Kids & COVID: An Update

What have we learned about COVID-19's effects on kids and teens since the start of the pandemic?  What do parents need to know about multi-system inflammatory syndrome in children (MIS-C)?  Do kids need to get the flu shot this year? And how do we keep them safe as they go back to in-person education?

Five months after our initial podcast on kids, adolescents and COVID-19, host Dr. Jonathan Fialkow welcomes back Fernando Mendoza, M.D., medical director of the pediatric emergency department at Baptist Hospital for an update on how the pandemic is affecting kids physically and emotionally, and what parents can do to help them.

For more information about COVID-19 please visit BaptistHealth-coronavirus.com

Transcript

Announcer:

At Baptist Health, South Florida, it's our mission to care for you when you're injured or sick; and help you stay healthy and fit. Welcome to the Baptist Health Talk podcast, where our respected experts bring you timely practical health and wellness information, to improve your family's quality of life.

Dr. Fialkow:

Hello, Baptist Health Talk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a practicing preventative cardiologist and lipidologist, at the Miami Cardiac & Vascular Institute at Baptist Health, South Florida; as well as chief population health officer at Baptist Health. Back in May, we brought you an episode focusing on COVID-19 in children and adolescents; where we talked about how the virus affected children differently from adults. Five months later, we learned a great deal more, and its important information that all parents need to know. I brought back Dr. Fernando Mendoza, medical director of Baptist Children's Emergency Center, and chief of pediatrics at Baptist Hospital. And, we'll discuss some recent research findings, that have physicians very concerned. Welcome to the podcast, Fernando.

Dr. Mendoza:

Thank you very much. Thanks for having me.

Dr. Fialkow:

So, following up in what the original conversations was. Let's talk about again, COVID what we've learned even further regarding the symptoms of COVID in children, adolescents. And then, I want to talk a little bit at the beginning about this, multisystem inflammatory syndrome in children; which is this hyper acute and dangerous situation, which again, made some press. So first going back, again, five months later from our last discussion, what are the symptoms we're seeing in children, and adolescents with COVID, or lack thereof?

Dr. Mendoza:

Well, probably one of the most significant symptoms in kids is, no symptoms. We're seeing a lot of asymptomatic conditions, where kids are coming up positive. And, even when they're just been tested for screening results, or very mild symptoms. It's still proven that... Approval in the beginning was still going on, where kids who are older, get a little more symptomatic; but really young kids may be very mildly symptomatic, with the same kind of symptoms that adults would get; upper respiratory symptoms, maybe sore throat, maybe headache, and most commonly nothing. And as they get older into their teens and early adulthood, the symptoms become more pronounced. Certainly not as pronounced as adults, or even older adults; but certainly much milder, than the adult population.

Dr. Fialkow:

So, I do want to get to some of the dangers in kids, because we don't want to portray this as a completely benign concern in young kids. But, can you tell us a little bit about, what we learned more about this multisystem inflammatory syndrome in children?

Dr. Mendoza:

Yeah. Sure. And, I'll go back to COVID. COVID itself, there have been fatalities, because of COVID in the U.S. And, there are certain high risk populations with the acute COVID presentation, especially asthmatic, obese kids; kids who have chronic medical conditions like cerebral palsy, [inaudible 00:02:50] systems like cancer kids. Those are the ones that are really having a hard time. And, they're getting really, really sick, and admitted to the intensive care unit, and have the same spectrum of with the acute COVID illness. So that pneumonia, as in respiratory failures. MIS-C or multi-system inflammatory syndrome in children, is exactly that. It's an inflammatory syndrome found in kids. And, it doesn't happen with acute COVID, or not with infection to active. It happens anywhere from four to eight weeks, after exposure to COVID, or actually having evidence of COVID.

Dr. Mendoza:

So, really the definition has been shifting a little bit. But, MIS-C is defined specifically by the CDC, as anybody who's less than 21 years of age; so including adolescents who has fever, they have to have some laboratory evidence of inflammation. Oh, but you have to be tested by a physician, or in an ER setting, when you get evidence of inflammation in your body. Evidence of a clinically severe illness requiring hospitalization. These kids get sick, and they have two or more organs that show some sort of dysfunction cardiac, your kidneys, your lungs, your blood, your GI symptoms, your skin. So, the interesting thing here is that most of the kids who get really sick with acute [inaudible 00:04:11] COVID, have underlying conditions. Over 75 percent of the kids who get MIS-C, are perfectly healthy, with no underlying medical condition.

Dr. Fialkow:

So, that's actually a great point, and I'm glad you brought that up. So, you first started by talking about appropriately, the kind of medical disorders that kids may have, which may afford them a more significant COVID course. They'll going to get sicker than kids who don't have things like asthma, and some of the things you mentioned. But, that does not correlate with the MIS-C, right? That's what you said, right?

Dr. Mendoza:

Actually, it's the perfectly healthy kids are becoming infected with MIS-C. The pathophysiology or the way the virus actually induces this multi-system inflammatory syndrome in kids, is still being worked out. But the thought is, that it's not an acute viral reaction. In other words, it's not those spikes on that coronavirus you see in the cartoons or in the drawings, all throughout the last seven months, that are affecting the tissues. It's the antibodies that are created after, in response to that viral infection, there are creating an autoimmune, or immune-mediated as it's called, response; where you really are creating a situation, with causing inflammation in the body. So, it always happens four to eight weeks, one to two months after the infection, or even, I guess, confirmed exposure to COVID.

Dr. Mendoza:

So, you have kids who never have any symptoms of COVID, but we're living with family members with COVID, and have positive COVID illness in the house; and then, they show up with MIS-C in the ER, or in the ICU setting. Or, they had a very mild illness, and they were tested positive; and one to two months later, they present to the emergency room or to the hospital with this syndromes.

Dr. Fialkow:

So, What are the things that parents should look for in their kids, if there's a concern about an MIS-C?

Dr. Mendoza:

First of all, we talk about parents need to realize, this is very rare.

Dr. Fialkow:

Right, I was going to get to the numbers, afterwards. That's great.

Dr. Mendoza:

This is very rare. Okay. Right now, I think the pediatric rate of acute COVID hospitalization, although it's kids who get hospitalized with COVID, that MIS-C is less, it's like eight per 100,000 people in the population. So it's very, very.... For COVID. MIS-C is even less. As of September 17th, which is the last CDC reported data. I think there are 930 or so cases, of MIS-C identified in the entire country. Okay. So, 935 I think. Out of those 19 are confirmed deaths from that; so it's very rare. But, I will tell you that, in any case, anytime your child has had a history of COVID or exposed to someone with COVID, and they have fever, you automatically got to think, could this be as something, that's a little more serious.

Dr. Mendoza:

Some of the most common presenting symptoms in MIS-C, we call it now, the pediatricians are calling it COVID belly, is abdominal pain and GI symptoms. Abdominal pain, vomiting, nausea, the things you normally might mistake for something like appendicitis; when actually fever, and belly pain, and throwing up, in normal times and pre-COVID times, we think, hey this person may have appendicitis, lets get an ultrasound, and do what we do for appendicitis. Many cases, this is really MIS-C presenting. There's actually quite a bit of evidence showing that, or quite a few cases rather, not so much evidence, that the kids are getting [inaudible 00:07:27] and that to me is done in the surgical suite, for suspected appendicitis. And, really what would end up happening is MIS-C. And, they go back in a post-surgical situation, they really have MIS-C, and have a multi-system organ situation.

Dr. Fialkow:

So, I think this is great. I'm really glad you took it in this direction. Part of the idea of the content, of the podcast, we thought was what, was seeing this, this MIS-C, this multi-system inflammatory syndrome in children, MIS-C. And, it's being reported in the papers, the morbidity and mortality weekly report, which is a standard of infectious disease and other diseases comes out, and was talking about it. So, part of it is to let people know what it is, and what to look for. But, the reality is the reassurance that this is very, very, very unlikely for your child, even if the child has COVID or has COVID exposure.

Dr. Mendoza:

True. I'll qualify that by saying, in this day and age, and I think this goes along with part of what we're going to talk about, maybe now, or another podcast you're going to discuss, don't delay care. If there's a situation where you thought your kid, something was off, they have a weird rash and fever, they have a headache and a fever, they have a fever and belly pain; something where you'd normally would have gone to see a physician, go see the physician. This is not a time where you want to delay care, because aside from MIS-C, there's other things that obviously, we're concerned about. With the delay in care that, many parents have been experience, or many patients have been subject too, because of the fear of getting COVID in a hospital setting.

Dr. Mendoza:

So yes, very rare. And by the way, it's very treatable. Most of these kids end up in the ICU setting, or a very closely monitored setting, when they get really sick; and most do very well with the right kind of interventional support.

Dr. Fialkow:

Right. The death rates in children is very low, especially compared to, of the populations and whatnot. So, we talked about, a little bit about COVID, COVID symptoms. Again, we had a podcast about that. We discussed before, a little bit about this MIS-C; again, for the multi-system inflammatory syndrome in children. Because, it's been in the press a little bit based on CERT reports.

Dr. Fialkow:

Now, let's talk about some of that public health type of discussion that you just meant. Let's talk about vaccinations. What would you recommend to the listeners? Because obviously, vaccinations in children and adults are appropriate. They help prevent disease progression. But, people are kind of afraid, if you will. What's the current public policy, and your recommendations regarding vaccinating children during the COVID pandemic?

Dr. Mendoza:

Dr. Fialkow, it's a great question. And, as a practicing pediatric emergency physician, unfortunately I do see kind of the results of undervaccinated or non-vaccinated situation. I say undervaccinated, because there's lots of thoughts about theories, about how you can space out, or skip certain vaccines, or I'll pick that one, and not this one. Those diseases are still out there. Okay. Measles, mumps, pertussis, especially in little kids. Those are real diseases, that cause significant mortality and morbidity. In other words, cause real severe illness; and even sometimes death in kids. And unfortunately, with the stay at home, kind of lockdowns, and with the real advice to stay from outdoors; and parents especially have become very cautious about going to the pediatrician, and I've seen a significant drop in the State of Florida, at least, and certainly across the country in vaccine rates. So April, which is at the very beginning of the COVID pandemic, saw 40 percent reduction in vaccinations, compared to the year before in 2019.

Dr. Mendoza:

That's significant [crosstalk 00:10:56]...

Dr. Fialkow:

Very scary.

Dr. Mendoza:

For a lot of kids in [inaudible 00:10:57]. Most of the vaccinations are given within the first two years of life, which means you have a lot of kids who's immune system still.... And, they're not circulating in the population. Think about kids who stay home, and aren't even exposed to the regular school age, school environment or sports environments. So now, they're going go out and get exposed, and they're not really being protected. My advice is first and foremost, follow up immediately with your pediatrician, get your kids back on that schedule of routine vaccinations, get your flu shot this year; I'm sure that'd be a discussion. I think you had a nice event a couple days ago, discussing this in a public forum.

Dr. Fialkow:

Sure.

Dr. Mendoza:

It was very important, so we get the complications of flu in kids, and with COVID combined would be pretty devastating. And, be on the lookout for those situations, where if your kid is undervaccinated, remember you did avoid the pediatrician, [inaudible 00:11:46] on your way to getting back on a vaccine schedule. These diseases that are out there, measles, those outbreaks in 2018 and 2019. Pertussis, we have periodic outbreaks. We had it in Florida in 2014 and 15, that's whooping cough. Be on the lookout for symptoms, that seem a little unusual, and that you wouldn't normally see in a regular kind of a cold, or runny nose situation.

Dr. Fialkow:

So, get yourself checked out. One of the things you mentioned early on, is don't delay care. That could be both in terms of, if your child has symptoms that are concerning, as well as the preventive type of care, like the vaccines. And quite frankly, and you've seen this, and I see this, especially in the Baptist system; the precautions that have been put in place, spacing, not allowing a lot of people in waiting rooms, division of wearing masks and protective equipment, hand washing, it's safe to visit your provider. It's safe to visit your doctor. It's more likely to get it from the community, than you are actually in visiting your doctor. So yeah, don't delay that care. Use the Care On Demand app, the online urgent care. You can go to an urgent care, you can go to an ER, but don't delay care if your child has symptoms and is sick, I think that's probably the most important message.

Dr. Mendoza:

I'll tell you, I feel safer at work in the ER, than I do sometimes in public, in certain situations, like in grocery stores and other gatherings, where I'm forced to go out in public.

Dr. Fialkow:

But, we've actually shown that the rates of people getting sick, in our health system, in our offices, in the hospitals, there's less than the average in the community. So, it's actually quite true, because of the precautions. School. School season. Obviously, kids are back in school. They're escalating that, the concern with kids is obviously, they can give it to each other. They can bring it to home. They give it to teachers. Where are you at in terms of precautions that should be taken, for parents who are sending their kids to school at this point?

Dr. Mendoza:

Well, I'm going to speak to you from a pediatrician perspective, but also from a parent of three school-aged children. The American Academy of Pediatrics is promoting the, going back to school campaign. I'm involved in a nationwide group, that discusses back to school strategies. And, the key here is that, you have to do it right. So, it really is every county, and even school depending on what kind of precautions do you need to take. You're going to have to take precautions. The school, your children are going to, or the school system, has to have the right mitigation steps, kind of preventative steps in place. Obviously, densifying or decreasing number of kids that are going at any one time. The protective measures for the kid's mask wearing is probably, the most effective thing we can do for our kids; nose and mouth.

Dr. Mendoza:

Even though kids don't get as sick, we are concerned about the teachers, and of the parents, and the grandparents, when they come back home. Hand-washing, those are really important. So, if you do it right, I think as a community, I think we'll be okay. Are we going to prevent every single infection? There's no way. We're not going to be able to prevent everything. And, knowing when your child is sick, the real responsibility of parents and kids, is to be honest with yourself and say, "I don't feel good today, maybe it's just a plain old cold, maybe it's COVID, maybe it's something else, let me stay home; so I don't expose a whole bunch of other kids to this, and let me report this to my school nurse, or whoever the administrator of school is, so that they can take the right step to make sure that they protect the other people, who you're exposed to."

Dr. Mendoza:

But really, mask wearing, the right protection, kids need this. Kids need their social interaction. We're definitely going to see an increase in rates of mental health illness, social kind of effects of anxiety and depression in kids who have not been exposed to their peers, and these learning activities over the course of the last seven, eight months. And, there's a real concern that, there's a lot of social support, when kids receive, there's school lunches and school breakfast, there's counseling support or special ed. There are things that kids or parents can't always give at home, and they really rely on the school system for that. So, work with your school, be inquisitive, be an advocate for your kids' safety, and participate in your kids re-entry into the school.

Dr. Fialkow:

Agreed, and I appreciate that. Don't get complacent, keep on these precaution and safety measures, like washing and distancing, and masks wearing and stuff; but it doesn't mean we can't move forward. And again, I think you gave a great perspective, as to that context. Well look Fernando, you've given great information, great update; both in terms of COVID, the risk in children and adolescents. Again, this multi-system inflammatory syndrome, this MIS-C, which I think made some press. Talked about the high risk populations. Talked about the importance of vaccines. You hit all my topics, man. I didn't have to prompt you, so I appreciate that.

Dr. Mendoza:

[crosstalk 00:16:22] We can talk football, we can talk baseball, we can talk basketball.

Dr. Fialkow:

You know what, I'm sure we could. And, unfortunately I'm a fan of the New York sports team; so the worst legacy I gave my children. So, we don't want to get into that, here. Anyway, thanks again. Any final comments, or any things you want to really emphasize, other than what we've [crosstalk 00:00:16:43]...

Dr. Mendoza:

I think for pediatric, especially, this is just like [inaudible 00:16:46], but really for pediatrics, we want to get our kids back to what they were doing normally. But, it's going to be a little different for the next few months, however long it's going to take. But realize that, parents and I always say this, moms know their kids best. So, you trust your mother or father's intuition, your parental intuition. If you think something's off with your kid, from an illness perspective, get the care you need; go to your pediatrician, go to the pediatric, you're Baptist Children's Emergency Center. We're here for you, 24 seven. We can help you, and alleviate any of those concerns, that you have about COVID, or any other illness. And certainly, in terms of getting back to everything, just hear, I guess, the advice of your local public health officials, keep that mask wearing up, teach the kids well; we'll be okay.

Dr. Fialkow:

That's great. And again, they can go to the pediatrician. They can download the Care On Demand app, at 24/7 tele urgent care. They can go to an urgent care. We can go to the emergency room. Don't ignore your children's symptoms. Thanks [inaudible 00:17:47]. 

Dr. Fialkow:

And, thanks for listening, to our podcast listeners. At this point, I'd like to publicly give a long overdue thanks to my producer, Carol Higgins, and my sound technician, Steve Pipho, in this time of virtual discussions like this podcast. They've had to deal with thunderclaps, dogs barking, my absentmindedly clicking my pen; and somehow they all make it sound good, and ensure that I make sense. So, thanks to you guys.

Dr. Fialkow:

As usual listeners, any thoughts, concerns, ideas for future podcasts. Please email us baptisthealthtalk@baptisthealth.net. That's email us at, baptisthealthtalk, one word, @baptisthealth.net. Stay safe, mask up.

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