COVID-19 Virtual Town Hall for Cardiac Center Families

The Cardiac Center at Children’s Hospital of Philadelphia (CHOP) held a virtual Town Hall on May 21 about the impact of COVID-19 on cardiac patients and families.

At the Cardiac Center’s recent COVID-19 Virtual Town Hall, we received a high volume of questions, some of which were not addressed during the live event.

All previously unanswered questions and clinician responses are now available below.

Clinical Questions

Q: Is CHOP seeing any patterns or trends in the inflammatory disease caused by COVID-19? Are there early warning signs doctors should look for, such as blood test results? What should parents be aware of?

A: Multisystem inflammatory syndrome in children (MIS-C) was only recently described, and we are continuing to learn about this condition at a rapid pace. MIS-C appears to be a delayed immune response to COVID-19 infection with symptoms occurring a few weeks after the initial infection. Fortunately, this condition still appears to be extremely uncommon.

While there is no specific test to diagnose MIS-C, elevated inflammatory markers are very common. Other signs include a prolonged fever and frequent gastrointestinal symptoms, such as abdominal pain, diarrhea or vomiting. Some symptoms are similar to those typically seen in Kawasaki disease, including conjunctivitis (red eyes), red and cracked lips, a strawberry-colored tongue, swelling of hands and feet, irritability, headache, stiff neck and/or muscle aches. Many of these symptoms may also be present in more benign conditions. If your child has a persistent fever and any of these additional symptoms, particularly if they have been exposed to COVID-19, we recommend that you consult with your primary care provider.

A team of physicians from a variety of specialties across CHOP has created a clinical pathway to assist other providers in the diagnosis and management of this condition.
  
Q: For a patient with a history of coronary aneurysms due to Kawasaki disease, who has also had symptoms consistent with COVID-19, would you recommend antibody testing in light of the recent information about multisystem inflammatory syndrome in children (MIS-C)?

A: There is no current evidence suggesting an increased risk of developing MIS-C in patients who have had coronary artery aneurysms and/or prior Kawasaki disease. For children hospitalized with MIS-C, antibody testing is considered in consultation with the specialists in Infectious Diseases. Antibody testing is not typically necessary in other patients.

Q: A recent CNN article highlighted a Mt. Sinai study which found that right ventricle enlargement is a major predictor for mortality among COVID-19 patients. What are your thoughts on this finding?

A: The authors of this study evaluated a series of patients admitted with COVID-19 infection who underwent echocardiograms, and concluded that right ventricular dilation is associated with an increased risk of death among hospitalized COVID-19 patients. However, these patients were adults with an average age of 66 years old. There’s also no suggestion that this right ventricular dilation was present before COVID-19 infection. Instead, the authors suggest that the cause of the right ventricular dilation may be related to thrombotic events (e.g., blood clots, such as a pulmonary embolism), constriction of the blood vessels in the lungs from decreased oxygen levels, direct damage from the virus or an inflammatory response. This study shows no evidence that suggests an increased risk for patients with baseline right ventricular dilation for non-covid-related reasons (e.g., tetralogy of Fallot).

Q: Do children with coronary aneurysms have a similar risk of severe COVID-19 infection as adults with coronary artery disease?

A: While coronary artery disease in adults is a risk factor for COVID-19 infection, there is no current evidence to suggest that children with coronary aneurysms would also be at high risk.

Q: What is the risk of COVID-19 to a patient with tetralogy of Fallot (TOF) and an enlarged right ventricle who is awaiting surgery to replace a pulmonary valve?

A: Currently, there is no evidence that children with congenital heart disease (CHD), including TOF, are at an increased risk of severe COVID-19 infection. It is important that you discuss your child’s individual situation and surgical timing with their primary cardiologist.

Q: Can a person who has had COVID-19 infection get it again?

A: Unfortunately, we are not far enough into the COVID-19 pandemic to know whether people who have had the infection have robust immunity (meaning they likely can’t be re-infected). When we think about other coronaviruses, infections do seem to cause immunity, at least for two to three months. As we continue to monitor people who have recovered from COVID-19, we will learn more about how long this immunity will last for this specific virus. For now, we do assume that most people who recover from infection will be immune for at least two to three months.

Q: If my son was exposed to COVID-19, should he be tested?

A: For people who have been exposed to known cases (e.g., they live in a house with someone who has tested positive), we recommend testing even if they do not have any symptoms.
We know from studies outside of the United States that about 15% of people who live in the same house as a known positive person will go on to develop symptoms and test positive.

For a patient who has had a positive contact in their home, we would recommend self-isolating for 14 days from their contact with the positive person. If they continue to live together, this would be 14 days from when the positive person has been declared COVID-recovered.

Q: What are CHOP’s treatment guidelines for SARS-CoV-2, the virus that causes COVID-19?

A: Like most hospitals, our treatment protocol for SARS-CoV-2 primarily involves around supportive care. This means providing treatments targeted at the disease caused by the virus,  such as providing oxygen support or ventilation for patients who develop lung disease from the virus.

There is developing — but limited — evidence on drugs that might be helpful in directly stopping the virus. One of these, remdesivir, is an experimental drug which early studies have shown might be effective. We are using this medication at CHOP as our first-line therapy for patients who have COVID-19 and meet criteria for its use.

Q: Can you share your covid-testing data? How many patients with no or mild symptoms have tested positive? What about the false negative and/or positive rate?

A: An internal group of researchers is collating all of our data on positive and negative test results and helping us generate some meaningful conclusions. Most of our positive tests have been in patients who have had some symptoms – primarily respiratory symptoms. We hope to have more details about CHOP’s experience with this available to the public in the near future. 

Q: Is CHOP doing any serologic (antibody) testing of patients? Can antibody test results indicate if a child has contracted SARS-CoV-2 and/or provide assurance of immunity? 

A: Serology testing looks for antibodies in the blood that are specific to a particular virus or bacteria. These antibodies are created by the patient’s own immune system. They are an indirect way of assessing for current or recent infection. The antibody test is different than the nasal swab test, which looks directly for the presence of virus.

As of right now, we are doing serologic testing at CHOP as part of research studies only. These studies are attempting to assess whether these tests are reliable in terms of detecting every patient who has had an infection, when antibodies might appear in the course of illness and how long they might last. We also want to make sure that these tests don’t capture inaccurately positive results in patients who have had other viral infections closely related to COVID-19. Lastly, we want to make sure that a positive test result means that a patient is immune, as determining immunity would be a likely reason to use the test in clinical care.

Until there are robust studies indicating these tests are reliable and accurate, we are not planning on routinely using them in patient care to detect infection or to make decisions about recovery.

School-related Questions

Q: Does CHOP have an education referral center to help navigate online learning if students can’t return to school in the fall?

A: Please contact your child’s school regarding support that may be available through your school district. For information about educational services available at CHOP, please contact Stephanie Endres, Manager of the Hospital School Program at 215-388-4936 or endress@email.chop.edu.

Q: If parents choose to homeschool their children at the beginning of the school year, would that be an accommodation covered under a 504 plan? Could this also apply to siblings of a patient with a single ventricle defect?

A: For information about 504 accommodations, please contact your local school district.

Q: Will school guidelines be provided for children with CHD to safely attend?

A: Schools across the country are considering strategies to reopen safely, and experts from the CHOP PolicyLab along with the Division of Infectious Diseases prepared a review of considerations for schools.


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