COVID-19 FAQs for Healthcare Professionals

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 epicenter of the outbreak is now in the United States and Americas. The illness it causes has been named COVID-19 (COronaVIrus Disease-19).

Get up-to-date information on the number of confirmed cases, deaths and people recovered from the Johns Hopkins Coronavirus Resource Center. Note that the majority of deaths have occurred in elderly people over the age of 65 and patients with underlying medical conditions.

Analysis of the genetic tree of the virus is ongoing, but early studies suggest that it likely originated from a bat virus that "jumped" into the human population through an intermediate host. While it is not uncommon for animal viruses to infect humans, in the vast majority of these instances they do not spread efficiently within human populations. SARS-CoV-2, however, shows efficient human-to-human transmission, resulting in the current pandemic. Evidence has proven incorrect the theory that COVID-19 is a product of laboratory engineering.

The virus spreads through respiratory droplets produced when a person coughs or sneezes, similar to how most other respiratory pathogens spread. There is evidence that transmission can occur due to aerosolized droplets at distances greater than 6 feet, particularly in enclosed spaces with poor ventilation. In experimental laboratory conditions, the virus has been shown to survive on some surfaces for up to 3 days, with an average survival time of 2-6 hours. This means that transmission is possible from contact with surfaces on which the virus is present (fomites). However, the biggest risk factor for transmission is prolonged, close exposure to an infected person.

Persons infected with SARS-CoV-2 can transmit the virus before developing clinical symptoms, and transmission from persons who remain asymptomatic remains a significant concern. Other viruses such as seasonal influenza virus also can spread before the onset of clinical symptoms.

Reported COVID-19 cases have ranged from people with little to no symptoms to people being severely ill and dying.

Although the most common symptoms in all aged patients appear to be fever, cough and shortness of breath, these may be less common in children. (source: CDC MMWR April 5, 2020 Vol. 69).

Additional symptoms include loss of sense of taste and smell, myalgias, sore throat, headaches, vomiting and diarrhea. Up to 70-80% of people infected have mild to moderate symptoms. Some infected patients are completely asymptomatic.

The overall case fatality rate is uncertain because true population prevalence has likely been underestimated with a bias toward testing moderately- to severely-ill patients. The majority of deaths have been reported in people older than 65 years of age or with underlying medical conditions.

The preponderance of existing evidence continues to suggest that most children with this infection have a mild course.

The current estimates of the incubation period of the virus (time from exposure to development of symptoms) is 2-14 days with a median of 5 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.

Starting in late April, clinicians in several countries, including the eastern United States, have reported several dozen cases of children presenting with a severe inflammatory syndrome with a laboratory-confirmed case of COVID-19 or an epidemiological link to a COVID-19.

The inflammatory disease is called multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). It has some similarities to Kawasaki disease, an illness that is most common in young children, as well as some characteristics of toxic shock syndrome. The most common presenting symptoms of MIS-C are fever, tachycardia, gastrointestinal symptoms, and conjunctival injection. Many children have evidence of cardiac dysfunction. This syndrome appears to be rare in children. Although the majority of children with MIS-C require intensive care, mortality appears to be low.

Case definition for multisystem inflammatory syndrome in children (MIS-C) from the CDC

• An individual aged <21 years presenting with feverⁱ, laboratory evidence of inflammationⁱⁱ, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
• No alternative plausible diagnoses; AND
• Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

_{ⁱFever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours ⁱⁱIncluding, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin}

Additional comments from the CDC:

• Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C
• Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection

For questions about potential patients with this condition, please call our Infectious Disease team via OneCall (720-777-3999 in Denver Metro or 719-305-3999 in Colorado Springs).

Download a PDF from the Royal College of Paediatrics and Child Health Guidance for more information on MIS-C.

Is MIS-C related to COVID-19?

We still don’t know if multisystem inflammatory syndrome in children is caused by coronavirus, but there is a strong association between MIS-C and COVID-19 in terms of timing as well as geographical association. The evidence points to MIS-C being a postinfectious, inflammatory process related to COVID-19.

What separates MIS-C from COVID-19?

A child can just have COVID-19 but not MIS-C. Some of the children who have been reported to have MIS-C have tested positive for COVID-19, and others have not.

Listen to our Charting Pediatrics podcast where pediatric experts discuss MIS-C.

Similar to preventive methods to prevent the spread of other respiratory viruses, the CDC recommends:

• Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
• Avoid touching your eyes, nose and mouth.
• Cover your cough and sneezes.
• Clean and disinfect frequently touched and dirty surfaces.
• Avoid close contact with people who are ill, and practice social distancing.
• Get the influenza vaccination for everyone 6 months and older.
• Stay home when you are sick.

We strongly recommend face coverings as a way of reducing spread of respiratory droplets from the wearer and potentially reducing face touching. Face coverings are required for visitation to any Children’s Colorado facility. Social distancing measures should be encouraged, and all local and regional orders should be followed.

We’re helping community providers with N-95 mask decontamination and face shields

We’re offering decontamination of N-95 masks to community providers. This process helps to conserve and safely extend the life of N-95 masks, allowing the user to get multiple wears out of the mask before needing to discard.

 

The guidance for infection control regarding COVID-19 is evolving and dependent on availability of PPE. The AAP, CDC and CDPHE have interim guidance, which is updated frequently.

How individual primary care practices handle infected or potentially infected patients is dependent on many factors, including availability of PPE and the physical environment of the practice. In general, at this time, it is best to keep patients with mild to moderate symptoms out of the office through use of telemedicine or telephone triage. Patients with more severe symptoms may be evaluated in the office to see if they may warrant admission. See our telemedicine resources for primary care providers during COVID-19.

For questions about the evaluation of suspected patients with COVID-19, you can call our Infectious Disease team via OneCall (720-777-3999 in Denver Metro or 719-305-3999 in Colorado Springs).

For patients seen in the office with suspected COVID-19, we recommend using the best infection control practices available at your office. The use of a standard isolation mask is appropriate in most clinical situations. N95 masks provide additional protection against aerosolized particles. N95 masks can potentially be sterilized for multiple-day wear. 

If paired with a face shield that extends low enough to cover the mask, a mask can be used in between patients for an entire day. Face shields should be cleaned in between patients. The use of gloves and/or strict hand hygiene are also very important personal protections.

Studies examining COVID-19 transmission in healthcare environments suggest that standard isolation/surgical facemasks and eye protection are sufficient for prevention of transmission during routine care and examination of patients.

Disposable gowns are not frequently available in community practices. Washable scrubs are a great option and can be washed in hot water and reused. To protect family members, exterior clothes worn during clinic should be removed along with shoes before entering the house. The clinician can then shower/change.

The highest priorities for testing include patients needing to be hospitalized, patients undergoing general anesthesia (because intubation is high risk for transmission) and healthcare providers with symptoms. If you are an EMS or pediatric healthcare provider exhibiting symptoms, you can be tested at Children's Colorado's test site with a referral or order.

Learn more about our test scheduling and result reporting criteria for SARS-CoV-2 testing.

Other priority populations include patients in long-term care facilities with symptoms, patients over 65 years old or with underlying conditions with symptoms, first responders with symptoms, people with symptoms who work with vulnerable populations or in group residential settings, and critical infrastructure workers with symptoms.

More widespread testing of symptomatic patients, even if mild, is critically important for case identification, isolation and contact tracing. Children’s Colorado now offers drive-through testing for your patients with a provider order.

See additional testing sites from CDPHE.

Yes; serologic testing is available as of May 26. Providers will order the lab like any other Children's Colorado lab:

• SARS CoV-2 IgG Antibody – LAB9144

Serology is most useful for those patients with a high pretest probability of disease and should only be ordered when it will impact clinical care. In addition:

• Serology testing should not be used to diagnose acute SARS-CoV-2 infection because an antibody response takes about two to three weeks to develop in most people after exposure to the virus.
• Positive serologic results do not imply immunity to the 2019 novel coronavirus and should not be used to make decisions regarding social distancing or PPE use.
• Assays will be run Mondays through Fridays with a next business day turnaround. The recommended assay for most patients is IgG.

If you have questions about serology testing, please contact the Infectious Disease team via OneCall (call 720-777-3999 in the Denver metro area or 719-305-3999 in Colorado Springs).

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. The current panel does not detect SARS-CoV-2. However, beginning November 17, we will transition to a newer version of this panel (RPP2.1) which will detect. SARSCoV-2 in addition to the other endemic coronaviruses.

The AAP and WHO have stated that as of April 3, 2020, there is not enough evidence to recommend against using ibuprofen if a patient has a suspected or confirmed COVID-19 diagnosis, unless the patient has an underlying medical condition that makes ibuprofen less safe.

Please reference our Clinical Care Guidelines (.pdf) for full details.

Over the past several months there has been extensive research into treatments for COVID-19. Recent studies indicate that both dexamethasone and the antiviral remdesivir provide benefit in the treatment of patients with acute, severe infections with SARS-CoV-2. Research for other possible treatments for COVID-19 are ongoing.

There is a large international effort to develop a SARS-CoV-2 vaccine, but this is many months away.

Hospitalization for patients with COVID-19 is based on need for appropriate level of care in an acute care or intensive care setting. For questions on potential admission of patients with known or suspected COVID-19, please call our Infectious Disease team via OneCall (720-777-3999 in Denver Metro or 719-305-3999 in Colorado Springs).

Leaders at Children's Colorado meet 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:

• All team members and visitors are being screened at all entrances to minimize risk of exposure.
• All patients who are admitted to our facilities will be tested for SARS COV2 regardless of presence of symptoms.
• All patients, visitors and team members are required to wear face coverings.

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 for families without a primary care provider. Our team members have all been updated with current COVID-19 recommendations.

Get answers to frequently asked questions about how we’re keeping our hospital safe for patients and families.

Since the onset of the COVID-19 pandemic, we’ve expanded our telehealth offerings to include all of our clinics and specialties. If you have a patient or family you’d like to refer to pediatric specialty care via telehealth, call OneCall at 720-777-3999 (or 719-305-3999 in Colorado Springs), or direct your patient to call our scheduling line directly at 720-777-1234. They can also use our online scheduling request form. Our team will work directly with the family on scheduling from there.

Telehealth allows patients and families to access the same great care as an in-person visit, but from the comfort and privacy of their own home. Conducted through our secure, HIPAA-compliant telemedicine software, video visits are a great option for appointments that cover topics like planning and follow-up. In many cases, with a parent’s help, we can even do detailed examinations — all from miles away.

Our team is actively working to provide you with ongoing updates through various channels for the latest information on COVID-19. Please use the following resources curated by our experts to help you during this pandemic:

Podcasts about COVID-19 epidemiology updates

• Coronavirus: what you need to know (February 13, 2020)
• Important updates for providers (March 5, 2020)
• Coronavirus mitigation phase updates (March 14, 2020)
• (Spanish) COVID-19, una pandemia global (May 21, 2020)
• COVID-19 updates: what we've learned (June 26, 2020)
• COVID-19 and flu season, pediatric updates with Sam Dominguez, MD (September 15, 2020)
• COVID-19 update: where this pandemic is headed for pediatrics (November 4, 2020)

Podcasts about COVID-19 testing, disease course and treatment options

• Recovery from COVID-19 (April 20, 2020)
• Convalescent plasma and antibody testing (April 27, 2020)
• Multisystem inflammatory syndrome in children associated with COVID-19 (May 16, 2020)
• Kawasaki disease or MIS-C: what we are learning about COVID-19 presentation in pediatrics (July 23, 2020)

Podcasts about healthcare delivery during the COVID-19 pandemic

• Innovative approaches to primary care (March 25, 2020)
• Implementing telemedicine during the coronavirus pandemic (March 31, 2020)
• PPE for coronavirus (April 10, 2020)
• Pregnancy and newborn care during the COVID-19 pandemic (May 13, 2020)
• COVID-19 and vaping: a call to advocacy and intervention (September 22, 2020)
• COVID-19 and the pediatric healthcare landscape (November 12, 2020)
• Rebroadcast: Taking care of adult patients during the COVID-19 pandemic (December 2, 2020)

Podcasts about mental health and wellness during the pandemic

• Mental health during the coronavirus pandemic (April 7, 2020)
• Healthy habits during the COVID-19 pandemic (May 19, 2020)
• Pediatrician resilience during COVID-19 (September 29, 2020)

Podcasts about school re-entry and return to sports

• COVID-19 and return to youth sports (June 11, 2020)
• COVID-19 school re-entry guidance (July 1, 2020)
• COVID-19, masks, asthma and the return to school (August 11, 2020)
• COVID-19 and return to sports cardiac screening guidelines (October 7, 2020)

Podcasts about vaccine development

• Operation Warp Speed and the race to develop a COVID-19 vaccine (August 20, 2020)
• Update on COVID-19 vaccine progress (November 20, 2020)

Other podcasts

• How the pandemic accelerated COVID-19 pediatric publications (October 27, 2020)
• Pediatric care for children in foster care during COVID-19 (November 3, 2020)