COVID-19
Frequently Asked Questions (FAQs)

• There are 170 cases in the whole hospital
• 49 cases in the ICU
• No pediatric ICU cases
• 1 hospitalization in Peds, which is not in the ICU, and is of an immunocompromised patient on immunotherapy
  • Doing well overall, on antibiotics
• 7000 cases in Massachusetts
  • Only 122 are kids, none in the ICU
• Take home: children are not getting critically ill
  • Theoretically, the ACE2 receptor is not as expressed in kids, preventing the virus from entering their cells
• This data is similar to data from Seattle, Italy, and China
  • Confirmed via personal communication with physicians from each of those regions
• Children under 1 are at higher risk
  • 11% are requiring hospitalization, oxygen, and critical care

• No! The PICU is relatively empty. Not full of kids with COVID!
• If the adult ICUs get full, the PICU as we know it will close
  • The PICU will be moved to Ellison 17 so there still will be ventilators if your child needs a ventilator

• Nebulizers could spread particles throughout the room faster than typical as this virus is spread via droplets
• A nebulizer will spread it faster than an inhaler
• When starting patients on one of these treatments, we will start on inhalers now rather than nebs
• The nebulizer doesn’t make COVID worse, it just spreads it to others faster
• Children on these at baseline (CPAP/nebs) should continue on their current treatment to optimize lung health
• Children with severe sleep apnea are being delayed in terms of their surgery
  • CPAP/BiPAP are kept on these if they needed it

• If the child is safe and on a preventative medicine only, then yes, switch
  • But they need to be old enough to tolerate this.
• If they have been on Flovent, budesonide, in the past two years, then we would resume this.

• We are still seeing patients in the office as needed. The patients we see include:
  • Patients with frank airway distress.
  • Those that need swallow studies to assess aspiration
• Zoom calls are very helpful for this, email or call so we can help take care of your child.
  • We can even evaluate (to some degree) stridor
  • Can get basic swallow information as well
• Sleep apnea can go untreated safely for a period of time. As long as the kids are ventilating well, they are ok for that period of time

• In an ideal world, we would test everybody but for now, as testing ramps up, we are testing patients who meet specific COVID criteria
• We are managing some kids with resp infections from home via Zoom or with help of PCP.
• There are also various urgent care clinics
  • RIC clinic (any family member who is sick), 7 days a week
    • If child is sick and parent is sick, then more likely COVID
    • If child alone is sick, then likely rhinovirus
  • Trying to keep kids and families away from ERs

• To limit exposure, we are not recommending transfer unless necessary
• If the local provider feels uncomfortable, then we would recommend transfer
  • We are also helping manage many of these children by communicating with the local provider via Zoom or other means

We can help pediatric anesthetists remotely should they have questions so we can discuss how to secure the airway

• No shortage of steroids
• As of now, no shortage of ventilators

• Children that need JRRP treated to breathe… we are testing these kids for COVID-19 prior to the OR to ensure safety
  • So kids who have papilloma, have stridor, can get expedited testing to ensure they have results before OR
  • If not, we will just treat them as if they are positive

• Other viruses (other than flu), it’s more common for other viruses to trump COVID
• Flu is less likely now that we are in April

Likely not, children are vectors but not affected as much.

Unsure, we just don’t have the data yet.

NO! Don’t postpone, its actually more important than ever to get these kids vaccines!

• Most agencies have PPE requirements for nurses going into the home.
• Its personal, are you comfortable with the nurse, etc.
• We are trying to keep nursing in the home, as parents need it
• There are guidelines in place
  • Most agencies have a symptom check everyday before they go to work
  • Its up to the agencies re: what PPE the nurses are using
  • Just a surgical mask typically, not n95s

• The NICU is seeing lots of kids with COVID
• 11% of kids under 1 required hospitalization, oxygen and some of these required critical care
• This is similar to other viruses because neonates and infants are more fragile.

• It’s important to be safe now.
• Careful for neonates, pulmonary issues and lung disease
• Touch base with a pulmonologist to make sure your meds are optimized.
• Don’t stop inhaled steroids

• Safe and important otherwise everyone is going to go nuts
• It’s important for both mental and physical health!
• Lots of playgrounds are shut down now.
  • Maintain physical, not social distance

We will have a better handle next summer hopefully.

• Not necessarily. For management of the cleft, we thin their diet in the spring, thicken over the winter
• Until the crisis is over, we won’t do aggressive thinning