Children's Doctor News and Updates: Summer 2020

CHOP Clinicians, Researchers Advance to COVID-19 Care and Research

Children’s Hospital of Philadelphia’s response to the COVID-19 pandemic was swift and across the institution — including the Research Institute. CHOP continues to offer the latest research-backed information and to update the clinical pathways for screening and treating children with suspected COVID-19, both as inpatients and outpatients. 

In early March — just as the first cases of COVID-19 were confirmed in Pennsylvania — CHOP became the first hospital lab in the state and the second in the nation to get Food and Drug Administration emergency authorization to begin testing patients for coronavirus. Soon, CHOP had expanded testing to outpatients, staff and as many members of the public as possible. By mid-March, CHOP was offering drive-through COVID-19 testing sites. Time to receive results dropped from 24 hours, much shorter than the national average of 2 to 5 days at the time, to 7 hours to rapid 1-hour testing for critically ill patients. By the end of May, CHOP had conducted more than 10,000 COVID-19 tests on patients, staff and community members.

Here are brief summaries of some of CHOP’s published research:

PolicyLab’s Risk Model Gain National Attention, Use

National leaders and policy makers across the country studied CHOP PolicyLab’s COVID-19 model that projects the risk for second waves of the pandemic depending on several factors not included in other models, such as relaxation of social distancing, humidity and population density.

David Rubin, MD, MSCE, director of CHOP's PolicyLab, and his team updated the model several times, taking into account how aggressive communities have been about reopening.

“I’m encouraged to see that our models have been accurate—that as we predicted, many communities, including large cities, may be ready to reopen if they take a cautious and slow approach,” Dr. Rubin says. “However, we continue to caution that reducing the likelihood of additional outbreaks will require individuals and business owners to be vigilant with personal protection, wearing masks and practicing proper hygiene, and instituting strong workplace safety measures. Unfortunately, we are already seeing some areas move too quickly and without enough vigilance.”

To learn more about the model, see the most updated data and search for your community.

PolicyLab also collaborated with CHOP’s Division of Infectious Diseases to compile emerging evidence and considerations for local jurisdictions and school administrators to consider when planning for school reopenings.

Understanding Multisystem Inflammatory Syndrome in Children

Researchers at CHOP published a case series describing 6 patients with suspected multisystem inflammatory syndrome in children (MIS-C) in the Journal of Pediatric Infectious Diseases.

The key findings indicate that fever, abdominal pain and diarrhea, shock, and variable presence of rash are the main symptoms, as well as conjunctivitis, extremity edema, and mucous membrane changes. Although the symptoms appear to overlap with Kawasaki disease (KD), author Katie Chiotos, MD, attending physician in the Division of Critical Care Medicine, notes that MIS-C is distinct from KD, particularly in that children with MIS-C are generally sicker and need ICU care. In addition, children with MIS-C present with abdominal pain and diarrhea, which is not typical in KD.

Total Number of Fractures Down, But More Happen at Home

Social distancing measures due to COVID-19 have led to a nearly 60% decrease in pediatric fractures, but an increase in the proportion of fractures sustained at home, a recent CHOP study in the Journal of Pediatric Orthopaedics found.

Some examples of these at-home fractures include bicycle and trampoline injuries, highlighting the need for heightened awareness of safety measures even for recreational activities close to home. “It is important to remind parents about the importance of basic safety precautions with bicycles and trampolines, as many children are substituting these activities in place of organized sports and school activities,” says orthopaedic surgeon Apurva Shah, MD, MBA, a senior author of the study that compared fracture data from March-April 2020 the same months in 2019 and 2018. 

Families Skipping Routine Vaccines During Pandemic

A CHOP study published in Morbidity and Mortality Weekly Report found a decline in childhood vaccination coverage during the COVID-19 pandemic.

Researchers used data from the Michigan Care Improvement Registry to evaluate vaccination status of children ages 1, 3, 5, 7, 16, 19 and 24 months. They assessed a sample of 9,269 patients for the study years 2016 to 2019, and a sample of 9,539 patients for 2020, as of May 2020.

The study team found that up-to-date vaccination status declined for all age groups, from approximately two-thirds of children from 2016 to 2019, to approximately half of children in 2020.

ED Visits for Asthma Drop by Three-Quarters

The number of patients visiting the emergency department (ED) for asthma treatment dropped by 76% in the first month of the COVID-19 pandemic, according to a CHOP study. The proportion of ED visits that led to a patient being hospitalized also decreased over this period, suggesting the decrease in overall visits was not solely due to patients avoiding the hospital due to the pandemic or delays in care for less serious asthma events.

CHOP—which sees nearly 6,000 asthma patients in its ED every year, more than 2,000 of whom require hospitalization—compared data from the first 4 months of 2016 to 2019 to this year. They also compared the mean daily asthma ED visits from January 1 to March 18, 2020, before mandated social distancing measures went into effect, to the mean number of visits from March 19 to April 18, 2020.

In the pre-pandemic period, an average of 24 patients visited the ED for asthma treatment each day, similar to the prior 4 years. After March 19, when the City of Philadelphia implemented a stay-at-home order, the average number of asthma-related ED visits dropped to fewer than 6 per day.

“The COVID-19 pandemic and associated policies have had a dramatic impact on the number of patients we are seeing in the ED with asthma exacerbations,” says Chén C. Kenyon, MD, MSHP, a general pediatrician and first author of the study, which was published in JACI in Practice. “These results may offer new insights on where to best focus efforts to improve asthma outcomes outside of a pandemic scenario.”