So, it’s Sunday morning, April 12th. Easter Sunday. I’m sitting at my computer at home, and I open up my folder with the previous blogs I have written for CHD Families of Tucson. I start reading the blog that I wrote in December, “Questions and Answers about Congenital Heart Disease and Cold and Flu Season.” It’s still hard to believe how much Covid-19 has changed our lives. Cold and flu season is a very important time of year for our families to manage, and it always will be. Who knew that the world would be sucker-punched by a virus called Covid-19 when I wrote that (seemingly simple) blog about cold and flu season just a few months ago? No one could have seen it coming. Nevertheless, here we are, and we’re all forced to deal with it day in and day out.
Naturally, we’re going to worry about our kids. It’s something we do well as parents. In that December article, I wrote about the general vulnerability of our heart kids when they get a respiratory infection. I wrote about their decreased energy reserves, and the importance of knowing your child’s functional status. Typically, children are much more susceptible to cold and flu complications. How could Covid-19 not be an equal risk or a colossally bigger risk to our kids as RSV or other flu viruses? We may not have the reason why it isn’t, but it isn’t. Thank goodness it isn’t.
I’m not an infectious disease specialist or immunologist or epidemiologist, but I’ll try my best to explain the theories as to why kids aren’t getting sick and relate that to our heart kids. First, some stats. Looking at the early data from China out of 72,000 total cases, 0.9% of the cases were in patients younger than 10 years of age. 1.2% of cases were in patients 10-19 years of age. The US experience so far is also encouraging for pediatric patients avoiding severe disease. A recent CDC article reports the following: “Among 149,082 U.S. cases of COVID-19 reported as of April 2, 2020, for which age was known, 2,572 (1.7%) occurred in patients aged <18 years. In comparison, persons aged <18 years account for 22% of the U.S. population (3). Although infants <1 year accounted for 15% of pediatric COVID-19 cases, they remain underrepresented among COVID-19 cases in patients of all ages (393 of 149,082; 0.27%) compared with the percentage of the U.S. population aged <1 year (1.2%) (3). Relatively few pediatric COVID-19 cases were hospitalized (5.7%–20%; including 0.58%–2.0% admitted to an ICU), consistent with previous reports that COVID-19 illness often might have a mild course among younger patients (4,5).”
It seems that children infected with Covid-19, if they become symptomatic, predominantly demonstrate upper airway symptoms rather than lower airway symptoms. They have sore throats, runny noses and headaches rather than pneumonia, wheezing and shortness of breath. By avoiding pneumonia, kids can ride out the illness at home without the need for oxygen, intensive care and ventilators. It is unclear why kids are not susceptible to lower respiratory disease with Covid-19. Without widespread testing, we are not sure if kids are not getting infected at the same rate as adults or whether they remain relatively asymptomatic compared to adults when they get the virus. Other theories on the pattern of illness involve how the virus attaches to cells in kids’ respiratory tract vs. adults. Kids may lack (or have different types) of receptors on their cells that makes it tougher for the virus to attach and infect the cells. Children may also have better immunity to this strain of Corona virus because of higher exposure to and cross-immunity to other Corona viruses. Or, children may not mount the same intensity of immune response as adults do. All of this is speculation, of course. Until more research is done over the coming months comparing the immunity of kids to adults, we won’t have the answers.
The rates of infection in children are low, and the rates of severe infection in children are extremely low. There is no data as of yet showing that children with cardiovascular disease are at higher risk than the general pediatric population. We can theorize about increased risk for certain, limited subsets of patients with congenital heart disease. Infants with congenital heart disease and cyanotic infants with single ventricle heart disease are likely at somewhat increased risk compared to the general population. Pediatric patients with congestive heart failure and/or decreased ventricular function and pulmonary hypertension are likely at somewhat increased risk compared to the general population. Outside of these groups of patients, the overwhelming majority of patients with congenital heart disease are not at increased risk of complications from Covid-19 compared to the general pediatric population.
We have a lot to worry about these days. Thankfully, the health of our children isn’t and shouldn’t be a major worry. Keep up to date with the latest recommendations from the CDC, keep washing your hands frequently and keep social distancing. I look forward to seeing you all again soon when we’re able to gather!
Brian Blair, MD
Physician Liaison for CHD Families of Tucson