Transcription:
COVID-19 and Children

This Dignity Health podcast on COVID-19 recorded on July 2nd, 2020.

This is Hello Healthy, a Dignity Health Podcast. Here's Bill Klaproth

Bill Klaproth: So what are the effects of COVID-19 on children and what is systemic inflammatory syndrome that has parents around the country very worried. So let's find out what Dr. Stan Calderwood a pediatrician and pediatric hematologist oncologist at Dignity Health. Dr. Calderwood thank you so much for your time. Great to talk with you. So how does COVID-19 present in children?

Dr. Stan Calderwood: Well, usually children who get COVID-19 infection will have either no symptoms at all, or will have very minimal symptoms that might include a runny nose or a mild sore throat. They might get an upset tummy or some vomiting and diarrhea. The symptoms usually get better on their own within several days. Children usually recover spontaneously and don't need anything other than supportive care, like Tylenol for fever or pain and, plenty of clear fluids.

Host: So you said the children generally get better on their own. If the COVID infection in children gets serious, what could happen then?

Dr. Calderwood: Well, some children will develop a viral pneumonia. So the, the virus moves from the upper airway where it causes cold and flu like symptoms down into the lower airway or the lungs where it can cause an inflammatory response that kids might experience some shortness of breath and coughing or chest pain. Those kids, especially if they become more severely ill may require are some additional treatments like dexamethasone for the inflammation, oxygen support, new antiviral medications that are becoming available. And sometimes in rare cases may need admission to intensive care unit for intubation and for airway support. But fortunately the data from the CDC currently are suggesting that that's a really, really rare thing in children.

Host: So if a child is home sick, at what point should a parent bring their child in to see the doctor.

Dr. Calderwood: So typically you'd want to bring your child to the doctor If they have a fever that persists for longer than two or three days, if at any point they appear to be having trouble breathing or working really hard or struggling to breathe, they have a severe cough. If they have any tiredness or lethargy, any color change where they look pale or cyanotic, or if they're having bad GI symptoms like vomiting and that can't keep down any liquids or diarrhea and they look like they're getting dehydrated. Those are all reasons that you would want to bring your child to the doctor for immediate attention.

Host: So on the news, we have been seeing around the country, kids suffering from systemic inflammatory syndrome due to COVID-19. This has a lot of parents worried. Can you explain to us what this is?

Dr. Calderwood: Yeah. So the systemic inflammatory response syndrome, called SERS for short, and it has a number of other names as well, like multi-system inflammatory syndrome or macrophage activating syndrome. They key feature for those illnesses is persistent high-grade fever in a child who really looks unwell. They're tired and lethargic. They don't want to eat and drink. They don't want to get up and go and play with their friends. Many many other symptoms can be seen in association with the SIRS, including skin rashes, red eyes, mouth sores, swelling hands and feet, change in the urine output and it bares a lot of resemblance or overlap to another condition that we've known about for a long, long time called Kawasaki disease, where many of the symptoms are the same, but Kawasaki disease also causes some inflammation in the blood vessels that, especially the blood vessel that supply the heart muscle and can cause some blockage of blood flow to the heart. So they're potentially very dangerous conditions.

Host: Right. So what is Kawasaki disease then exactly?

Dr. Calderwood: So Kawasaki disease is another condition that pediatricians have been aware of for at least a generation or more. It's a syndrome, which means we don't really know what causes it. And the key features of the syndrome are persistent high fever, red eyes, mouth sores, skin rashes, swollen glands, swelling of the hands and feet peeling of the skin. And, the real problem with Kawasaki is that the blood vessels themselves, can become inflamed. That's what we call A vasculitis, and if the blood vessels to the heart are involved in it, can form what we call aneurysms and blocked blood flow, blood supply to the heart and cause long-term complications like cardiac failure. So Kawasaki disease is, a diagnosis that we make by the children's clinical presentation and their signs and symptoms, and there does seem to be a slight spike in the number of systemic inflammatory response syndrome cases or Kawasaki disease syndrome cases in children during this pandemic. That doesn't mean that it's a proven cause. However, it could be that just like any other infectious process or toxin or, trauma or other condition that can trigger an inflammatory response, Covid could be one of the new triggers for that abnormal inflammatory response.

Host: Right. And do we know what causes Kawasaki disease?

Dr. Calderwood: No, we don't really know, but the, thought for both SIRS and Kawasaki disease is that there's a trigger, often a virus or an infectious process. It could be a toxin in the environment. The immune system attempts to respond to that trigger. Anytime we get an infection, our immune system kicks in to try and get rid of the infectious agent and heal up the damaged tissues, and usually that immune response is controlled and functional, but sometimes it seems to get out of hand and instead of a localized, systemic, inflammatory response to an infection, it goes generalized. So yeah, I think the analogy that might be good way to think of this is when, the difference maybe between a campfire and a forest fire. So a campfire is a small fire. Well contained, with a specific purpose, maybe to keep us warm or cook our food or something like that. But every once in a while, a campfire will set off a forest fire and the forest fire is big and destructive and damaging and we don't really know why it is that's some kids will go from that campfire to that forest fire, but once the forest fires starts, then it's really critical to get immediate treatment to try and bring the fire under control and contain the damage.

Host: Well, that's a really good analogy and really puts it into perspective. So for parents who are wondering or concerned about this, if a child does come up with systemic inflammatory syndrome or Kawasaki disease, how do you treat this? And are there long-term effects?

Dr. Calderwood: So if a child shows up and they have enough criteria to make a diagnosis of Kawasaki Disease or Kawasaki syndrome, we treat them with something called immunoglobulins. Immunoglobulins are basically antibodies, that are donated. When people give blood, the plasma is collected and the antibodies are taken off of that and pooled. I don't know if maybe that's a little bit too sophisticated, but, but we have antibody treatments that are available for Kawasaki and we also treat it with aspirin. If the child is treated within 10 days of the onset of Kawasaki disease, the prognosis for recovery is excellent. They generally 90, maybe even more than 90% will recover without Sequella. But if the inflammation goes on for too long, then the damage can be irreversible and some children will end up with a coronary artery aneurysms and, heart disease later on in life. So it's critical again, when a child's systemically unwell like that to see a doctor right away so we can get the diagnosis and treatment started. And then for Sers, there's also some newer medications that are available that are specifically trying to inhibit the chemicals your body produces that trigger inflammation, the so-called cytokines, and they're proving to be, very effective as well. So getting the Sers or the Kawasaki, it's a bad thing, but if we get to it early, the vast majority of children will recover and lead normal, healthy lives.

Host: Okay. That is good news. And I'm sure parents, everywhere are happy to hear that. So I guess the messages, if you're concerned don't hesitate to contact your local pediatrician, have the child seen right away. And then is there anything else you want parents to know Dr. Calderwood?

Dr. Calderwood: Well, I, I think probably, the focus on the really small percentage of children who can develop a severe illness. It gives us a slightly skewed view of COVID-19. I want parents to feel reassured that the vast majority of children who get COVID infection, even though it's still very small numbers, do perfectly fine. They have a cold or flu like illness and they get well. So you need to be cautious, need to follow the guidance wear a mask, wash your hands, stay away from people who are sick, isolate yourself at home. If you are feeling sick, see a doctor right away, but for children anyways, not as serious in illness as it might be for, adults, especially adults who have, comorbidities like lung disease and heart disease and diabetes.

Host: Right well, that's really important perspective. Dr. Calderwood, this has really been informative. We appreciate your time. Thank you so much.

Dr. Calderwood: Thank you. It's been my pleasure

Host: That' s Dr. Stan Calderwood and for more information, please visit dignityhealth.org/central-california. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth thanks for listening.