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Children’s Hospital Colorado
Anschutz Medical Campus
13123 East 16th Avenue
Aurora, CO 80045
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Coronavirus Research and Innovation
When the novel coronavirus was identified and began to rapidly spread, our pediatric experts were closely watching the situation and devising a response. Experts from various departments within Children’s Hospital Colorado quickly came together during the initial phase of the COVID-19 pandemic to respond.
Collaboration between experts in our Infectious Disease Department and several other teams within Children’s Colorado led to the rapid implementation of coronavirus testing. In fact, we were the first hospital system in Colorado – and one of the first in the nation – to offer coronavirus testing. Foresight and quick action from experts within the Blood Donor Center led to the evaluation and use of convalescent plasma as a promising potential treatment for COVID-19.
In response to stay-at-home orders, our Telehealth Department made swift adjustments in the use of telemedicine to enable continuity of high-quality care for our pediatric patients.
Research article
- abril 27, 2021
The percentage of parents who refuse all vaccines for their children is small. There is, however, an increasing number of parents who refuse or want to defer individual vaccines or use an immunization schedule for their child that is not recommended. Research on vaccine hesitancy is helping specialists pinpoint and understand parents’ fears and how to address them.
Research article
- enero 21, 2021
Learn about the benefits of telehealth and the work we’re doing to enhance quality of care and improve patient and provider satisfaction.
Research article
- julio 09, 2020
Learn how Children’s Hospital Colorado quickly developed a testing process for the new coronavirus.
Clinical trial
Medical experts at Children’s Hospital Colorado are studying the effectiveness and safety of the Pfizer-BioNTech COVID-19 vaccine in children ages 5 to 11.
- Diagnosis
- Healthy children who have not had COVID-19
- Age
- 5 to 11 years
“The idea of ‘What we do today prepares us for tomorrow’ has really carried us through. With no real end in sight, we’re grateful to have accomplished so much in such a short amount of time.”Sam Dominguez, MD
What our coronavirus response means to patients and the community
The collaborative efforts of experts across our hospital has led to increased access to COVID-19 testing and availability of antibody-rich convalescent plasma for critically ill patients. These efforts have benefited our patients and their families as well as our care team members and adult patients receiving treatment outside our hospital walls.
Children’s Colorado continues to adjust processes as necessary to limit the spread of infection and ensure the safety of team members, patients and the broader community.
In addition, COVID-19 prompted us to quickly ramp up our existing telehealth services within Children’s Colorado, which has led to valuable insights on its use. Our ability to rapidly provide increased access to virtual care across various specialties during the COVID-19 pandemic has proven that telehealth is an effective healthcare delivery method that has become a new standard of care.
As we continue to learn more about COVID-19, we are committed to sharing our knowledge with all healthcare providers by providing resources for healthcare professionals.
We also continue to investigate innovative methods of responding to the COVID-19 pandemic through review of the growing body of COVID-19 clinical research as well as our own research efforts.
Scientific advisory council
Rapid-cycle review of a growing body of evidence is informing how Children’s Colorado protects team members and delivers the best possible care during COVID-19 operations. More than 40 experts across Children’s Colorado have joined together to track more than 250 new articles released daily about the 2019 novel coronavirus. Four working groups rapidly review evidence to answer clinically and operationally relevant questions:
- Clinical course and epidemiology: Edwin Asturias, MD, and Justin Lockwood, MD, lead this workgroup. It outlines the natural course of COVID-19 disease in children, with a focus on factors that predict worsening pulmonary, hematologic or immunologic status. Through improving our understanding of these factors, this group’s work guides clinicians in the timing of evaluation and management of patients throughout the phases of illness.
- Diagnostics: Donna Curtis, MD, MPH/MSPH, leads this work group. It is reviewing the test characteristics and appropriate allocation of use of serologic and diagnostic assays to help guide decision-makers in determining appropriate use of these tests.
- Clinical management/therapies: Juri Boguniewicz, MD, and Robert Fuhlbrigge, MD, PhD, lead this workgroup, which continues to synthesize the rapidly evolving literature on antiviral and adjuvant therapies, including anti-inflammatory medications, convalescent plasma, corticosteroids and anti-coagulation. The Scientific Advisory Council is compiling the clinical guidance documents iteratively updated by this team into an overall pathway for pediatric patients at Children’s Colorado.
- Infection control: Suchitra Rao, MD, leads this workgroup, which has focused on improving the safety of providers in various clinical settings, including during minimally invasive surgeries. Recently, this group has focused on a QI project assessing the negative predictive value of a SARS-CoV-2-negative nasal wash in a child with no COVID-19 symptoms. The plan is to use the results of this project to help make operating room operations more efficient.
The advisory council is chaired by Marion Sills, MD, MPH, pediatric emergency medicine and Eva Nozik Grayck, MD, pediatric critical care.
Coronavirus research at Children's Colorado
Anschutz Medical Campus COVID-19 Research Consortium
Children's Hospital Colorado and University of Colorado Hospital are collaborating on a new protocol to collect patient electronic health record data and biological samples for analysis. The study is now active at both hospitals, and the first specimens have been collected.
A second collaborative effort is underway to develop a protocol specifically evaluating the risks our own team members face as frontline healthcare providers. The goals are to:
- Determine the incidence of COVID-19 among healthcare workers
- Identify risk factors for severe illness
- Evaluate the humoral and cellular response to SARS-CoV-2
- Characterize the effects of COVID-19 on healthcare workforce capacity
The results of this study will help us protect our team members and guide operational planning into the future. This collaborative approach to understand the clinical characteristics of COVID-19 disease in pediatric and adult populations, as well as the underlying characteristics of patients and their treatment responses, will help us comprehend why children seem better protected from COVID-19. Children are usually one of our most vulnerable populations to viral respiratory infections.
HEROS study
The goal of the HEROS (Human Epidemiology and Response to SARS-CoV-2) study is to learn more about the number of people who may have the coronavirus without knowing it, particularly children. The study will also help us learn how the virus spreads from person to person and the nasal response to the coronavirus. Sponsored by the NIH National Institute of Allergy and Infectious Diseases, the HEROS study is considered mission critical. Andrew Liu, MD, pediatric pulmonologist and Glenn Furuta, MD, pediatric gastroenterologist will lead our participation as one of 11 study sites. National Jewish Hospital is the lead lab for the study.
Treating COVID-19 lymphatic clots and airway plugs
Patients with severe COVID-19 have small clots in their blood vessels and fibrin plugs in their airways. Through work with the Airway Research Center, Livia Veress, MD, has shown in animal models that using a clot-busting drug (alteplase) can treat the airway plugs that develop after sulfur mustard gas exposure. Dr. Veress and Deborah Liptzin, MD, have also used alteplase to treat children with plastic bronchitis (small lymphatic clots in the airways). They are developing protocols to treat patients with severe COVID-19 disease with alteplase both in the lungs and intravenously. They are also providing guidance to adult and pediatric providers throughout the country on how to use these drugs.
Airway Inflammation, Resilience and the Environment (AIRE) Research Program updates
Children's Colorado is the clinical performance site for the NHLBI-sponsored program project grant “Defining Molecular Phenotypes of Exacerbation Prone Asthmatics” and is now COMIRB-approved to convert to tele-research and add COVID-19 surveillance. We have long been interested in the determinants of airway inflammation versus resilience to common cold viruses. Molecular phenotyping and translational research can lead us to new therapies and prevention for severe respiratory viral illness, asthma exacerbations and perhaps the common cold.
Role of SARS-CoV-2 virus in activating the complement immune system
Endothelial cells play a key role in activating complement. Kurt Stenmark, MD, and team are studying whether the SARS-CoV-2 virus, in conjunction with hypoxia, might be acting on endothelial cells to activate complement, and whether anti-complement therapies aimed at the pulmonary vascular endothelium might help. Dr. Stenmark’s team received a $200,000 grant from the American Lung Association to support this research.
“A lot of people who come in with COVID-19 are severely hypoxic,” Dr. Stenmark says. “We’re seeing evidence of vascular involvement, severe endothelial injury and cell death, inflammation and thrombosis. A lot of the same stuff we see in pulmonary hypertension.” Read related research.
Navajo Nation Community Asthma Program Research
We have added COVID-19 surveillance to our current NHLBI-sponsored grant focused on asthma management with a cohort of children from the Navajo Nation and their families. The prevalence of asthma in children from the Navajo Nation is nearly 20%, which is double the U.S. prevalence. National Jewish Hospital is also highly involved in this work, serving as the principal investigator for this study. Our goal is to improve resources to better manage asthma and coronaviruses for the Navajo Nation, where COVID-19 infection and death rates per capita are much higher than surrounding communities.
Defining Molecular Phenotypes of Exacerbation Prone Asthmatics (ENIGMA)
This twelve-month surveillance study was added to an existing study focused on the impact of rhinovirus on asthma severity. The study compares pre-pandemic, current and post-pandemic environmental exposures, lung mechanics and asthma severity among non-infected, symptomatic and symptomatic SARS-CoV-2 infections. Researchers analyze cellular and gene expression responses to SARS-CoV-2 and other common respiratory viruses, enabling the team to investigate factors contributing susceptibility or resilience to these viruses in children with asthma. The allergy and immunology investigator is Andrew Liu, MD.
COVID-19 in type 1 diabetes
The Centers for Disease Control and Prevention reports that individuals with diabetes are at high risk for severe illness and poorer health outcomes with COVID-19. Research suggests this might be due to poor glycemic control or chronic hyperglycemia, yet information on clinical outcomes specifically for patients with type 1 diabetes who have confirmed cases of COVID-19 is limited.
To learn more, the Barbara Davis Center for Childhood Diabetes at the University of Colorado, the primary type 1 diabetes service provider for Children’s Colorado, helped rapidly form a national COVID-19 registry. “In partnership with other U.S. pediatric and adult diabetes clinics, the registry helps pinpoint factors associated with poorer outcomes,” says pediatric endocrinologist Todd Alonso, MD.
An early publication from the registry last August demonstrated poor outcomes and symptoms in patients with type 1 diabetes. A third of patients in the study developed diabetic ketoacidosis, or DKA, a life-threatening illness often precipitated by other illnesses. Subsequent studies showed clear inequities in those who were hospitalized and developed DKA, particularly Black and Hispanic patients, mirroring observations in other patient populations. The registry has also studied new onset diabetes during the COVID-19 pandemic. It found that patients were very sick at onset, suggesting healthcare access has significantly suffered. “These papers show that DKA is a big risk for this patient population,” Dr. Alonso says. “It’s more important than ever to optimize blood sugar management.”
Sniffing out COVID-19
Basic science research on SARS-CoV-2 in adults shows that the virus attacks nerves in the nose called the olfactory bulb, causing a dramatic change in sense of taste and smell. It seems to be an early sign of infection, developing sooner than more severe symptoms. Little is known about how the virus affects kids. But, if kids’ symptoms are similar to adults’ symptoms, could sense of smell be an effective way to screen kids before they start their school day?
That’s a question that researchers at Children’s Colorado are asking, and they’ve secured $150,000 over two years to find out. Led by pediatric otolaryngologist Sarah Gitomer, MD, the study is administering a 40-question scratch-and-sniff quiz to a sample of patients who’ve received a COVID-19 test from Children’s Colorado, regardless of whether that test was positive or negative. Researchers are hoping to learn:
- how the virus affects kids compared to adults
- whether scratch-and-sniff tests can be an effective screening tool
- if certain smells are more effective than others
This collaborative effort has been made possible with essential contributions from across the Anschutz Medical Campus.
Treating COVID-19 lymphatic clots and airway plugs
Patients with severe COVID-19 have small clots in their blood vessels and fibrin plugs in their airways. Through work with the Airway Research Center, Livia Veress, MD, has shown in animal models that using a clot-busting drug (alteplase) can treat the airway plugs that develop after sulfur mustard gas exposure. Dr. Veress and Deborah Liptzin, MD, have also used alteplase to treat children with plastic bronchitis (small lymphatic clots in the airways). They are developing protocols to treat patients with severe COVID-19 disease with alteplase both in the lungs and intravenously. They are also providing guidance to adult and pediatric providers throughout the country on how to use these drugs.