still. We don’t know why that is but there’s some theories.”
Dr. Fialkow: “Is the COVID fear driving parents to bring their kids more early or more readily? Or kind of keeping them from coming in?”
“We’ve done a really good job as a community, as a healthcare system, and as community leaders in healthcare, to tell people, ‘Don’t go to the ER unless you’re really sick.’ We are seeing a lot of concern by parents of not going to the ER because they think that we’re kind of overwhelmed by COVID, which is not the case actually … The question on everybody’s mind for the past couple of months is: ‘Is this COVID?’ What we have to remember is that kids get fevers often and that’s pretty much a number one presenting complaint when it comes to the emergency room — is a pediatric fever. Just because you have a fever doesn’t mean you have COVID. But just because you don’t have COVID, it doesn’t mean you don’t have something else. So, we have to kind of weigh both the situations there. We have a lot of parents are concerned, but we also have a lot of parents who are being very wary of seeking medical care right now.”
Dr. Fialkow: “When would you say, ‘You know what? Take them to the emergency room. We’ve got to get them checked out’ versus calling your pediatrician or using a Care On Demand app. What would be the symptoms you would look out for?”
“Unfortunately, they’re not that different from other respiratory and fever illnesses that kids get. That’s the quandary and that’s what we’ve been seeing with COVID. Typically, the number one sign is fever; a close number two is cough or shortness of breath. Well, that’s not very different from influenza or an asthma attack or pneumonia. So it’s not that much of a differentiator. We can’t say there’s one symptom where we’re seeing that, ‘Man, that really means your kid has COVID.’… Now, Care On Demand from Baptist Health is a really good way of getting an initial screening. But sometimes you have to have a physician listen to the lungs, you might need an X-ray, and you might need testing. So that’s where you can go — or to your pediatrician where they have sick visits usually in the afternoons. Most pediatricians, locally at least, are blocking off mornings for well-childcare. So all the babies get their vaccinations in the morning, and then all the sick visits come in the afternoon. That’s what they’ve been doing recently. Or the ER, which we’re always set up for that kind of stuff.”
Dr. Fialkow: “Have you had to admit any children with COVID-19 to Baptist Hospital?”
“Every single patient that we’ve had test positive at Baptist Children’s Hospital has been discharged home, and basically nobody’s been needed to be admitted or intubated or have a severe respiratory illness …The bottom line is: we haven’t had very serious respiratory illnesses in kids needing intubation. That’s actually been kind of the trend across the region. I have colleagues at the local pediatric emergency rooms all throughout Miami-Dade and Broward County, and we’ve all been seeing the same thing. Not a lot of patients that are needing a lot of acute care in terms of admission for COVID.”
Dr. Fialkow: “Should kids wear masks if they go out of the house?”
“Yes. Yes, they should. That recommendation applies to kids over the age of two. Under the age of two, number one, it’d be pretty hard to get a toddler to keep a mask on. But number two, there’s some concern about choking and the ability to breathe … Remember, masks are there so that we don’t transmit to somebody else who may be near us. Where you can’t have appropriate social distancing, masks are definitely in order for kids also.”
Dr. Fialkow: “People may have a tendency to hyper focus on COVID-19, the pandemic, and ignore other things that they normally should be paying attention to. Any particular things that you want parents to keep in mind even though it might not be specifically related to the coronavirus?”
“That’s a great point. I think one of the things we’re starting to see a little bit more of, a little earlier than usual, are actually submersion or drownings in the ER … And it’s been very tragic. We’ve seen a couple of these already that are a little bit of an uptick compared to last year. Having pools at home, kids are going to wander and you want to really be very, very careful with your water safety, with pool safety, having alarms on those sliding doors, or French doors in the backyard, to make sure you know when a kid goes out. Keeping that pool fence up is, even though toddlers can get pretty creative, will help deter, not always prevent, but deter … And then poisonings. Keep an eye out for where you have those poisonous items. One of those things that’s really always very tragic is the detergent pods.”
“We alluded to it a little bit at the beginning; if your child is ill, please don’t ignore it and stay at home because you’re afraid of contamination. Can you talk a little bit about what’s been done at the facilities to prevent that cross contamination?”
“Patient safety has always been number one. I do want to emphasize that if your child does have a true emergency, whether it’s an asthma attack, belly pain, it could be appendicitis, any kind of injury, things that need to be seen by a doctor, I want parents to not be afraid that walking into a hospital there’s going to be COVID on the walls and in the air and everywhere. It’s not like that.
“Actually, we do have areas where we partition or we put a patient that we think are COVID-suspected, there’s areas they get screened at. So, we have very safe areas, especially for kids, and, again, most of our kids don’t have COVID. Everybody when they walk in now gets a mask, every practitioner or provider, every employee has a mask. Hand washing is the utmost importance with a great amount of hygiene and disinfection that goes on in the facility.”
Dr. Fialkow: “Anything you want to add?”
“Pediatric ER visits and pediatrician visits have plummeted. We’re worried that parents aren’t getting their routine vaccines with their pediatricians. And that could — down the line, six, eight months, a year from now — could really result in a bump in vaccine-preventable diseases. If I had one thing to tell parents, it’s make sure that, especially your young kids, keep them on that vaccination schedule. The last thing you want, should your kid get COVID, which obviously is very, very unlikely, it’s going to happen anyway, is to have influenza along with that, or pertussis or measles or something else that’s catastrophic. So, it’s really important to stay up with those vaccines with your pediatrician on those vaccine-preventable diseases.”
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