EMSC Connects Special Issue

March 2020 COVID-19

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Pedi Points - Tia Dickson, RN, BSN, Primary Children's Hospital

Providers, we know you are on COVID-19 overload right now and we all have our hands full with medical response. This issue is simply to increase your knowledge as parents, aunts/uncles, and humans, help you understand the impact of this disease on our kids, and give you some resources for managing our littlest patients.

Know that your EMSC staff is cheering you on and we know this state is in the very best hands!

COVID-19 and children: What you should know - From Primary Children's Hospital

The following information is provided by Dr. Andrew T. Pavia, University of Utah Health and Primary Children’s Hospital. Dr. Pavia is the George and Esther Gross Presidential Professor and the Chief of the Division of Pediatric Infectious Diseases at the University of Utah and Director of the Hospital Epidemiology Program at Primary Children’s Hospital.


COVID-19, the disease caused by the new coronavirus first identified in December in Wuhan, China, has rapidly spread around the world. As of this writing, more than 300,000 cases have been diagnosed worldwide. Cases have been detected in all 50 states in the United States, and people have many questions, particularly about children.

There has not been a lot of focus on COVID-19 in children. We are learning more about this new illness every day but now can give a pretty good picture of the disease in children.


Is COVID-19 dangerous in children?

COVID-19 appears, on average, to be much milder in children than it does in healthy adults or in older adults. Of the first 70,000 patients in China diagnosed with COVID-19, only 2.1 percent were children younger than 19 years old. No children younger than age 9 died according to this report. Only one death was reported in a child between the ages of 10 and 19.


Does that mean children are not getting infected?

No. While we don’t know exactly how many children are infected, there are a number of studies where all family members have been tested. These suggest that children are frequently infected, but often have few or no symptoms.


Is COVID-19 more dangerous for children with other medical conditions?

It seems likely that children with serious medical illness may be more at risk of becoming more ill if they become infected, but we don’t know for sure. In adults, those with serious underlying conditions such as heart and lung disease or cancer are more likely to have severe symptoms with COVID-19.There are currently no reports to help us know if this will be true for children.


If they are infected but not sick, can they spread the virus that causes COVID-19?

We don’t yet know how important infected children are in the spread of the disease but we think it is highly likely that infected children can spread COVID-19. With most viral diseases, children are most infectious when they have symptoms since coughing and runny noses help spread droplets with the virus. This is probably true for COVID-19.


What are the symptoms of COVID-19 in children?

Many children have few or no symptoms. Symptoms include fever, runny nose, and dry cough, and occasionally, diarrhea. In a few children, this has progressed to shortness of breath. Some of those with progressive symptoms have developed pneumonia. A very small number have required intensive care.


Is there any treatment for COVID-19 in children?

As with other viral illnesses in children, most can be treated at home and will do well. At present there are no specific drugs to treat the infection. Drink plenty of fluids. Medications to reduce fever may make your child more comfortable.


Should I get my child tested for COVID-19 if they have a runny nose, fever, or cough?

In general, testing is not necessary, and it is best to avoid visits to a doctor’s office or emergency department if your child has mild or moderate illness. Testing will become more available in the future, but is still largely limited to people who are more severely ill or when knowing the diagnosis will make a difference in treatment or management.


When should I seek care?

You can think of this as you would any cold or flu. If your child has difficulty breathing, is not able to keep down fluids, or is very limp or non-responsive you should seek care immediately. There are good sources of information you can use to help you decide. The Utah Department of Health has an information line 800-456-7707. You can also use Intermountain Healthcare’s Connect Care online or through the mobile app.

All Connect Care providers are trained in screening specifically for COVID-19. Connect Care uses a video chat function to be seen by an Intermountain caregiver.


I understand it makes sense to care for my child at home, but how do I protect the family?

We should all take precautions to avoid infection in the first place. Wash hands frequently with soap and water, or if that’s not an option, use an alcohol-based hand sanitizer. Clean commonly touched surfaces in your house. Stay home when sick and cover your cough with tissue or cough into your elbow.

If someone in the household is sick, all of these steps become even more important, paying special attention to cleaning your hands after touching the ill person, handling their tissues, etc. In addition, if age appropriate, the ill person should sleep in a separate bedroom. Avoid sharing household items with the patient. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. After the patient uses these items, you should wash them thoroughly. Wash bed sheets and clothing, especially if they have contact with mucous, blood, or stool.


What about face masks?

Face masks worn in public do not provide any meaningful protection to healthy people. However, if the person with COVID-19 wears a mask, it helps protect those around them. Caring for a sick child or adult in your house does increase the risk for close exposure. The CDC recommends using a face mask if you are cleaning up blood, stool, or body fluid such as saliva, sputum, nasal mucus, vomit, urine.


What are some trustworthy sources if I want to know more?


The latest on children with Covid-19

A new study has come out of China recently


See the summary @aap_pediatrics on Instagram or click this direct link to the study

Epidemiology of COVID-19 Among Children in China

HOW DOES COVID-19 AFFECT THE BODY?

Protocol in Practice - Respiratory Distress

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Ask Our Doc

Do you have a question for our EMSC Medical Director, Hilary Hewes, MD, PCH, ER Attending Physician about this newsletter topic or anything pediatric related? Shoot an email to the address below and look for her response in our next newsletter.


tdickson@utah.gov

From Our Medical Director Hilary Hewes

Help improve your agency and emergency department’s readiness to take care of pediatric patients and participate in a national quality improvement project!


The national EMS for Children program, with the help of the National EMSC Data Analysis Research Center (NEDARC), will be launching two national surveys in 2020.

The 2020 EMS Annual Data Collection started on January 7, 2020. The survey for your state is now open for respondents at emscsurveys.org. This survey asks basic demographic information about each agency including number of staff, level of certification, annual number of calls, number of pediatric calls, as well as critical information about whether your agency has a Pediatric Champion or Pediatric Emergency Care Coordinator (PECC). It will also ask what kind and how often agencies do skills checking on pediatric equipment. Please ensure someone in your agency completes this survey. It is important for us to see how Utah agencies are doing in general and how we compare with similar agencies across the country.


The data collection will run through March 31, 2020.


June 2020, the National Pediatric Readiness Project will launch the 2020 Assessment. This assessment will be sent to nurse managers and medical directors of all emergency departments across the country to evaluate structural processes and policies in place to be ready for pediatric patients. Those who take the assessment will get immediate feedback with a gap report comparing your score with previous scores (if taken in the past) and comparing you with similar emergency departments across the country. These scores have been linked to outcomes such as mortality from critical illness, and participation in the project is very important for the Utah Department of Health to better understand the state of pediatric preparedness in Utah.

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https://emscsurveys.org/

Please take our survey, let your agency be heard!

Emergency Medical Services for Children, Utah Bureau of EMS and Preparedness

The Emergency Medical Services for Children (EMSC) Program aims to ensure that emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure that the system is backed by optimal resources and that the entire spectrum of emergency services (prevention, acute care, and rehabilitation) is provided to children and adolescents, no matter where they live, attend school, or travel.