by your Coast Docs Shakha Gillin and Lori Taylor
As we enter summer, kids and families are normally focusing on summer activities like surfing, swimming, camps, outdoor experiences and time with friends. Summer is a time that, under usual circumstances, children are active and involved with each other. But today many parents are questioning what is safe, and are worried about what the pandemic means for the health of their children.
Rest assured that severe illness from COVID-19 in children is exceedingly rare, and that pediatricians are well prepared to treat children who experience these uncommon events.
Recently, much attention has been given to a newly described Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 that appears to be similar to Kawasaki disease. This is not an unfamiliar foe, as pediatricians have been diagnosing and caring for children with Kawasaki disease for almost 50 years. Kawasaki disease is thought to be an inflammatory response triggered by a viral infection. It affects children globally, including up to five thousand children per year in the US. The newly recognized MIS-C has symptoms that are similar to Kawasaki disease including fever, poor organ function, and cardiovascular shock; both conditions have the potential to affect the blood vessels of the heart. A recent report from Bergamo, one of the hardest hit areas in Italy, describes the differences between children diagnosed with a Kawasaki-like syndrome after the COVID-19 epidemic began compared with a similar group diagnosed pre-COVID-19. The COVID-19 group were older and had evidence of more severe disease, with a higher rate of cardiac involvement, however there were no reported deaths. Treatments exist for both conditions and are aimed at decreasing the inflammatory response; they may include aspirin, intravenous immunoglobulin and steroids. With early diagnosis and treatment the prognosis of Kawasaki disease is good, and reports suggest that the same is true for this newly described MIS-C. It must also be noted that although this syndrome currently appears to be uncommon, pediatricians across the nation are well aware of its existence and are prepared to evaluate children when the need arises.
Overall severity of COVID-19 in children is very low. A recent study published in JAMA evaluated Pediatric ICU admissions for COVID-19 in children in the US and Canada. Thirty out of 46 hospitals did not have any Pediatric ICU admissions during the study period of March 14 through April 3. Forty out of 48 children that were admitted to an ICU had pre-existing underlying medical conditions, and two of these children died. When compared with adult COVID-19 ICU admissions, pediatric outcomes were encouragingly positive, with an ICU mortality rate that was a fraction of adult ICU mortality rates. The most recent data from the UK’s Office for National Statistics paint a similar picture. Among children ages 0-14 there were two deaths attributed to COVID-19 during the peak 5 weeks of the epidemic. This stands in contrast to the over 22,000 deaths in the 65-90 age group during this same time period, especially when it is noted that both age groups make up approximately the same percentage of the UK’s population. Severe COVID-19 disease in children remains quite rare.
What is of great concern to pediatricians and the American Academy of Pediatrics (AAP) is the decline in families seeking medical attention for their children during the COVID-19 pandemic. The number of children accessing needed health care has sharply declined during the past two months, and as a result immunization rates have plummeted. It is estimated that the immunization rate for all recommended childhood vaccines in the U.S. declined approximately 40% between late February and mid-April. This may set the stage for outbreaks of vaccine preventable diseases such as measles, rotavirus and whooping cough. The AAP has also expressed concern about missed well care, physical exams and developmental surveillance, all of which have repercussions on child health and wellness. With guidance from the AAP, pediatricians are working to ensure that their offices are safe places for children to receive needed care including immunizations.
The effect of the COVID-19 pandemic on children and families cannot be ignored. Parents and children are both feeling the stress of adjusting to “distance learning” in the absence of face to face school instruction. Our youngest children are growing up in a time where people outside immediate family wear masks and do not hug or touch, the effects of which we can only begin to imagine. One of the biggest areas of concern for pediatricians is missed healthcare as families shelter in place and have concerns about visiting medical offices. As for medical complications from COVID-19 in children, the outlook continues to be positive. Even taking into consideration the newly recognized MIS-C, severe COVID-19 associated disease in children remains quite uncommon. Pediatricians suspect that future data will reveal that the biggest impact that the COVID-19 pandemic has on children has less to do with medical complications of the disease itself, and more to do with missed healthcare, family stress due to work and childcare issues, missed face to face school instruction and other psychosocial issues. If proper support is in place to mitigate these issues, then it is our professional opinion that, as the Who told us years ago, “The kids are alright.”