COVID-19 and the care of children with chronic diseases

Complex Care

During this unprecedented time, Paediatric Project ECHO and Children’s Healthcare Canada have partnered to bring this webinar, primarily tailored to paediatric healthcare providers in Canada to answer questions about COVID-19 and the care of children with chronic disease on April 2nd, 2020. Participants learned about the current epidemiology on COVID-19 as it applies to pediatrics and data/evidence available to-date in terms of management (e.g.,novel therapeutics and pharmacological management). Click on the video below to watch the webinar.

Presentation Outline:

The Coronavirus family
Transmission
Epidemic curve
Clinical presentation
Risk factor for severe disease in children
Defining & protecting high-risk patients

Upton Allen, MBBS, MSc, FAAP, FRCPC,

Dr. Upton Allen is a Professor of Paediatrics at the University of Toronto. He is Chief, Division of Infectious Diseases, and interim director of the Transplant and Regenerative Medicine Centre, Hospital for Sick Children. He is a Senior Associate Scientist in the Research Institute, Hospital for Sick Children. His primary appointment is with the Division of Infectious Diseases, Department of Paediatrics at the Hospital for Sick Children. He is cross-appointed as a professor in the Institute of Health Policy, Management and Evaluation, University of Toronto. Dr. Allen is a past director of the Infectious Diseases Society of America and Fellow of the Society. He is a Fellow of the American Academy of Pediatrics, Fellow of the Royal College of Physicians and Surgeons of Canada and Fellow of the Royal College of Physicians (UK). He is a past Chair of the Infectious Diseases Specialty Training Committee, Royal College of Physicians and Surgeons of Canada (RCPSC). Past awards include the Clinical Science Established Investigator Award from the American Society of Transplantation. In 2018, he was awarded the Order of Ontario, the highest honor awarded by the province. He is a general infectious diseases specialist, and actively involved in clinical and research activities relating to immuno-compromised patients, notably those who have undergone organ and stem cell transplantation and cancer therapies. He has had numerous invited lectures internationally, visiting professorships, more than 300 scientific publications and 190 scientific abstracts, several book chapters and peer-reviewed research grants.

Moderators:

Dr. Julia Orin, Complex Care Medical Lead
Michelle Ho, Nurse Practitioner

Panel Members:

Dr. Eyal Cohen, Complex Care Medical Lead
Dr. Zia Bismilla, Staff Physician
Dr. Catherine Diskin, Clinical Fellow
Jas Otal, Clinical Pharmacist
Kathy Netten, Social Worker
Ashley Edwards, Social Worker
Erika Gibson, Registered Dietitian
Jordan Beaulieu, Registered Dietitian

General Points

Flattening the curve refers to measures undertaken to slow the spread of infection so as to avoid a steep increase in the number of cases that would overwhelm the capacity of the health care system. These efforts to flatten the curve include physical distancing (keeping 2 metres away from others), frequently washing hands well, disinfecting surfaces and high touch objects and correct cough and sneeze etiquette (using elbow or tissue rather than hands).
In children and young adults, mortality is low. Preschool children and infants were more likely to have severe clinical manifestations than older children.

What should we be recommending our families do in terms of medications at home and being prepared for the coming future?

Canadian Pharmacy Association and Ministry of Health (Ontario) have recommended that no more than 30 days supplies be dispensed to avoid future shortage. We are encouraging families to have a 4-week supply of medication and formula on hand and to be proactive in seeking refills.
We are not actively recommending avoiding non-steroidal anti-inflammatory medication (NSAIDs including ibuprofen) although do suggest using alternatives e.g. Acetaminophen (Tylenol) first.
We advise patients to continue current medication including ACE inhibitors. In the event, a child contracts COVID-19, treatment decisions would be taken on a case by case basis.

What is the Complex Care team doing to plan for important care that is currently deemed non-essential and may become essential if left unattended?

Whilst in-person visits have been reduced at this time, the Complex Care team similar to many clinicians continue to provide care during this time, typically using telehealth. This includes actively considering what is considered essential and what can be deferred. For example, whilst a G/J-tube change may not be essential at this moment but should something change, it will be prioritized.
Hospitals have developed clear procedures for protecting children, families and staff from getting an infection. Additional measures include screening on entry and reduction in visitors. It is important to attend a hospital, if a child requires emergent medical care or as directed by clinician.

Is there research/data individual outcomes specific to certain disease populations (ie. cystic fibrosis, type I diabetes, congenital heart disease etc.)?

There are not specific published studies that take into account certain disease populations.
The Canadian Paediatric Surveillance Program (CPSP), in collaboration with the Public Health Agency of Canada are conducting rapid surveillance on COVID-19 in Canadian children. They are contacting Paediatricians weekly with a COVID-19 reporting link to facilitate online reporting. Any questions about the CPSP study can be directed to: cpsp@cps.ca. That account is monitored multiple times a day, and will be re-directed immediately to the appropriate person.
Feel free to contact the Paediatric Project ECHO team if you have any otherr any other queries or suggestion at project.echo@sickkids.ca

Session Materials

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