Listening to @sharpsgroup COVID-19 webinar, the NYC #pediatrics experience: Adam Rather from NYU Langone speaking on epi: NYC 1,523 cases age 0-17. Three confirmed fatalities. As of 4/8
NYU + Bellevue prelim data: approx 50-60 pos pediatric COVID tests (stresses underestimates real burden!). N=30 confirmed positive. N=8 infants of exposed moms all negative on DOL 0-1, and DOL 5 if still inpt.
Median age of confirmed cases: 7.8 years (range 5d to 24 years)...they are taking young adults in PICU as part of survey plan. 16/29 in PICU. Three PICU patients needed intubation.
Supportive care is paramount!!! HCQ for new oxygen requirement or getting sicker. Tocilizumab to sickest few if sig inflammation issues. One teen will ALL got remdesivir via study. One young adult got sarilumab via study.
Edit: Dr Adam Ratner (autocorrect fail)
(The ALL patient developed prolonged QT on HCQ - stopped - and continued to worsen. Got remdesivir)
Next up: Dr Betsy Herold from Bronx (Montefiore). Now taking adults into pediatric hospital — she has patients up to 70 years old! Total peds: 52 cases in first 3 weeks of epidemic. The Neonates presenting with fever, not too sick, home rapidly.
Admission criteria: oxygen requirement! Otherwise no room in hospital. Adults all getting HCQ on admission. Pediatrics not giving HCQ to all. Three pts have gotten remdesivir. They had a COVID pt with Kawasaki disease!
Montifiore has had 4 sickle cell patients, several solid organ transplant kids with COVID-19 — all admitted and home quickly. Obesity and chronic lung disease main risk factors in kids.
Now hearing from Dr Philip Zachariah from Columbia. They have total 59 positive kids (14% positivity rate).
Total Admitted 44, 10 of these needed at least one PICU day. 8 ventilator. One death.
Total Admitted 44, 10 of these needed at least one PICU day. 8 ventilator. One death.
Sick Infants (n=13) range 15d-7mos, most present w fever alone. Not much resp illness in infants / Newborn Nursery: NO exposed neonates have tested positive at 24 hrs of life....
Few unusual cases: new onset seizures, 2 w primary GI symptoms (abd pain, emesis).
Sickest kids: 8 needed vent. Obesity, sickle cell, IDDM (1). Two with cardiac arrest (one died - HbsC and acute chest).
Hyper inflammation: around day 7. High CRP, high IL-6.
Sickest kids: 8 needed vent. Obesity, sickle cell, IDDM (1). Two with cardiac arrest (one died - HbsC and acute chest).
Hyper inflammation: around day 7. High CRP, high IL-6.
Columbia also focusing on supportive care! Med Treatment only if worsening hypoxia, etc. Yes kids get HQC side effects: QT, severe GI, and blurry vision...
Infection prevention also paramount! ❤️
Betsy and Adam: Disease seems biphasic for severe cases. Initial infection (low IL-6 levels when checked early), then a MAS-like syndrome follows. Many immunomodulator clinical trials including IL-6, ongoing.
None of the panel members are giving Vitamin C or zinc for COVID patients
Panel members are seeing false negatives despite high pre-test probability. They think sampling is main issue...perhaps later illness lower resp tract better to detect virus?? They are not doing mid-turbinate sampling.
Reminder from @Joshuawolf and @JasonGNewland : there is a national Peds ID registry for COVI-19 patients.
From @Joshuawolf : 
*surge* plan. Autocorrect fail.
/ end of webinar
Perhaps most important conclusion from one NYC pediatric ID physician: Hydroxychloroqine is more trouble than its worth
