As the media continues to pump out information, some accurate and quite a bit that is not, it is critical to take a breath and step back from the hype and look at what we really know. For your mental health, I recommend limiting your own consumption of news to once per day – information is not changing that quickly and you will not miss out, I promise! And you will be a lot happier for doing it.
THE DATA
So how many of the documented cases are kids? As reported, actually only a small proportion of the cases.
United States: 2% of confirmed cases of COVID-19 were among persons aged <18 years.
China: 2.2% of confirmed cases of COVID-19 were among persons aged <19 years old.
Italy: 1.2% of COVID-19 cases were among children aged <18 years.
The larger unanswered question is how many kids are without symptoms and not getting tested? In Virginia, the AAP found close to 15% of the kids tested were asymptomatic. The best I can tell you is to stand by. Once testing becomes more widely available, the number of people who are positive and not symptomatic is likely to rise.
SYMPTOMS
Not surprisingly, the signs of COVID-19 in kids looks it does in adults. Many present with the typical symptoms of a cold with runny nose, cough, fever, and body aches. What is somewhat different in kids is that they often have more gastrointestinal symptoms, particularly diarrhea and over 50% do not have fever! Signs of the disease usually starts between 3-7 days from exposure to an infected person. Based on limited data on children with either suspected or confirmed infection, infants (<12 months of age) may be at higher risk of severe or critical disease compared with older children, with hospitalization being most common among children aged <1 year and those with underlying conditions, such as chronic lung disease (including asthma), cardiovascular disease, and immunosuppression.
MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C)
Now the news is reporting about a new complication of COVID-19. In true medical form, we have come up with a long forgettable name so we will call it MIS-C for short. This is still a rare entity with only 4 cases known at Children’s National in DC out of thousands of children infected. Patients with MIS-C have presented with a persistent fever and a variety of signs and symptoms involving multiple organs and elevated inflammatory markers. Not all children will have the same symptoms, and some children may have symptoms not listed here. MIS-C may begin weeks after a child is infected with COVID-19 and they may not even have had COVID-19 symptoms! While a bit scary, there are things we can do for those with this complication to help AND it is uncommon.
TESTING
As testing gets to be more readily available, it is important to understand what the take away is from each test. The swabs from the nose you see people getting are the most helpful. These are molecular tests that detect the virus. While not 100%, these are the tests that help us know who is actively infected and/or likely to spread the disease.
The second kind of test is a blood test to detect antibodies. They detect evidence of the body’s response to the infection even after the infection is gone. Unfortunately there are dozens of these blood tests being marketed in the US that may or may not be providing accurate information and are not comparable to each other. Normally the FDA validates these tests before coming to market – this process is under way but may not be completed for some time. It is also not clear even if you have antibody present, whether that will keep you from being re-infected. Lastly, how long will that protection last? Completely unknown. While the blood tests for antibodies will likely be useful in the future – don’t use it yet to make decisions on what you should and should not do with regards of exposing yourself or your child to others. It may prove deadly wrong to someone you love.
FINAL THOUGHTS
As cases in the US finally seem to be falling, it is important to know what to do in case of exposures. The department of health has put a nice infographic together that most health care providers, including us at Einstein Peds, will use to make decisions about isolating kids and family members after exposures. It is based on the scientific evidence and provides a good road map to follow.
A last note. Please keep up to date with vaccines and checkups. We are seeing problems building ahead with kids not getting the needed care and interventions. There are real concerns of disease outbreaks (not just COVID-19) as vaccine rates have plummeted and children return to group settings soon.
Be well and know that we are here supporting you, our Einstein families!
Dr. M
