Children's Hospital Colorado

COVID-19 FAQs for Healthcare Professionals

This page was updated on May 18, 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.

About the coronavirus (COVID-19)

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 Europe. 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.

Currently, it is thought that the virus spreads through respiratory droplets produced when a person coughs or sneezes, similar to how most other respiratory pathogens spread. Additional potential modes of transmission include being in close contact (within 6 feet) with an infected person, and from contact with surfaces on which the virus is present (fomites). 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.

Recent data support that persons infected with SARS-CoV-2 can transmit the virus before developing clinical symptoms, and transmission from persons who remain asymptomatic may be a significant problem and risk for healthcare workers specifically. Other viruses such as seasonal influenza virus also can spread before the onset of clinical symptoms.

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.

There is far less data available on clinical presentation of children with COVID-19. 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).

There have also been numerous reports of loss of sense of smell. Some patients have reported 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 currently estimated to be approximately 5%, but this statistic 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 fatality rate for people younger than age 30 is 0.2%.

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. Some of the presenting features include those of Kawasaki syndrome such as rash, conjunctival inflammation, prolonged fever, mucosal changes and extremity edema.

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

The Children’s Hospital Colorado Scientific Advisory Council on COVID-19 is developing a clinical care guidance for MIS-C based on local and international expertise and the evolving evidence on this condition. 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 related to the coronavirus. There is a strong association between MIS-C and COVID-19 in terms of timing as well as geographical association. There is a suggestive relationship between the two; however, this a new and evolving situation that we continue to monitor and learn more about.

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.

Many large children’s hospitals in the U.S. have not reported MIS-C because it is very rare – despite seeing high numbers of cases of COVID-19.

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.

The CDC recommends face coverings as a way of reducing spread of respiratory droplets from the wearer and potentially reducing face touching. Face coverings should not be considered effective at protecting the wearer from transmission from an infected source. 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 UV 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 four wears out of the mask before needing to discard.

Our teams are also working to supply pediatricians and their staff with face shields. Please submit a request and let us know the quantity you would like (one per provider). We cannot guarantee you will receive your requested amount, but we will respond to your request within 48 hours.


Testing and treatment for the coronavirus

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.

Alternatively, if you determine through telemedicine 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).

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. 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. N95 masks can potentially be sterilized for multiple-day wear. Face shields should be cleaned in between patients. The use of gloves and/or strict hand hygiene are also very important personal protections.

In some countries, where healthcare workers used only simple face masks and strict hand hygiene for suspected COVID-19 outpatients, there has been minimal to no healthcare worker transmission.

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.

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 to patients with a provider order.

See additional testing sites from CDPHE.

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.

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.

Although there is active research on possible treatments for COVID-19, the NIH currently does not support routine use of antivirals in clinical care. Treatment at this point is primarily supportive care. See the NIH treatment guidelines for COVID-19.

Several research groups are actively working on the development of 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).

COVID-19 resources from Children's Colorado

Leaders 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:

  • Although we temporarily closed select locations to consolidate clinical services, we began a phased reopening in late April. Watch a video about our plans for reopening.
  • 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 in nonclinical roles are required to wear cloth face coverings.
  • 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 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.

How can the CARES Small Business Economic Disaster Loan Program help?

President Trump signed the CARES (Coronavirus Aid, Relief and Economic Security) Act on March 27, 2020. This Act provides small businesses (<500 employees) with working capital loans up to $10 million to help them overcome the temporary loss of revenue. These funds must be used to retain workers by maintaining payroll, pay mortgage interest, lease and utility payments.

There are many key requirements and loan terms that our team has detailed for your reference. Please review our CARES Act information (.pdf) in detail and email our Physician Relations team with any questions.

Additional Children's Colorado resources