What Parents Need to Know About COVID-19, Sepsis, and Children: a Conversation with Dr. Elizabeth Alpern
April 21, 2020
In time for Pediatric Sepsis Week, Sepsis Alliance interviewed pediatric emergency medicine physician Elizabeth R. Alpern, MD, to find out what parents and caregivers need to know about how COVID-19 and sepsis affect children.
Dr. Alpern has been a pediatric emergency medicine physician for over 20 years. She is currently the Division Head of the Pediatric Emergency Medicine Division at the Ann & Robert H. Lurie Children’s Hospital of Chicago and at the Northwestern University Feinberg School of Medicine. She is passionate about researching pediatric sepsis in order to improve the diagnosis and treatment for children who arrive at the emergency department with signs and symptoms of sepsis.
Below is our interview with Dr. Alpern. This interview was edited for length and clarity.
How does COVID-19 present in children? What should parents be looking out for?
We do know that COVID-19 can present in children in similar ways as in adults such as fever, cough, shortness of breath, body aches, and malaise (feeling ill). We also see some children with sore throat, vomiting, or diarrhea. However, fortunately, children are usually less sick than adults.
What is the rate of children getting COVID-19, and of children who contract it who actually need to be hospitalized?
Fortunately, we do know that, internationally and in the United States, children seem to be less severely affected by the SARS-CoV-2 infection, or COVID-19, and we find that the majority of children that we have seen with COVID infections are not severely ill and are able to be cared for at home. There is a small minority of children that do become more severely ill and need hospitalization.
Why are some children more severely affected by COVID-19? Are they children with preexisting conditions?
We have seen that children with other preexisting conditions may have more severe presentation of COVID-19. They can have more severe progression of their symptoms and may need hospitalization.
What conditions would make children more susceptible to COVID-19?
We are particularly worried about children that have underlying immune deficiencies (weak immune system) that would predispose them to having infections. We also know that younger children or infants are at increased risk of severe disease. We also look at other chronic conditions that are also seen in adult patients, such as obesity, or preexisting pulmonary concerns.
What would be an example of a preexisting pulmonary concern?
We don’t have that much information related to those children that are having severe COVID -19 infections, but we suspect that children with preexisting chronic lung disease due to other causes, for example, those with tracheostomy tubes or cystic fibrosis are at more risk. We are worried about their pulmonary function (how well their lungs work) and their ability to maintain that with COVID-19.
Would a child who survived sepsis be more at risk?
We are always worried that people who survive sepsis have some immune deficiencies (weak immune system). Certainly, right after survival, they are maybe more prone to developing other infections and that puts them at increased risk. As with all people with underlining comorbidities (having more than one chronic disease), or other concerns, children who just survived sepsis should be very careful about having exposure to other people who could be sick. They want to be sure to maintain their social distancing. To stay at home as much as possible and not to come into contact with anyone who is ill. This will decrease their exposure to the virus that causes COVID.
We don’t know about the risk of COVID-19 in long-term sepsis survivors who do not have other underlining immune deficiencies.
When should a parent seek medical attention for their child, considering that people are being told not to go to the doctor if they have symptoms of COVID-19?
I think that a good rule of thumb is that if you have concerns and your child has a fever, sore throat, body aches it is always good to contact their primary care doctor to discuss their symptoms and discuss your next options. Primary care pediatricians are becoming more able to provide telemedicine and have the ability to communicate with families related to the current symptoms of their child and help them determine when they should either seek care in person with their pediatrician or come to the emergency department.
If a child is having acute difficulty breathing, is not acting themselves, is lethargic, appears dehydrated then a parent should seek immediate care for their child and come to the emergency department. We are working very hard in the emergency departments to keep the environment safe for your child when you need us.
Have you seen a connection with COVID-19 and sepsis in the patients you are seeing in the emergency department?
In the emergency department, the majority of children we are seeing with COVID infections are able to go home and do not have sepsis. There are a very, very small minority of children who have COVID-19 who have needed to be admitted to the hospital, and a portion of those do have sepsis.
Sepsis is the body’s response to any infection, and it can be a response to the COVID virus infection, just like any other. Fortunately, we really are seeing that children are tolerating this disease process very well with most affected children have only minor illness and can be cared for as outpatients.
Even though children may not show symptoms, they can spread COVID-19 to others – correct?
Anyone who has the COVID-19 virus can pass that on to someone else, even if that person does not have symptoms (is asymptomatic) or has only mild illness. Particularly in families, we worry about anybody who is ill passing that on to someone who can become severely ill with COVID, like older adults, grandparents, and other people who are immune-compromised.
We definitely say that it is best to keep your family unit together, in the sense of not seeing people outside of that unit. That, unfortunately, means that your children may not be able to see their grandparents in person. Luckily, many of us can access social media, zoom, telephone, even mail as ways to stay in communication with family members who are at increased risk and still keep them healthy.
It really is upon all of us to keep our entire community healthy. We do know that there are people who have COVID-19 but don’t have symptoms and they can spread that to somebody who can become severely ill and potentially die.
How long after a child stops showing symptoms of COVID-19 do they stop being contagious?
The CDC recommends that you should self-quarantine and stay away from others until you are feeling better, it has been at least seven days after the start of symptoms, and at least 72 hours after the resolution of fever, whichever is longer. These recommendations are always evolving. The CDC is a great website to look at for both sepsis information and COVID-19 information.
What is the one symptom, or combinations of symptoms that would make you think “this child needs to go to the emergency department he has sepsis?
The children that we worry most about with sepsis, in general, are children who have fever, very fast heart rate, aren’t acting themselves, and are lethargic. We call it an acute change in mental status meaning they are just not being their usual self, not even when their fever comes down. Also, when they have signs and symptoms of dehydration and/or significant shortness of breath. Those children we worry a lot about sepsis, and we want to see them in the emergency department. We know that the first hours of care are the most important to start medical treatment for children with sepsis and that has been shown to improve outcomes and decrease mortality in pediatric sepsis.
We want to partner with our families, and with our patients, and if they are worried about sepsis come on in and tell us. They should say to us “this is just very different for my child and I’m very worried about them. I’m worried that this could be sepsis.”
If there anything you would like parents to know?
One of the things I want parents to know is that we work best as a team and that we want to partner with parents. We want to understand their concerns, understand what is happening with their child, and how things are different than usual for their child. We want to partner with them for the best care of their child.
In this time of COVID, I understand how hard it is to have children at home and to keep up with our physical and social distancing, but it really is upon us to do this, to take care of our community, to take care of our children who are at increased risk for COVID-19 and sepsis, and to take care of those in our families who are also at risk for very serious disease in this situation. But we are here for you and your child if you need us.