Ask The Doctors: Listener Questions On Coronavirus, Children
We thought kids were relatively safe. New data out this week from the American Academy of Pediatrics and the Children's Hospital Association however founded almost one hundred thousand children in the US tested positive for the corona. Virus. In the last two weeks of July alone. So what are we actually know what is the impact of Covid nineteen and the coronavirus on kids and what does that mean for Massachusetts cities and towns that are currently trying to figure out how to reopen schools next month for the rest of the hour let's ask the doctors call with your corona virus and Children questions and your other coronavirus questions to we're at one, eight, hundred, four, two, three, eight, two, five, five, that's eight hundred four to three talk joining us for this conversation is Dr Rick Molly Senior Physician in pediatrics at the division. Of Infectious Diseases at Boston Children's Hospital and a professor of Pediatrics at Harvard Medical. School Dr, Mollie welcome back to Radio Boston. For having me. And also joining us is Dr Laura Vinson Guzman a general excuse me a general pediatrician that's hard to say associate medical director of the Pediatric Complex Care Program Floating Hospital for children at Tufts Medical Center Dr, Arvidsson Guzman Welcome to Radio Boston and you for having me. All right. So let's start with something that president trump said last night at a White House, Corona virus briefing discussing the impact of the virus on children. We're GONNA have sound for you just injustice second. In what the president is saying here, I think we'll just skip the sound and I'll summarize it. He says I think for the most part kids do very well, they don't get very sick they don't catch it easily. And he says that they don't transport it to other people not very easily. So let me start by asking the two of you is that the case and what do you make? Of the transmission numbers, we've just heard from those last two weeks, of July, given that claim. Or why don't you start? So fortunately, we've been very lucky for the majority of children. Cases have been very mild This is always excellent. We don't want our children to be sick, but it presents a major public health problem because many of our children have you or no symptoms, they don't necessarily come to medical attention on, but they are at risk of spreading the virus others and this makes it a challenge especially when we think about reopening schools that children may serve as doctors and bring the virus home to other family members or household members who are at high risk. So, Dr Mollie. Let me follow up with you then because the president also mentioned in his briefing that the mortality rate for children who get the virus is quote a tiny tiny fraction of death and quote and that children are quote essentially immune and quote I just want to find out. Do those statements follow the? Science. Well in general I think it's important to. Focus more on the data and and less on some political statement. So I will just summarize it by saying that children are absolutely not immune to the virus. It's the the you quoted. To Santa are exactly indicative of that children can get infected and we also know both from our work at Boston Children's at Tufts Medical Center in everywhere across the country that even if children are less likely to get sick from this virus, the laws of large numbers suggest that once you start having a lot of kids getting this virus, you're going to have some children who get very severely ill some of them unfortunately might even die and it is not helpful to think of it as children being a completely safe from this. Because we know that unfortunately as the virus continues at spread, some children will suffer gravely from the consequences of infection. Okay. So one more baseline question there before we go to the phones I I hear you. I am confused about this from studying for this today. So I WANNA ask it does appear from the data. However, that children are at least less likely to get the most severe forms of the disease. Is that correct Dr Insane Guzman? That is correct on overall for some reason, children seem to do much better than their older counterparts typically with respiratory illnesses were used to seeing both the very young and the very old suffering about. In this virus seems to be a little unique in that respect. However, there have been cases as you may have read about yours may have read about I'm about the multi-system inflammatory syndrome that has been seen in children on, and some of these cases have been quite severe and resulted in unfortunately does of some those affected. And actually what we know about that syndrome I mean it's this terrifying thing that's looming out there. What do we know? Dr Mollie do we have you? Yes I'm sorry I was disconnected for a second. Great. So were you able to hear my question or would you like me to repeat it? Please repeated sorry this this syndrome, this syndrome that we're seeing among very young children. That Dr Arvidsson. Guzman was just talking about it seems scary and also kind of. Hard to get our hands around, what do we actually know about it? Well. You're absolutely right. It's a very scary syndrome it is rare but when it happens, it can be devastating to the child and it can induce all sorts of complications including cardiac complications or heart problems. For example, what we think is happening with this syndrome and again six months ago didn't even know that this syndrome would even exist. So A. Lot of these data are preliminary. What we think is happening is that children for some reason who are exactly as Davidson Guzman said less likely to get very sick from covid nineteen seemed to have a delayed immune reaction to the virus such that somewhere around a month after the peak disease in any city in the US for example, on the East Coast. That, we've seen we start seeing these kids show up with this very unusual syndrome while there's no more detectable virus in them or if it's there, it's at very, very low amounts and what we do see is that they have an antibody response to this virus, which suggests that they saw this virus maybe a month ago and that it took them about. A month to develop an inflammatory response that is very dangerous and damaging to their body. It's rare. But when it happens, it's very scary. It's very dangerous and unfortunately as the numbers of cases in children increase as the report you mentioned indicates, we can expect an unfortunately fear that we're going to see a lot more of these cases in the coming weeks. I. WanNa. Turn to the phones here one, eight, hundred, four, two, three, eight, two, five, five that's one eight hundred four to three talk to ask your question about corona. Virus and kids. We've got Devon on the line from Gloucester Devon go ahead. Hi there I'm a mother of two and my biggest question in regards to getting the disease is, what is the hospitalization rate looking like? Now, the cases for children have increased what kind of hospitalizations rate can we expect if that continues to be the theme? Okay Great Question Devon. Dr Arvidsson Guzman. Is that something you can answer for us I would probably defer to Dr o'malley who may have were up to the information on that. Oh. Sure. So from the report that we saw, which was again from the American Academy of Pediatrics, very recently, which looked at twenty states and also New York City they didn't have all the data from New York but they mostly had data from New York City showed that. About somewhere between one to eight percent of cases of covid nine, thousand, nine, hundred, and a child resulted in hospitalization. So it's a wide range unfortunately would which reflects the fact that these data were collected in different states using different criteria but that number of somewhere around one to ten percent of hospitalization when a child actually comes down with. Kobe nineteen. Is is a ballpark. Importantly. The. Greatest number of those children did not were able to be discharged and recovered from the infection, but it still is, of course, very scary and very disturbing for any family in a child to have to be hospitalized for an illness like this one. One to ten percent is a huge swing. Do you think we'll be able to narrow that down to a nearer band of sort of certainty or what we know over time or is it really just that variable? It's a great question I think that once you start looking at other factors, some of which Dr Arvidsson Guzman is an expert in for example, in in complex care of children with multiple co morbidity, you will probably start seeing that in healthy children, for example, who have no. Potential risk factors. The number is going to be much closer to the one percent that I mentioned or even less, but unfortunately as of now. We have to sort of take into account. The possibility that some of these children have other complications, other important medical needs, and when you add that to Kobe nineteen, that might mean that the safest thing to do for the child is to be hospitalized. Dr Arvidsson Guzman before I go back to the phones. Is there anything you'd like to add to that? I'm yes. I would say certainly children who have underlying medical conditions are at higher risk of for more severe complications related to Covid Nineteen I would say that's fair to say in my patients as well. Those I've seen who are hospitalized generally have underlying conditions may be on respiratory support at home on May have required additional support that landed them in the hospital virginal care. When eight, hundred, four, two, three, eight, two, five, five, that's eight hundred four to three talk to ask your question about the coronavirus to our doctors. Today, we've got denise on the Line Medford Denise go head. Hi, thanks for taking my call. My question is this children under the age of one likelihood of contracting, Colvin and other any differences for those infants that have been breath at. Dr Arvidsson Guzman. Let me come back to you on this one. Yes. I would say this is certainly an area where still learning quite a bit about in terms of infants, they certainly can be affected and generally from the data I've seen shows some of the similar symptoms in terms of respiratory being a primary symptom. In terms of being breastfed it's difficult to say we you know the benefits of breastfeeding in terms of the antibodies that mother may provide her child. However, if the mother has never been exposed covid nineteen herself before she may not necessarily have a protective antibody to provide to the child as for a mother who may contract covid nineteen while they are pregnant on, it still remains to be seen if there's any sort of. Ability for the mother to transmit some sort of protection through breastfeeding her child. Dr Mealy I. Want Hark back that I call from Gloucester who was calling about hospitalizations because there was research at at the end of the week from the CDC showing that children of color are much more likely to be hospitalized from corona virus than white children are let next children are eight times more likely black children are five times more likely to be hospitalized. Why is that the case? Do we know? I think it's fair to say that that we don't really know. This This Syndrome is disease has surprised most clinicians and epidemiologists more times than we can remember over the last six to seven months. But one of the things that has come out very clearly from every study that we have seen is that this is truly disease of social and economic disparity. So certainly, populations that are more vulnerable from an economic or social perspectives are at much greater risk for serious there at greater risk for getting the infection and also at greater risk forgetting severe complications from the disease. What is unfortunately so bring in this is that we hoped that that would not then trickled down to their children but unfortunately, the report you cite really does indicate that the social disparity and the risk factors really do extend across all ages. There are lots of possibilities. In hypotheses that people are evaluating for the An. Honestly, at this point I think it would be very. Imprudent to try to say which one is the most likely but I think it's very clear that when you have populations. That are socially and economically disadvantaged the risk to their children as well as to the adults is greatly magnified. Dr, Arvidsson. Guzman the the big question right now about kids in the corona virus is schools. What do you tell your patients when they ask about sending their kids back to in-person schooling? Any kind this fall It's such a difficult decision and I think it really is a very personal decision as well on considering the needs of the Child on terms of their education. Considering who else is in the household is. WHO might potentially high risk in for some students in particular who are receiving Special Education Services on it becomes an even bigger discussion although our special education teachers are fantastic. Some of the students rely on equipment and adaptive technologies that simply can't be translated through the ritual setting. Unfortunately, some of these children are also have other medical co morbidity is that put them at even higher risk of complications if it were to contract covid nineteen So it's it's a big balancing act between educational needs focus on social emotional halt these children as well as balancing safety of the child, the family and the teachers and administrators at the school. Dr Mollie, we talked to the Superintendent of schools in Chelsea yesterday her cities at almost five percent positive test rate which led her to determine that she's not comfortable offering any in person education at the start of the year. Is there a positive test rate that would be appropriate to reopen schools? It's a very good question. I think what I encourage people to do is to look at the trajectory of their positive or negative rates of of testing in other words. If you start seeing that the numbers are creeping up to to go the opposite direction under question if you see a community where it's one percent, two percent three percent and keeps on rising and the behavior of the population is not changing there's no new restrictions as no changes in behavior, it just doesn't Doesn't take a mathematical model or to tell you that the number is gonNA keep on increasing and some measures probably need to be taken or the school will need to be a shutdown conversely to get to your question once you start seeing that measures are being taken that for example, the areas that we believe are representing hotspots of transmission that those areas are being closed down. For example, that certain activities are being reduced and the numbers start decreasing below that five percent positivity that you site. Then I think consideration of reopening wisely and carefully could be entertained. And I'm going to have to terrible run out of show that Dr Rick, Molly of the Harvard Medical School Dr Laura Arvidsson Guzman of the floating hospital for children at Tufts Medical Center. Thanks to both of you.