COVID-19 – Life under Level 5 and social bubbles
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We spoke with Dr Terry Prendiville, Consultant Paediatric Cardiologist at Children’s Health Ireland at Crumlin, on children with congenital/inherited heart conditions and returning to school in the era of COVID-19
Q. How does COVID-19 affect someone with Long QT Syndrome (LQTS)?
A. Thankfully, we have not seen any specific effects of COVID-19 on patients with LQTS, and I have not heard of other international centres seeing any specific risk of the virus alone.
Some of the experimental therapies to treat COVID-19 in intensive care however do require careful ECG monitoring, especially in patients with LQTS. The Irish Cardiac Society has developed an expert statement for doctors on how to do this appropriately and safely.
Q. Is it safe for my child who has a congenital/inherited heart condition to return to school?
A. The big question for many families is whether or not their child needs to continue to socially isolate. This, of course, has to be balanced against the psychological, social, and educational impact of keeping a child out of school. To try and answer this question, we have looked at the medical evidence on how children are being affected by the virus, and we have also reflected on our experience of caring for children with COVID-19 in the hospital setting.
The clear message is that, thankfully, children appear to be remarkably spared the severity of illness seen in adults.
We have and continue to see children testing positive for the virus through our emergency room presentations and admission screening procedures but, by-and-large, the vast majority do not require intensive care or breathing support. Also, it is a great relief to see that children with chronic conditions such as heart failure, unrepaired heart disease, or even cystic fibrosis, are not being significantly impacted by Covid-19.
It is our experience that our most vulnerable children are not carrying a burden of disease worse than their similar-aged peers at school or healthy siblings. This has given us the confidence to be able to tell the families of the children we care for that they are as safe as any other child and, in reality, it is the parent who is much more likely to be significantly affected by the disease.
I should state that any virus or infection in some of our patients can be a risk to them, and clearly these families are more careful than others in minimising exposure to people who might be unwell. But specifically, COVID-19 does not have a heightened risk over the other childhood infections they might come across in the home or school setting.
The only group of cardiac patients we are making individual guidance advice for is children who have undergone a heart transplant and we are in frequent contact with those families as part of their routine care.
We are clearly advising all families to follow the government advice on social distancing, cough and sneeze etiquette, appropriate mask use, hand hygiene, and self-isolating if unwell through the coordinated care of the local GP.
" The clear message is that, thankfully, children appear to be remarkably spared the severity of illness seen in adults,"
Q. Is there anything else I can do to help protect my child this winter?
A. Please take up vaccinations as recommended and don’t forget to get the flu vaccine for yourself and your children early in the autumn – it is available to all medically vulnerable children and is now also available free of charge to all children aged 2-12 years.
It is also important to remember that children can develop illnesses, specifically non-COVID related illnesses at any time, and if unwell you should contact your GP or local emergency department as appropriate.
Q. I have heard of a condition associated with COVID-19 that makes young children very sick can you tell me about it?
A. This is a very rare inflammatory condition related to COVID-19 infection involving the heart (coronary) arteries called Paediatric Inflammatory Multisystem Syndrome or PIMS for short. We have seen what we suspect are a few cases of this condition over the last few months and the children (none of whom have a chronic underlying medical condition) have all done very well with appropriate treatment.
Q. If children with congenital heart problems/inherited cardiac conditions are no more susceptible to contracting COVID-19 than anyone else – are there any problems with the treatments for the virus or spikes in temperature?
A. It is important in children with an inherited heart condition to treat fevers aggressively using paracetamol (Calpol), ibuprofen, a tepid cloth and cooling the room by opening a window, for example, although the absolute risk of harm from a fever is very low even in conditions such as LQTS.
" We don't live in a risk-free world and families have to make the best decisions they can based on high-quality information from sources such as government websites and organisations like the Irish Heart Foundation,"
Q: Is LQTS part of any of the HSE classifications for risk for COVID-19?
A: I don’t believe the HSE has placed Long QT syndrome in a specific risk category for coronavirus infection. The Irish Cardiac Society has issued a statement cautioning the use of some of the experimental therapies for COVID-19 in patients with prolonged QT. You can read it here
Q. I am an adult with a heart condition, am I more at risk of contracting COVID-19 now that my children are going back to school?
A. As best as we understand, children are not thought to be highly infectious to others when sick with COVID-19 compared to some other common winter viral infections, but schools have been given clear advice on how to manage a child with symptoms.
This is going to be a challenging time for everyone and, inevitably, I think there will continue to be cases of COVID-19 until a vaccine is developed and that is likely many months away.
We don’t live in a risk-free world and families have to make the best decisions they can based on high-quality information from sources such as government websites and organisations like the Irish Heart Foundation.
Our outpatient and in-patient cardiac services (including cardiac surgery) remain largely fully functional albeit with accommodation made for safe delivery of care and social distancing. We are a little bit behind on appointments but are working evenings and weekends to try and catch up and clear the back-log so I ask our families to bear with us as we adapt to life with Coronavirus Covid-19 as best we can.
Our clinical nurse specialists remain available for any urgent clinical query and they are doing their very best to support our families through this pandemic.
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