Interim Physician-in-Chief Dr. James Versalovic and several other Texas Children’s physicians recently published a paper in the Oxford Academic: The Journal of the Pediatric Infectious Diseases Society detailing the clinical course of 57 children with COVID-19 cared for at Texas Children’s at the beginning of the pandemic. Dr. Catherine Foster with Infection Control and Prevention is the lead author of the paper and Dr. Judith Campbell with Infection Control and Prevention is the senior author.

The paper’s overall findings were that most of the children were mildly symptomatic, and only a few patients with underlying medical conditions required hospitalization. System wide, the patient evaluation processes at Texas Children’s allowed for prompt identification and management of patients with COVID-19.

“These outcomes are an affirmation that we were doing what we need to do to provide the best care for patients and their families,” said Campbell, medical director of Infection Control and Prevention. “They tell us that we are identifying patients early and getting them the help they need quickly all while helping to reduce the spread of COVID-19.”

Some key findings of the study, which took place during the first five weeks of the outbreak in Houston include:

Identification process

  • Pre-procedural surveillance testing identified three patients who had no respiratory symptoms
  • The majority (71 percent) of cases presented in the ambulatory setting

Patient demographics

  • Fifty-six percent of all 57 patients were male
  • Median age was 10.7 years (range was 0.1 – 20.2 years)
  • Asthma (12 percent) was the most common underlying condition, followed by sickle cell disease (7 percent)
  • More than half of the cases (54 percent) reported a laboratory-confirmed COVID-19 household contact
  • International travel was reported in two cases (Mexico and Commonwealth of Dominica) and interstate travel in one case (New Jersey)
  • Most patients (83 percent) presented with either fever or cough, including all of the patients who presented to the Emergency Center
  • Fever was reported in 53 percent of ambulatory patients, 90 percent of EC patients, and 25 percent of hospitalized patients

Patient care

  • Six patients were cohorted in the Special Isolation Unit at Texas Children’s Hospital West Campus
  • Half of the hospitalized patients required supplemental oxygen via nasal cannula, and 1 patient was on home bilevel positive airway pressure without supplemental oxygen.
  • No patients required mechanical ventilation
  • The median length of stay was 2 days (range, 1 – 10 days)
  • None of the 57 patients received therapeutic agents to treat COVID-19
  • No patients died

In addition to the data above, the paper evaluated Texas Children’s Hospital’s integrated system approach to the evaluation and management of patients during the COVID-19 pandemic by performing a retrospective assessment of all pediatric patients with COVID-19 cared for through the Texas Children’s system.

COVID-19 was declared a pandemic by the World Health Organization on March 11. As of the beginning of June, the Centers for Disease Control and Prevention reported more than 1.8 million COVID-19 cases and 100,000 plus deaths in the United States. Early reports have provided critical insights on the clinical manifestations of the disease in children. Most children appear to have asymptomatic or mild to moderate respiratory illness, whereas adults, especially the elderly, are more likely to suffer severe respiratory illness and a higher case fatality rate. Given the rapidly evolving nature of the COVID-19 pandemic, data on the epidemiology and clinical course of pediatric patients with COVID-19 in the United States are lacking.

“That’s why it’s so important to document what we are seeing and doing and share these findings with the medical community worldwide,” Versalovic said. “Texas Children’s has been doing this since the onset of the pandemic and will continue to be on the leading edge of scholarship and care of pediatric COVID-19 patients.”

Paper authors include:
Dr. Catherine Foster, Infection Control and Prevention
Dr. Elizabeth Moulton, Infection Control and Prevention
Dr. Flor Munoz, Infection Control and Prevention
Dr. Kristina Hulten, Infection Control and Prevention
Dr. James Versalovic, Interim Physician-in-Chief
Dr. James Dunn, Pathology
Dr. Paula Revell, Pathology
Dr. Tjin Koy, Infection Control and Prevention
Dr. Amy Arrington, Special Isolation Unit
Dr. Lucila Marquez, Infection Control and Prevention
Dr. Judith Campbell, Infection Control and Prevention

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Tuesday, June 23, 2020