Covid-19 and children.

How concerned should parents be?

Hello and welcome to PBS39.

WLVT community update on coronavirus It's brought you with help from our community partner Lehigh Valley Health Network.

We're coming to you live from the PPE public Media Center in Bethlehem.

I'm Brittany Sweeney.

Our guest today include a pediatric physician from Ryley Children's Hospital in Salisbury Township, We also have a mother and her 6-year-old daughter who is recovering from a rare inflammatory disease linked to Covid-19.

We'll be meeting in just a moment.

If you have a question, you can give us a call.

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Now let's get a look at today's top headlines.

The State Department of Health reported 7600 19 new coronavirus cases and 349 more deaths.

That brings the state total to more than 740,000 cases.

18,000 80 Pennsylvanians have died from Covid-19 in Lehigh and Northampton counties.

There have been near nearly 43,000 cases and 1073 deaths.

A state run program that gave $175 million in federal aid to help nursing homes contain outbreaks has come to an end.

11 regional health systems were enlisted to help nursing homes.

State officials say they're working to preserve a scaled down model of the program and asking the federal government for more money.

The Pennsylvania National Guard has completed its mission at Phoebe Allentown, an independent living and skilled nursing facility battling a Covid-19 outbreak.

A few guard members remain to help train staffers, but the nurses and medics summoned to help fill shifts ended their formal stay yesterday.

The facility had 169 coronavirus cases in residents and 41 in staff members Lehigh Valley Health Network is planning a mass Covid-19 vaccination site at Dorney Park A timeframe for when it might open and who might be served has yet to be announced, LVHN says.

It will be ready to vaccinate everyone who wants a vaccine in each of the state's phases of distribution, but only after more vaccines are made available through Operation Warp Speed.

All right.

Let's meet our guests for the day.

Dr Lee Burrill LaRussa is vice chairman of the Department of Pediatrics at Lehigh Valley Health Network.

He treats patients at Lehigh Valley Ryley children Hospital.

I'd also like to welcome Martha and Penelope Davalos of Clifton Heights, Pennsylvania.

Penelope is six years old and she and her mother have a rather frightening story to share about their experience with a rare but serious condition associated with Covid-19.

Thank you so much for joining us today.

Martha and Penelope, we're going to get to your story in just a couple of minutes.

I'd like to first start with the doctor to give us a quick overview.

Dr LaRosa, throughout this pandemic, we've learned that the viral infections in children in both numbers and severity aren't as great as they are in adults.

But that hasn't in everyone's experience.

We have seen an increasing number of Covid-19 cases in children in the last few months.

In October, Pennsylvania had about 10,000 cases of the virus in kids between ages 5 and 18.

That number grew to more 50,000 by the end of the year.

What some of the reasons for such a large increase in a short time.

Let's start there.

Thank you, Renee.

Yeah.

I would say in general that matches what we're seeing with overall spread.

You're right.

Children have been overall less affected by the acute Covid infection.

But we'd still see it.

And many of the kids are not symptomatic.

So that also is a challenge where we don't necessarily know they have it.

But overall, following the general trend.

Absolutely.

Now most kids have mild or their asymptomatic, but some of the kids do get severely ill. Let's talk about some of those cases.

Why are we seeing that kind of wide range where some kids are getting really, really sick?

Other kids are not.

Do we know why that's happening?

Well, with the acute Covid infection, generally kids haven't been as sick.

Again, many asymptomatic.

And we think that has to do in general with most kids are pretty healthy in general and don't have the same type of risk factors that many of the adults we're seeing get critically ill.

There is also the MASC inflammatory condition, which is a bit of a different entity and we are seeing a lot of kids, not a lot I should say.

We are seeing kids with that severe illness and that probably has more to do with the state of a child's immune system being very different than an adult.

And in some kids triggering this profound inflammatory response.

Charming to talk more about that in just a couple of minutes.

But first, if you could talk about some of the general symptoms that you're seeing in children.

I know oftentimes they're mild, but does it present like a common cold?

Are kids losing that taste and smell like adults are a little harder to say with some of the kids.

They may not be able to tell us the.

I would say to the unique features we're seeing as in babies, we certainly had a number of infants who have come to the hospital with fever.

And that's an important entity regardless of Covid.

If an infant has a fever, they need to be evaluated.

And then part of the evaluation we're checking for Covid.

So we've had a number of young infants that have had fever with really little other symptom found to be Covid positive and then they do really well.

Those kids really don't end up having many other symptoms in general, just need some supportive care.

And then the older kids that we've had some mild respiratory symptoms, we've only had a few cases where they really had severe respiratory symptoms.

And those children did have some of those same co-morbidities high risk factors.

The other thing I would say is important for for parents and folks know that the GI symptoms so the gastrointestinal symptoms do seem to be a little more prevalent in children or noticeable.

So that may be vomiting, some abdominal discomfort, maybe diarrhea.

And so that's led to a few hospitalizations where kids have needed supportive care with fluid hydration until they recover from the illness.

Sure.

It seemed in the beginning of this last year whether it was a few weeks or a few months, we really weren't seeing kids get this.

Is there anything we know now that we didn't know then?

I'm sure there's a lot when it comes to treating this, but what would you say you know, now that you wish you knew then?

I think there's a lot more kids that had it that we didn't know because testing was limited and we were testing a lot of kids because they weren't we didn't think they were necessarily spreading.

And so they weren't in workplace schools closed down.

And so they need to test kids was less.

And so we were reserving the tests that we did have for adults and nursing homes, etc.

So I think that was probably a much higher prevalence in children.

We just didn't know.

So that's one thing that we've certainly learned over time.

And then I think the realization as we talked about a moment ago, that the presentation in children is just different.

As a pediatrician, when talking to students or learners parents, we always say that children are not just small adults.

They're different.

And this is another example.

Absolutely.

And let's talk a little bit about that more severe case of Covid-19 or what Covid-19 is presenting in children.

Something called multi-system inflammatory syndrome.

Can you talk to us a little bit about this?

I know started the data started being collected on this around June.

So talk to us about what that is.

What are those symptoms for that and what does that look like?

Yes, in the first cases really were reported in a cluster primarily out of the United Kingdom where they started this inflammatory condition that looked a lot similar, very similar to something called Catasauqua Disease, which pediatricians have been treating for decades.

And we saw our first cases here actually in May and then continued to learn more about the condition through collaboration across the country.

So that's a unique entity for it seems primarily children where the body's immune response after having been exposed to Covid amounts of profound inflammatory already cascade of events that leads to inflammation throughout the body can in fact affect many organ systems and can be quite serious.

The most concerning which is involving a heart and they can show signs of shock where the heart is functioning as effectively as it should and it can affect really any organ because we believe it affects the blood vessels.

So obviously that's everywhere That's really scary for any parent.

I'd like to bring up a map from he CDC that shows where this is happening in children.

I know that there is right around a little bit more than 1600 children who have been plagued by this condition.

In Pennsylvania, though, it looks like we have more cases as well as Florida and Texas.

But here in Pennsylvania, 51 plus cases, which doesn't seem like a lot.

But when this is such a rare thing that a lot in the grand scheme of things, why do you think we're seeing it in these larger population areas?

Yeah, I agree.

50 actually the last number I looked at was 74 in Pennsylvania have been reported.

Doesn't sound terrible, but it's a very severe condition and it can be life-threatening.

So that map, if you overlay the overall number of cases of Covid and the number of cases of children with Covid would probably look quite similar.

So it's really a percentage of the overall population and the number of people with Covid.

So a subset of the children are getting it.

And then a smaller portion I think about roughly one in 1,600 children with Covid have had masc.

And have you treated any @s LVHN?

I know you mentioned in the spring you saw some.

Have you treated them personally and what's kind of the treatment for that?

I yes, I've been involved with the care of a few here.

We've had about a half a dozen that we've treated at Lehigh Valley Riley Children's and the treatment is a multi-pronged approach to try to stop the inflammation and the subsequet organ damage that can happen.

I mentioned earlier that it's very similar, a condition called Kawasaki disease, which is another inflammation of blood vessels so that the treatments that were proposed early on really mirrored how we treat Catasauqua disease.

And that's with primarily two main medications, something called IB IRG or intravenous immuno globulin, which helps bind up the body's antibodies and reduce the amount of inflammation.

And then also using steroids to quiet the immune system and those would be the two main parts of the therapy and then some children, depending on what the profile of a virus looks like, if they still seem to have active virus in their system.

We can use antivirals.

Some of you may have heard remdesivir that's been used in some cases.

And then there's a number of additional supportive treatments.

One thing we know actually somewhat similar to the adults that have severe Covid acutely is that because the effects on the blood vessel children with this condition seem to be at higher risk of blood clots and so many of them are put on blood thinners during that treatment and then kept on some low doses for a while afterwards.

Sure.

Dr La Russa, a lot of students are heading back to in-person learning in the next few weeks.

How concerned should parents be?

No.

That's a tough question.

Should they be concerned about this?

I would say yeah, they need to keep in mind what I don't want people to feel is that, oh, well, children don't get it as much.

And when they do get it, it's not severe.

While these cases of MASC are certainly rare, as I said before, they can be fatal.

And so sometimes people don't realize that until strikes close to home.

That may have been the case Covid in general early on.

And now people are realizing mask wearing that's still number one on the list of things to keep yourself and your children healthy is mask wearing.

And then if you've had an exposure, is really quarantining until you know that you're not contagious to others.

And then if your child does have Covid or in many cases families didn't even know that children had Covid.

But if children start to have fever, certainly with any other symptoms like rash, trouble breathing, feeling or looking overall ill, you need to call your pediatrician or family doctor whatever takes care of your child and haven't seen.

And if you're concerned about them, then bring them to an emergency department.

Absolutely.

Some great information.

Let's talk about the other side of the aisle.

Adults, of course, getting the vaccine already.

Let's talk about when we think children will be getting that vaccine.

And when teens are able to as well.

From my standpoint, not soon enough.

The teens.

So the current studies did look at 16 and up.

I believe.

And so some of our older teenagers will be eligible when there's enough vaccine.

The younger children, those under 16.

I know some of the vaccine makers are still gathering data, starting some studies to make sure that it's safe and effective for children.

I believe they're looking at three and older.

So that would be that three to 16 range, the children younger than three.

I really haven't heard anything about a plan for that.

Then what's going to be much probably lower priority at this point?

Sure.

We'll just have to wait and see.

Dr La Russa from Lehigh Valley Riley Children's Hospital, thank you so much for joining us.

My pleasure.

We continue this community update on coronavirus PBS39.

The show is also rebroadcast on the radio on WLVT News.

91 3F.

Let's bring in our next guests.

Martha Davalos is a nurse that Crozier Chester Medical Center and she's here with her daughter 6-year-old Penelope.

Thank you, ladies, so much for joining today.

Absolutely.

Unfortunately, in the past few months, you've seen first-hand the impact that Covid can have on a child.

Penelope developed what doctors call multi-system inflammatory syndrome over the holidays.

Martha, can you please start by sharing your experience with this?

When did this all start?

Sure.

You know, my family, including Penelope and her older brother who's 11, we were diagnosed with Covid in late November.

I probably had worse with Penelope and her older brother having I would say a very mild case of Covid, a slight fever.

They complain maybe as a about headache and some fatigue.

Other than that they get better relatively quickly.

Maybe for days.

So actually after that I felt I felt relievd.

I like OK, we've had it.

It wasn't as bad as, you know, You can hear it.

It can be.

So I kind of thought that we were in the clear for a little bit, you know, or or her immune system would be working on December 21st, which was a Monday.

Penelope said that she didn't feel well.

She had a pretty high grade fever.

It was like 100 2.8.

That fever actually lasted until Saturday.

Like you said, I'm a night nurse or a night shift nurse rather.

I came home Saturday morning and Penelope's symptoms had just really gotten worse.

She had a rash all over her body.

Her eyes were bloodshot and then, of course, the fever.

This was day six with the fever.

So I took her to Chop's emergency room and that's when they diagnosed her with the mitha, which is the multi-system inflammatory syndrome that children can get.

Host Covid infection.

Sure.

And you're a nurse.

And at first I know when we had spoke about this you said you weren't even sure what this was when it first presented.

You thought maybe hand, foot and mouth because of the rash.

Can you talk to us about your reaction when they told you that this was Missy, that multi-system inflammatory syndrome?

Sure.

So I think that it was hand, foot and mouth.

So I got sick on Monday.

On Thursday is when the rash presented, but it was only on her hands and feet.

So I was kind of shocked and I was like, how did she get hand?

Now, when we haven't been anywhere in like a month and a half.

So we have actually gone to her doctor the day before on Wednesday because at that point she'd had the fever for three days.

They swabbed her for strep, for the flu, for Covid.

Everything came negative.

So when she told me that she had the rash on her hands, feet.

All right.

I don't know how you got, but I guess you have hands, mouth.

And then it was a sixth of the fever, the rash spreading all over.

And then her eyes were bloodshot.

When I got home, So I heard about Missy.

I read a lot about Covid and I try and keep myself up to date.

So I kind of every symptom that she had you kind of checking off another bar that kind of led to me thinking maybe it could be that.

And then I was like, that's pretty rare.

Campi my kid.

So when we went to the ER and they said, you know, we think that this is what she has, we're going to do some bloodwork to see if he has those inflammatory markers and then it did in fact come back to being, you know, what they thought was Mesi.

It was scary or scary.

Yeah, because I read and heard on the new Y, you know how that disease kind of progressive Shaw and Martha.

Can you tell us about these pictures here?

Is that kind of the rash you were seeing her for her cheeks or kind of flushed?

There is no if you look at you look at her overall skin tone.

She is very pale.

That rash actually at that point, I think she had gotten some ibuprofen.

So her fever really wasn't too high.

So actually the rash looks looks a little more faded in that picture.

That was as soon as we got to the regular med or after Penelope was admitted to the hospital.

Sure.

Penelope, what did that feel like?

That probably felt pretty yucky.

Didn't it?

What's the rush?

She calm down kind of itchy.

What was it like at the hospital when you were getting all those medicines?

Not very fun, huh?

Yeah.

You just well, it's composed.

I'm sure she did.

Martha, can you tell us what doctors had to do from that point?

How did they treat Penelope for us?

So we know they draw her blood work.

I mean, or and they saw those elevated inflammatory markers.

They also draw blood work to look at.

Enzyme that could also indicate an inflammation response.

So that was on Saturday night, Sunday morning.

They through the same lab to see which way either up or down those labs were trending.

Penelope's case of labs trended up.

So after that they did an echo cardio gram, which is essentially an ultrasound of her heart at that point, they found that her cardiac function was very decreased.

So they actually we were like fast tracked to the ICU.

So that they could start that IV G treatment, which is what the doctor was talking about.

And then they actually coupled her treatment with steroids and daily bread.

That can't be easy for a 6-year-old little girl.

Talk to me about how she was a I'm sure a champion through all of this and how was she able to get all these meds and get treated through all of this.

She did very well.

I think at the first of these she really, you know, wasn't feeling her now because of the fevers.

And, you know, she had a stomach-ache with this, too.

So that was making her uncomfortable.

But she really kind of took everything in stride.

And we just kind of together took it step by step.

They told us, you know, what we were doing, what we were going to do next.

And we followed their instructions and just kind of waited for more instruction to come after that.

Shawn, this picture is a couple days in when she decided to take a walk through.

Could she not really get up?

Well, she's very lethargic through all of this.

He was super weak.

That was two days after her first IV IV treatment by I think that was 48 hours after she been fever free.

Prior to that walk in the hallway, she had gotten up like a couple times to walk to the bathroom, which proved to be a little bit difficult and took a little bit more time than I even expected to on this day.

She really kind of woke up with just a little more energy.

Didn't want to be sitting in the bed any more.

She kind of got up and sat at the table with us to have lunch, which is also kind of the first time she's eating a little as well.

And in over a week.

And so the nurse asked her she wanted to go to the playroom and she did awesome.

And obviously you are home.

She looks pretty healthy to me.

But what are the steps moving forward and what did you have to do after those days?

You've got after you got home?

I mean, initially when we first got home, she didn't have the fever any more, but she was pretty tired and fatigued.

It probably three days after we got home, she really started to have her energy back, really dive into her Christmas present that she hadn't gotten to initially on Christmas because Christmas was kind of right smack in the middle of the week that she was sick with this as harsh treatment.

She came home on oral steroids, which was they say treated them down.

And now she's finished with those and she does take the daily aspirin smar morning.

We actually follow up with cardiology and then next week we follow up with immunology.

Are immunology I'm sorry, rheumatology because she really had a team of doctors from three different three different fields kind of beat her.

Kate Shaw and Martin Penelope, I want to bring Dr La Russa back in here because your story from what you're telling me, it sounds like any parent would look at this maybe like a cold or like you said, hand, foot and mouth.

Dr LaRaza, what are some of the signs and symptoms that parents should really be aware of and be looking out for?

Yeah.

So if you know your child's head Covid, then this tends to show up about 2 4 weeks after the acute infection.

So in that timeframe, if you started to see fever rash, there's like Penelope.

So those are probably the first two signs and symptoms that a parent would notice.

The other findings are kind of difficult to see on the outside.

You can get cracked lips, you can get some swollen lymph nodes and then the eye finding the bloodshot eyes as Martha described.

So.

So those probably the things that you'd see on the outside and then the lethargy, it does make kids feel very ill. And so that coupled with fever, they should be evaluated.

And I'll add, these kids can progressed very rapidly.

It sounds like Penelope had several days of symptoms, but in some cases within 24 hours, these kids critically ill needing significant support.

Absolutely.

Martha, I'll ask you a similar question.

As a parent, what you learned through all of this, what would you pass on to other parents?

What do you wish you knew then that you know now you're pretty much the same thing that the doctor pointed first is that timeframe from the point that you suspect or your child was with Covid that 2 4 weeks timeframe is super important.

I was not aware of that timeframe and had I been, I may have taken Penelope a day or two sooner to the ER but that timeframe is really, I think pertinent piece of information for parents to know with this that this particular syndrome absolutely.

Well, we are so glad that Penelope is feeling better.

Martha and Penelope, thank you so much for joining Dr Lorusso.

You as well.

And we want to thank you for watching community update on coronavirus.

We'll be here 4pm each Monday, Wednesday and Friday on PBS.

39.

And on the radio at 9:30 on those same nights on WLVT News.

We'll be back Friday 4 with the executive director of the Lehigh Valley International Airport.

If you have a question, you can give us a call.

That phone number is 44 8 2 1 0 0 0 8 4 PBS39 and WLVT.

News I'm Brittany Sweeney.

Stay safe.