This page was updated on March 31, 2020. Due to the shifting nature of the coronavirus pandemic, recommendations can change quickly. Please follow all rules and guidelines set by your state and local public health and safety authorities. Reference the Centers for Disease and Prevention Control (CDC) and the Colorado Department of Public Health and Environment (CDPHE) for immediate updates on COVID-19.
We know that healthcare professionals are getting many questions from patients and their families regarding the coronavirus (COVID-19). We will maintain important and timely information here and through our Epidemiology Alert. Please use PedsConnect or Children's Colorado Connect to view the Epi-Alerts. Contact Physician Relations if you would like to set up an account to view this information.
What is COVID-19 and where did it come from?
SARS-CoV-2 (the 2019 novel coronavirus) is a coronavirus identified as the cause of a respiratory illness outbreak first detected in Wuhan City, Hubei Province, China beginning December 2019. The illness it causes has been named COVID-19 (COronaVIrus Disease-19).
The World Health Organization (WHO) has confirmed over 719,000 cases worldwide and over 33,000 deaths. The majority of deaths have occurred in elderly people over the age of 65 and patients with underlying medical conditions.
How might this affect children with chronic illnesses?
We understand that your primary questions for our experts are likely around children with chronic illnesses or other health conditions. Fortunately, current information suggests that children are unlikely to become severely ill with the coronavirus (COVID-19).
However, children with certain underlying conditions may be at higher risk, specifically those children with problems that impact the heart, lungs or ability to fight infection. Examples of conditions include:
- Chronic lung disease
- Heart disease
- Neurologic conditions (including muscle disorders)
- Immunodeficiency conditions
- Organ transplant
- Cancer treatment
- Treatment with medications that lower the immune system
If your patients have any of the above conditions, below are general recommendations:
We do NOT recommend your patients stopping any long-term medications. Maintaining good control of underlying conditions is one of the best strategies to avoid more severe coronavirus. Avoiding flares of underlying disease will help prevent unnecessary trips to the hospital, where ill patients are likely to be seeking care. It's a good idea to make sure your patient's parents have refilled their child's prescriptions and have at least a two-week supply of medications on hand.
Routine clinic visits
To maximize social distancing and keep our patient families safe, many of our non-urgent appointments are being postponed or converted to telehealth visits. Learn more about our temporarily closed locations and other important updates.
Most schools are currently closed in compliance with directives from local public health departments, which are assessing community risk of the coronavirus.
We currently recommend against travel. Staying at home is the best way to protect kids and families from getting sick.
The outbreak could last for a long time. Public health measures, such as shelter-in-place, are intended to reduce person-person contact.
Encourage your patients and their families to stay at home, as that is the safest option to avoid exposure. Ensure they first have sufficient stock of prescription medications, over-the-counter medications, medical supplies, household items and groceries.
If your patient has symptoms of a cold but it is not an emergency, call their care team at Children's Colorado to get advice. Remember that influenza and other respiratory viruses that are not COVID-19 are still making children ill in the community and are the most common causes of fever and respiratory symptoms.
Most patients with the coronavirus are not sick enough to require hospitalization or an emergency department visit and can be managed at home. We prefer to keep your patients away from the hospital unless there is a medical emergency.
Families with children with a central line should continue to follow normal guidelines for management of fever.
About the coronavirus (COVID-19)
The full extent of the clinical spectrum of infections due to SARS-CoV-2 is not known. Reported COVID-19 cases have ranged from people with little to no symptoms to people being severely ill and dying. The most common presenting symptoms are fever, cough, myalgias, fatigue, shortness of breath, and loss of sense and smell. A few patients have reported headaches and diarrhea. Up to 70-80% of people infected have mild symptoms.
The overall case fatality rate is currently estimated to be approx. 1-2%. The majority of deaths have been reported in people older than 65 years of age or with underlying medical conditions.
There is very limited data about pediatric cases. There are case reports of asymptomatic children, children with mild upper respiratory tract infections and children with pneumonia requiring hospitalizations. There have been no reported pediatric deaths. Similarly, there have been only a few pediatric cases with MERS and previous SARS outbreaks. It is unclear if this is related to exposure to virus or differences in physiology of children.
The current estimates of the incubation period of the virus (time from exposure to development of symptoms) is 2-14 days. Recent data from China suggest that the recovery time for those with mild disease is about 2 weeks and for those with severe or critical disease about 3-6 weeks. Several reports suggest the potential for clinical deterioration of infected patients during the second week of illness.
Analysis of the genetic tree of the virus is ongoing, but early studies suggest that it likely originated from a bat virus. The virus likely originated from an animal source that "jumped" into the human population. However, the virus is now spreading from person to person.
The current estimated basic reproductive number (R0), a measure of how many additional persons an infected person can spread the disease to, is somewhere in the range of two to five. This makes SARS-CoV-2 more easily transmissible than SARS-CoV or pandemic influenza but less transmissible than measles which has an R0 of 12-18.
Currently, it is thought that the virus likely spreads through respiratory droplets produced when a person coughs or sneezes, similar to how other respiratory pathogens spread. Additional potential modes of transmission include fecal-oral (the virus has been isolated from stool specimens) and from contact with fomites (although at this point in time it is not clear how long the virus can survive on surfaces outside of the body). Because the transmission dynamics are not definitive the personal protective equipment recommendations for healthcare workers include airborne protection with N95 masks or PAPRS.
Recent data supports that persons infected with SARS-CoV-2 can transmit the virus before developing clinical symptoms. Other viruses such as seasonal influenza virus also have the ability to spread before onset of clinical symptoms.
The CDC has issued a Travel 3 travel warning to many countries in Asia and Europe, recommending travelers avoid all nonessential travel to these countries. The CDC has also issued a Travel 2 warning for all travelers, asking they monitor their health and practice social distancing for 14 days after returning from travel.
Similar to preventive methods to prevent the spread of other respiratory viruses, the CDC recommends:
- Practice good hand hygiene.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Cover your cough and sneezes.
- Avoid close contact with people who are ill.
- Influenza vaccination for everyone six months and older.
- Stay home when you are sick.
The CDC does not recommend wearing isolation masks outside of a health care setting. Additionally, when widespread community rates of SARS-CoV-2 occur, social distancing measures should be encouraged.
On March 11, 2020, the WHO declared the COVID-19 outbreak a pandemic. Based on current information, the immediate health risk to the general public in the U.S. is thought to be low at this time. However, with recent developments of sustained local transmission in several countries outside of China, the likelihood of eventual widespread community spread of COVID-19 in the US is high. The CDC has encouraged individuals, businesses and healthcare systems to prepare for this possibility.
This respiratory season, the CDC estimates there has been 29 million flu illnesses, 280,000 hospitalizations, and 16,000 adult and 105 pediatric deaths due to influenza. The overall case fatality rate from influenza is estimated to be less than 0.1%. In contrast to influenza, there is no natural immunity to SARS-CoV-2 in the U.S. and there are no antivirals or vaccines. SARS-CoV-2 is estimated to have a case fatality rate 5-20 times greater than influenza.
Testing and treatment for the coronavirus
If you are concerned that a patient might have COVID-19, you should immediately place an isolation mask on them and anyone accompanying them (family, relatives, etc.). Place any suspected patient and family or visitors in a private room with the door closed or in a negative pressure room if available.
All healthcare providers entering the room to evaluate a suspect patient should wear a gown, gloves, isolation mask (N95 mask or PAPR if available), and eye protection (goggles or face shield; glasses are not sufficient).
Notify your local health department or the CDPHE to discuss the patient and potential need for testing. If you need to send a patient you suspect might have a COVID-19 infection for further evaluation and/or treatment, call our Infectious Disease team via OneCall (720-777-3999 in Denver Metro or 719-305-3999 in Colorado Springs).
We request that patients sent for evaluation are sent only to the Anschutz Medical Campus emergency department or the Colorado Springs hospital emergency department after prior notification via OneCall.
Identifying persons infected with SARS-CoV-2 is strongly encouraged. Patients should be considered at possible risk for infection if they meet the following criteria:
- Have fever OR respiratory symptoms such as cough or difficulty breathing AND
- Have a history of travel to a country with known community transmission OR close contact with a person under investigation (PUI) for COVID-19 in the last 14 days before symptoms onset.
- Have a fever with severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization and without an alternate explanatory diagnosis (e.g., influenza).
The respiratory pathogen panel (RPP) utilized at Children's Colorado is able to detect four of the common respiratory coronaviruses (human coronaviruses HKU1, NL63, OC43 and 229E) that circulate every year in the U.S. and are known to usually cause mild upper and lower respiratory tract infections. Therefore, it is not able to detect the novel COVID-19.
Currently, the only test available in the U.S. capable of detecting SARS-CoV-2 is a PCR test performed at the CDC and CDPHE. Testing for common causes of respiratory symptoms and pneumonia (with an RPP and/or chest radiograph) is recommended as part of an evaluation of a person under investigation for the SARS-CoV-2.
Currently there are no antivirals or vaccines available for COVID-19. Treatment at this point is primarily supportive care. Clinical trials evaluating the use of remdesivir, an investigational antiviral drug, and lopinavir-ritonavir, a licensed HIV medication, are currently being conducted.
Several research groups are actively working on the development of a SARS-CoV-2 vaccine, but this is many months away.
Hospitalization is based on need for appropriate level of care. Patients meeting clinical criteria for admission will be cared for in negative pressure rooms with staff adhering to N95/PAPR airborne precautions.
Information from Children's Colorado
Team members at Children's Colorado are meeting regularly to update and further develop our preparedness and response plan building upon our current processes to screen for contagious illnesses and protect patients, families and healthcare workers. Some of our current measures include:
- We have closed select locations to consolidate clinical services, and limit appointments and elective procedures, surgeries and diagnostic radiological studies.
- Travel screening questions for all patients, family members and visitors arriving at Children's Colorado have been updated to include risk factors for COVID-19.
- Personal protective equipment (PPE) conservation strategies have been implemented due to global shortages.
- Surge planning protocols are being reviewed and revised.
We are working closely with our public health partners regarding communication strategies and utilization of pre-hospitalization services such as nurse call lines. Our free ParentSmart Healthline is available 24/7 at 720-777-0123 to help answer health questions and has been updated with current COVID-19 recommendations.
Additional COVID-19 professional resources