In the article “COVID-19: Thoughts while circling the wagons,” Dr. Andrew Schuman describes 4 major concerns relevant to clinical practice and the COVID-19 crisis: 1) the United States’ dependency on drugs manufactured in other countries leaving our country without drugs critically needed to treat the most compromised COVID-19 patients; 2) the significant length of time for the US Food and Drug Administration’s approval process for drugs or devices; 3) inflation of medication prices by drug companies; 4) insurance companies’ role in both the refusal of payment for better quality point-of-care services and testing as well as high insurance deductibles, which then divert parents to using urgent care centers negating the quality of care children receive in a medical home.
Once the COVID-19 pandemic subsides, all health care professionals must collectively and collaboratively address these concerns in one strong voice to ensure significant health policy changes in the delivery of health care.
Children, adolescents, and COVID-19
The Centers for Disease Control and Prevention (CDC) has been collecting and reporting data including the ages of individuals who have been hospitalized with COVID-19 since March 1, 2020.1 To date, children/adolescents aged younger than 18 years have had significantly fewer cases than individuals aged older than 18 years. However, Dr. Robert Redfield, the director of the CDC, suggests that 1 in 4 individuals are coronavirus carriers.2
Epidemiological data from China revealed that 2133 COVID-19 positive pediatric patients were reported to the Chinese Center for Disease Control and Prevention from January 16, 2020, to February 8, 2020.3 Children of all ages were affected by the virus, with children aged younger than 1 year most affected. Of the 2133 children/adolescents, 94 children were asymptomatic, 112 had severe illness, and 13 were critically ill.3
Pediatric nurse practitioners and all health care providers must inform parents that all asymptomatic individuals, including children, adolescents, and adults, silently transmit disease. Thus, prevention of direct exposure by asymptomatic individuals to at-risk individuals and populations is an essential strategy until a definitive treatment or vaccine becomes available. Today, the National Institutes of Health published the COVID-19 practice guidelines that include a section on children.4
Returning to school—what is needed and reasonable?
Schools across the country were immediately closed with the implementation of “stay-at-home” orders. A reduced prevalence of COVID-19 in the pediatric population may be reflective of early school closures. As I am writing this commentary, large numbers of state residents who oppose stay-at-home orders are protesting and demanding to return to work and their normal lives, which one must assume includes children returning to school.
Data from John Hopkins University daily statistical reporting on cases and death rates reveals that for many of these states the number of COVID-19 cases are continuing to rise. Will opening schools too early adversely affect the health and disease burden for children, adolescents, and their families? Will point-of-care testing and antibody testing be available for school children and their families to identify asymptomatic carriers? Will asymptomatic carriers be excluded from school? Will asymptomatic children place the teaching workforce at higher risk of infection? All these are questions that must be asked and answered before stay-at-home orders are lifted.
Trauma from the disease burden
How are children coping with the trauma many families are currently experiencing in their family lives? Many families have elder parents and grandparents in nursing homes and have been unable to visit. Families are concerned about the safety of their loved ones in nursing homes. One or both parents may be hospitalized with the COVID-19, separating parents from children. With more than 40,000 deaths in the United States, thus far, so many children, adolescents, families, and extended family members are grieving their losses and are trying to cope with the tragedy of their loved ones being “alone” when they were so critically ill and dying. Are schools and pediatric offices prepared to help children and adolescents cope with their losses? When plans are made to stay-at-home for high-risk communities and states and the gradual opening of other communities and states, we must also make plans to meet the mental health needs of the children, adolescents, and families traumatized by losses, enabling them to begin returning to a new state of health and well-being.
1. COVID-NET: COVID-19–Associated Hospitalization Surveillance Network, Centers for Disease Control and Prevention. Website. Updated April 11, 2020. Accessed April 22, 2020. https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html
2. Woodward A. ‘Between 25% and 50%' of people who get the coronavirus may show no symptoms, Fauci says. Here's the latest research on asymptomatic carriers. Business Insider. Published April 14, 2020. Accessed April 22, 2020. https://www.businessinsider.com/coronavirus-carriers-transmit-without-symptoms-what-to-know-2020-4
3. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China [in press]. Pediatrics. 2020; doi: 10.1542/peds.2020-0702. https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf
4. National Institutes of Health. COVID-19 treatment guidelines. Updated April 21, 2020. Accessed April 22, 2020. https://covid19treatmentguidelines.nih.gov