7 minute read
PUBLIC HEALTH UPDATE
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DR. KAREN DAHL, VICE PRESIDENT, QUALITY, PATIENT SAFETY AND MEDICAL AFFAIRS, VALLEY CHILDREN’S HEALTHCARE DR. CARMELA SOSA, VALLEY CHILDREN’S HEALTHCARE MEDICAL DIRECTOR, PRIMARY CARE AND THE GUILDS CENTER FOR COMMUNITY HEALTH MICHAEL DANOVSKY, PH. D., VALLEY CHILDREN’S HEALTHCARE, MANAGER, PEDIATRIC PSYCHOLOGY
When we set out to write this article, our intent was to briefly discuss the impact of COVID-19 on our kids. But then along came the wildfires, a natural disaster of another kind with profound impacts on our kids, their health and the health of their families and communities. We have included some comments about the wildfires in the context of this COVID-19 pandemic. At this point, it seems that every adjective to describe COVID-19 has been used---unprecedented, fast-moving, unlike anything we have seen in a century. All of those words---and more---continue to apply to COVID-19 and our response to this pandemic. Our understanding of the disease as medical professionals is changing almost daily and guidance from the Federal and State agencies is changing almost as often.
And, in many ways, those same adjectives apply to the recent wildfires that have devastated our own mountain areas as well as dozens more across our State, Oregon, Washington, and beyond.
But here is what we know for certain when it comes to children and COVID-19:
Children are not immune to COVID-19. From an August 11, 2020 article in the Journal of Pediatric Infectious Diseases, “children comprise a small proportion of overall COVID-10 cases at 5.2% of laboratory-confirmed infections in the U.S.” Despite an ongoing narrative questioning the impact of COVID-19 on kids, children can contract the virus, become very ill, and some will not survive. Valley Children’s has administered nearly 14,500 COVID-19 tests to our patients as of September 14, 2020 with a positivity rate of 8.8%. Since the start of this pandemic, approximately 170 children have been hospitalized at Valley Children’s with COVID-19, and a third of them were hospitalized solely for COVID-19. Sadly, we have experienced one fatality from the virus.
A specific pediatric complication is Multisystem Inflammatory Syndrome (MIS-C) which can follow COVID infection and is characterized by high fevers and may affect other body systems, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs. This will almost always result in severe enough disease for the child to be hospitalized, often needing intensive care, and some children have died from that condition.
We have treated a number of children who have met the criteria for MIS-C during this pandemic.
Children with underlying health conditions---just like adults---are a special concern, as well as kids with complex medical conditions. The rates of childhood asthma, diabetes, and obesity, as examples, are very high in our communities and put children at increased risk for severe disease should they acquire COVID. Children with complex conditions such as cystic fibrosis, metabolic syndromes and genetic syndromes are also at increased risk. Children can transmit COVID-19. Studies at leading universities in this country and around the world have demonstrated that kids can transmit the virus. Headlines from summer camps in Georgia to school re-openings---and then closings---across the country demonstrate the risk of transmission between and among kids and the adults caring for them.
COVID-19 transmission can occur anywhere. Many families have expressed concerns about visiting their pediatrician or coming to the hospital for fear of being exposed to the virus. Families need to be alert to the risk in the community and among their extended family. In many ways, families are safer in healthcare settings where every precaution for our visitors, patients, families and staff are employed. No family should risk future health consequences by delaying a visit to their physician or an Emergency Department if needed.
COVID-19 is having an impact on potential increased future vulnerability for other childhood diseases. The Centers for Disease Control and Prevention (CDC) is reporting fewer childhood vaccines being administered during this pandemic as compared with January-April 2019. (www.cdc.gov) In addition, the CDC continues that “the identified declines in routine pediatric vaccine ordering and doses administered might indicate that U.S. children and their communities face increased risks for outbreaks of vaccine-preventable diseases.” Routine immunizations and well child checks for infants are particularly important.
There currently is not an effective oral treatment or a vaccine for COVID-19. The best way for children, their families and for all of us is to protect ourselves is by social distancing, masking, and good hand hygiene. Remdesevir has been of benefit to some patients, and we have used it to treat patients at Valley Children’s.
The impacts of COVID-19 extend beyond the physical consequences and its psychological impacts are significant concerns, as well---for all kids and particularly for school-age children whose traditional ‘back to school’
experiences have been disrupted by the pandemic. As with all significant events in a child’s life, there are some key principles to keep in mind:
• Children and teens react, in part, to what they see the adults around them doing/saying. When parents/guardians deal with COVID-19 calmly and confidently, that is the best support they can provide for their children.
• Watch for behavioral/emotional changes in children and teens. Not all children respond to stress in the same way (nor do adults). If families are unsure or worried about their kids’ emotional health, encourage them to reach out to their child’s teacher, school psychologist, pediatrician, pediatric psychologist, or others. Ask for help.
• Reassure children that they are safe and that as the adults in their lives, we will make sure they are safe. Let them know it is okay if they feel upset or worried.
• Limit the family’s exposure to news coverage, particularly social media.
• Try to keep a regular schedule with regular routines. For school-age children, the ‘virtual’ return to school, while bringing its own challenges, can help with this.
• Make sure that children can spend time with parents/guardians or other family members doing meaningful activities (besides school) e.g., cooking, playing board games, talking with grandparents or other relatives so that they know they are safe, etc.).
As if COVID-19 wasn’t enough, then came the Creek Fire.
Another unprecedented event, this wildfire has provided further disruption to our lives---from those displaced by the fire to all of us dealing with declining air quality levels in the Valley. From a health perspective, layered on top of the ongoing concerns around COVID-19, we offer the following suggestions, useful for all of us but particularly important for children with asthma, cystic fibrosis or other pulmonology issues:
1. 2. Stay indoors as much as possible. Keep children indoors with the doors and windows
closed. Use your “clean room”. If you have an air conditioner, run it with the fresh-air intake closed to keep outdoor smoke from getting indoors. Use your portable air cleaner as well. Reduce health risks by avoiding strenuous activities. 3. Regularly check air quality at www.valleyair.org for daily air quality forecast. Wait until air quality improves to begin outdoor activities. 4. Although it is important to keep wearing a cloth mask to protect you from COVID-19, a cloth mask will not protect you from the harmful effects of ash and smoke.
N95 masks are best for protection from smoke and ash but are not available in pediatric sizes. It is best to stay indoors until air quality improves. 5. Children should not participate in ash clean-up work as their lungs are more susceptible to airway toxicants.
Environmental exposures can alter immune function and lung mechanics in at- risk populations, including children. 6. Keep a 7-10 day supply of medication on hand. 7. Call the doctor if your child has trouble breathing, shortness of breath, a cough that won’t stop, or other symptoms that do not go away. 8. Call 9-1-1 or go right away to an emergency department if your child has significant difficulty breathing, is very sleepy, or refuses food and water. 9. If your child has asthma, allergies, or a chronic health condition, he/she is at high risk from health effects related to wildfire smoke and ash. Be even more cautious about his/her exposure to smoke, and seek medical advice as needed. For children with asthma, follow the asthma action plan. 10. If you are at risk for evacuation, make sure you have a supply of the child’s essential medical equipment ready to go. And if evacuated, please do not return to your house until you have been told to return by local authorities.
The healthcare system in our region is strong, prepared and very skilled in caring for all that comes our way. Our physician partners are often the first-line contact for families worried about their children. Valley Children’s Healthcare stands ready to partner with you as we all work to get through these dual challenges together.
For more information: www.valleychildrens.org/covid19 https://www.valleychildrens.org/media-center/wildfiresafety
