This online discussion will be held Thursday, Oct. 15 from 12:30 p.m. to 1:30 p.m. and is designed for general practitioners, family practitioners and other healthcare providers.
Dr. Antonio Arrieta, medical director of pediatric infectious disease at CHOC, and Dr. Jasjit Singh, assistant medical director and medical director of infection prevention and control, will present information on COVID-19 in children and the world of infectious disease. Particular focus will be given to counseling patients about the importance of influenza and other routine vaccines this fall. Given the current pandemic and concerns that flu season may exacerbate it, this timely lecture is ideal for providers looking to address preventative matters with patients.
This virtual lecture is part of a series provided by CHOC that aims to bring the latest, most relevant news to community providers. You can register here.
CHOC is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians and has designated this live activity for a maximum of one AMA PRA Category 1 Credit™.
Please contact CHOC Business Development at 714-509-4291 or BDINFO@choc.org with any questions.
For Steve Emfinger, donating his blood plasma at CHOC Children’s was fast, painless and a way to give meaning to his battle with COVID-19.
“It was very simple,” he said. “And to know it’s helping kids is very cool.”
Registered with the U.S. Food and Drug Administration, the CHOC Children’s Blood Bank is available to collect and process blood plasma donations from COVID-19 survivors. These donations are being used to help patients at CHOC and throughout the community.
“We’re still learning about COVID-19, but it’s possible that those who have recovered from the disease have produced antibodies to protect them from the infection,” says Dr. Antonio Arrieta, a pediatric infectious disease specialist who is studying the use of convalescent COVID-19 plasma at CHOC. “If so, their blood plasma would contain these antibodies and may be helpful in the treatment of COVID-19 disease in others.”
Since CHOC began collecting and processing blood plasma donations from recovered COVID-19 patients this spring, more than a dozen CHOC patients have benefited.
And as COVID-19 diagnoses continue to mount in Orange County and fall approaches, the need for blood plasma donations will only grow at CHOC, Dr. Arrieta says.
A surprising diagnosis
Typically, an early riser with boundless energy, Steve just felt zapped in late winter. Attributing the lethargy to two back-to-back trips he’d just taken, Steve decided to work from home.
Though his symptoms – including a slight cough and dizziness – were minor, Steve’s energy shift was so atypical that he ultimately decided to go to a local hospital. There, he was tested for the flu and strep throat and had a chest scan, which all came back negative.
Steve had one more test – for COVID-19. A couple days later, he got word the test was positive.
Steve hunkered down at home, and notified any friends, family and neighbors he’d been in contact within the weeks before his diagnosis. Some days he felt good – able to work remotely and cook meals – and others were much more challenging.
All in all, though, Steve felt fortunate to have mild symptoms, never experiencing a fever, body aches or significant respiratory problems, despite a lifelong mild case of asthma.
“I think I’m blessed to know that I had minor symptoms and was able to get through it and my family didn’t get sick,” he says.
As Steve’s diagnosis came early into the pandemic’s spread in Southern California, he was initially reluctant to share his story with a broader network of friends, family and colleagues. But as he got more comfortable, Steve’s decision to tell others proved fortuitous.
A friend who worked at CHOC told Steve about the COVID-19 convalescent plasma program and how badly donations were needed.
“I had heard that blood plasma was needed, but I didn’t know where to find a donor center,” he said. “I called CHOC the next day to make an appointment.”
Steps to donate
Potential donors must meet some criteria to be eligible:
Donors must show laboratory test proof of their COVID-19 diagnosis either through a diagnostic test (nasopharyngeal swab) at the time they were sick, or a positive serological test for SARS-CoV-2 antibodies after they recovered.
Donors must have been symptom-free for at least 14 days before they donate.
They must meet all other health requirements for blood donors.
Though donors may be male or female, female donors will need to meet some additional requirements that the Blood Bank team will help explain further.
Confirming these requirements takes about a week. Once donors are confirmed and at the Blood Bank, the simple donation process takes about two hours. Donors can return every 28 days to donate again.
Steve is already on his second donation at CHOC and plans to continue in the future – in addition to donating blood and platelets.
“To help someone else makes it all worth it,” he says.
Multisystem inflammatory syndrome in children, or MIS-C, is a new syndrome that has been reported worldwide in an increasing number of children who had or were exposed to COVID-19. MIS-C shares many characteristics with Kawasaki disease, an inflammatory disease of childhood that can affect blood vessels.
MIS-C is a rare complication temporally associated with COVID-19. Here is the case definition, per a U.S. Centers for Disease Control Health Advisory:
An individual aged <21 years presenting with fever (>38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours); laboratory evidence of inflammation (Including, 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.); 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 (COVID-19) infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the four weeks prior to the onset of symptoms.
Is MIS-C dangerous?
MIS-C can be serious, but most children have recovered. MIS-C, like Kawasaki disease, can be a very uncomfortable illness because it causes prolonged fever, irritation and inflammation in many tissues of the body. The main concern with MIS-C and Kawasaki disease is heart and blood vessel involvement.
Conditions that involve inflammation in the heart, such as MIS-C or Kawasaki disease, can affect the heart in different ways. They may cause the heart muscle to be irritated and inflamed, affecting the overall function of the heart.
They may also weaken the wall of one or more of the coronary arteries causing them to bulge or balloon out. Blood clots can form in the ballooned area and possibly block the blood flow through the coronary artery. When this happens, the heart muscle will no longer receive an adequate supply of oxygen-rich blood, and the heart muscle can be damaged.
What are the symptoms of MIS-C?
Though clinicians have described differing presentations, sign and symptoms can include an ongoing fever, inflammation detected by blood test, and evidence of organ dysfunction or shock. Here are additional common symptoms:
Kawasaki disease-like features including conjunctivitis; red eyes; red or swollen hands and feet; rash; red cracked lips; and swollen glands. Some children have presented with coronary artery enlargement or aneurysms. Some children may present with more gastrointestinal (abdominal pain or diarrhea) or neurologic (headaches/meningitis) manifestations.
Toxic shock syndrome-like features with hemodynamic instability.
Cytokine storm/macrophage activation or hyperinflammatory features.
Shortness of breath suggestive of congestive heart failure.
Respiratory symptoms typically reported in adults with COVID-19 may not be present in pediatric patients with MIS-C.
Patients with the following symptoms ought to seek emergency care:
Pain or pressure in the chest that does not go away
Inability to wake or stay awake
Bluish lips or face
Severe abdominal pain
How is MIS-C diagnosed?
Children who present with symptoms may undergo expanded laboratory testing and a cardiac workup that may include:
Routine screening labs including CBC with diff, CRP, CMP, and appropriate cultures;
If expanded work-up is warranted for hospitalized patients, it may include troponin, pro-B-type natriuretic peptide, triglycerides, creatine kinase, , D-dimer, prothrombin time/partial thromboplastin time, international normalized ratio, ferritin, lactic acid dehydrogenase, and fibrinogen, if not already conducted;
COVID-19 testing performed with RT-PCR assay and serologic testing in every case;
chest X-ray; and
When should a provider suspect MIS-C?
Per the AAP, any child with suspected MIS-C should also be evaluated for infectious and noninfectious etiologies.
An initial sign may be a persistent fever without a clear clinical source. Providers should be suspicious of any fever accompanied by symptoms concerning in their severity or coincident with recent exposure to COVID-19.
Some children clinically progress rapidly and may develop hemodynamic compromise. These children should be followed and cared for in a hospital with tertiary pediatric/cardiac intensive care units.
How is MIS-C treated?
Kawasaki and MIS-C are best treated in the hospital by a qualified multidisciplinary group of pediatric specialists who will work to reduce inflammation and minimize long-term heart damage.
We know living through a pandemic can compound existing mental health problems or introduce new ones for young patients. And for many providers, the COVID-19 pandemic has prompted a flurry of tough questions from patients and their families: How do I explain this to my children? How do I help my child understand why their birthday party is canceled? How do I maintain normalcy while my child is out of school and stuck at home?
If you’re also fielding these questions from worried caregivers, this compilation of resources from CHOC Children’s — with more to come — can help address these questions and more:
Information, strategies for children, teens with depression, anxiety