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Infection control for children with chronic conditions in the COVID-era

Complex Care

This information is accurate to the best of our knowledge on April 23, 2020 and in line with recommendations provided by Public Health Ontario and Health Canada. We recommend staying up-to-date with information which is evolving day-by-day. Although there is plenty of information, there is also much that we do not know or fully understand yet – e.g. role of asymptomatic transmission, aerosolization. Society is navigating new questions including the resumption of activity including school and non-essential services. We encourage you to continue to explore the resources below.

Learning Objectives:

  • Discuss current status of the COVID-19 outbreak worldwide, Canada, and Ontario
  • To provide an overview of COVID-19 in children, including the presenting features and risk factors for severe disease
  • To review the infection prevention and control recommendations related to COVID-19 in the hospital and community settings

Michelle Science, MD, M.Sc.

Dr. Michelle Science, Infectious Disease Consultant and Pediatrician, The Hospital for Sick Children; Assistant Professor, University of Toronto. Dr. Michelle Science is an Academic Clinician in the Division of Infectious Diseases at The Hospital for Sick Children and an Assistant Professor at the University of Toronto. Since 2012, she has been the Medical Advisor for Infection Prevention and Control (IPAC) and the co-lead of the Antimicrobial Stewardship Program (ASP) at SickKids. More recently, she joined Public Health Ontario as a consulting IPAC physician. She has been involved in the response to the COVID-19 pandemic both locally and provincially and is currently leading a multicenter study testing healthcare workers for antibodies to COVID-19. This study aims to get a better understanding of the natural history of COVID-19, in particular whether the antibody response is protective and the duration of this protection, and describe how the seroprevalence is changing through the course of the pandemic.

Clinical presentation of COVID-19 in children

    Of all the cases worldwide, a very small proportion are reported in children. Presentation in those children can include fever, cough, sore throat, rhinorrhea, diarrhea and vomiting1. Presentation appears to be more non-specific compared with adults. Isolated gastrointestinal symptoms have been reported along with extremity findings.

Route of transmission

    The World Health Organization (WHO) Joint Mission on Coronavirus Disease 2019 (COVID-19) reports that the route of transmission is droplet during close, unprotected contact2. The majority of cases were linked to person-to-person transmission through close direct contact to someone with respiratory symptoms.

Recommendations for families who require nursing support

    • We emphasize with all family’s public health recommendations including hand hygiene, physical distancing, cough etiquette, and cleaning and disinfecting high touch objects and areas. Screening individuals prior to entering your home to ensure they are asymptomatic is strongly recommended.

 

    Our experience through this COVID-19 pandemic period suggests that there is need to work across the sector from hospital to community to confirm that children with medical complexity are recognized as among the most vulnerable to disease. We are asking for and offering to support rapid development of policies, procedures and processes that prioritize safe and sustainable care for children with medical complexity across all sectors, including community (e.g. group homes, respite facilities)/and home care.

Review of children with non-COVID-19 in the community setting

    • Recommendations currently for primary care and general office settings is to ensure appropriate screening approaches and triaging, using virtual care when possible and to see only those children that require essential appointments such as for newborn care or vaccinations. Indeed, attendance for vaccinations should be encouraged and facilitated.

Many offices have included signs on the door with screening questions as well as pre- clinic phone calls and physical plexiglass barriers. The maintenance of physical distancing measures in waiting room and during routine care is important. Have alcohol hand rub available.

In advance of a family attending an appointment, informing them of new procedures including that the number of people accompanying patients is being minimized is important.

References

1. Chan K et al. The acute management of paediatric coronavirus disease 2019 (COVID-19). Canadian Paediatric Society

2. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 16-24 February 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 6]. Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

Session Materials

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