Posts

coronavirus

Study finds children can become seriously ill with COVID-19

coronavirus

Despite early reports suggesting COVID-19 does not seriously impact children, a new study shows that children who contract COVID-19 can become very ill.

In contrast to the prevailing view that the novel coronavirus known as COVID-19 does not seriously impact children, a new study finds that children who contract the virus can become very ill—many of them critically so, according to physician researchers at Children’s National Hospital. Their results, published in the Journal of Pediatrics and among the first reports from a U.S. institution caring for children and young adults, shows differences in the characteristics of children who recovered at home, were hospitalized, or who required life support measures. These findings highlight the spectrum of illness in children, and could help doctors and parents better predict which pediatric patients are more likely to become severely ill as a consequence of the virus.

In late 2019, researchers identified a new coronavirus, known as SARS-CoV-2, which causes COVID-19. As the disease spread around the world, the vast majority of reports suggested that elderly patients bear the vast majority of the disease burden and that children are at less risk for either infection or severe disease. However, study leader Roberta DeBiasi, M.D., M.S., chief of the Division of Infectious Diseases at Children’s National, states that she and her colleagues began noticing an influx of children coming to the hospital for evaluation of a range of symptoms starting in mid-March 2020, who were tested and determined to be infected with COVID-19. One quarter of these children required hospitalization or life support.

“It was very apparent to us within the first several weeks of the epidemic that this was a very different situation than our colleagues on the West Coast of the US had described as their experience just weeks before,” DeBiasi says. “Right away, we knew that it was important for us to not only care for these sick children, but to examine the factors causing severe disease, and warn others who provide medical care to children.”

To better understand this phenomenon, she and her colleagues examined the medical records of symptomatic children and young adults who sought treatment at Children’s National for COVID-19 between March 15 and April 30, 2020. Each of these 177 children tested positive using a rapid assay to detect SARS-CoV-2 performed at the hospital. The researchers gathered data on each patient, including demographic details such as age and sex; their symptoms; whether they had any underlying medical conditions; and whether these patients were non-hospitalized, hospitalized, or required critical care.

The results of their analysis show that there was about an even split of male and female patients who tested positive for COVID-19 at Children’s National during this time period. About 25% of these patients required hospitalization. Of those hospitalized, about 75% weren’t considered critically ill and about 25% required life support measures. These included supplemental oxygen delivered by intubation and mechanical ventilation, BiPAP, or high-flow nasal cannula – all treatments that support breathing – as well as other support measures such as dialysis, blood pressure support and medications to treat infection as well as inflammation.

Although patients who were hospitalized spanned the entire age range, more than half of them were either under a year old or more than 15 years old. The children and young adults over 15 years of age, Dr. DeBiasi explains, were more likely to require critical care.

About 39% of all COVID-19 patients had underlying medical conditions, including asthma, which has been highlighted as a risk factor for worse outcomes with this infection. However, DeBiasi says, although underlying conditions were more common as a whole in hospitalized patients – present in about two thirds of hospitalized and 80% of critically ill – asthma didn’t increase the risk of hospitalization or critical illness. On the other hand, children with underlying neurological conditions, such as cerebral palsy, microcephaly, or global developmental delay, as well as those with underlying cardiac, hematologic, or oncologic conditions were significantly more likely to require hospitalization.

In addition, although early reports of COVID-19 suggested that fever and respiratory symptoms are hallmarks of this infection, Dr. DeBiasi and her colleagues found that fewer than half of patients had both concurrently. Those with mild, upper respiratory symptoms, such as runny nose, congestion, and cough were less likely to end up hospitalized than those with more severe respiratory symptoms, such as shortness of breath. The frequency of other symptoms including diarrhea, chest pain and loss of sense of smell or taste was similar among hospitalized and non-hospitalized patients.

Dr. DeBiasi notes that although other East Coast hospitals are anecdotally reporting similar upticks in pediatric COVID-19 patients who become seriously ill, it’s currently unclear what factors might account for differences from the less frequent and milder pediatric illness on the West Coast. Some factors might include a higher East Coast population density, differences between the genetic, racial and ethnic makeup of the two populations, or differences between the viral strains circulating in both regions (an Asian strain on the West Coast, and a European strain on the East Coast).

Regardless, she says, the good news is that the more researchers learn about this viral illness, the better prepared parents, medical personnel and hospitals will be to deal with this ongoing threat.

Other researchers from Children’s National who participated in this study include Xiaoyan Song, Ph.D., M.Sc.Meghan Delaney, D.O., M.P.H.Michael Bell, M.D. Karen Smith, M.D.Jay Pershad, M.D., Emily Ansusinha, Andrea Hahn, M.D., M.S., Rana Hamdy, M.D., M.P.H., MSCE, Nada Harik, M.D.Benjamin Hanisch, M.D.Barbara Jantausch, M.D.Adeline Koay, MBBS, MS.c., Robin Steinhorn, Kurt Newman, M.D. and David Wessel, M.D.

Meghan Delaney

Pathology chief appointed to board of pathology advisory committee

Meghan Delaney

The American Board of Pathology (ABPath) has appointed the chief of Pathology and Laboratory Medicine at Children’s National Health System, Meghan Delaney, D.O., M.P.H., to its Test Development and Advisory Committee (TDAC) for blood banking and transfusion medicine. As a member of the committee, Dr. Delaney will play a role in the development and review of the American Board of Pathology certification exam questions. Physicians selected to serve on the TDAC are established subject matter experts in their subspecialty, with knowledge on the latest advances in the field of pathology and patient care.

“As TDAC members, these physicians play a critical role in the development of the exams and are entrusted with maintaining the integrity of the board-certified designation. The appointment to a TDAC indicates the physician is highly regarded in the field of pathology and exemplifies the utmost standards of care,” states Rebecca L. Johnson, M.D., CEO of the American Board of Pathology.

Dr. Delaney joined Children’s National as Chief of Pathology and Laboratory Medicine in 2017. A diplomate of the American Board of Pathology, with certification in transfusion medicine/blood banking and clinical pathology, she is an active member of several professional societies. She serves as chair of the AABB Transfusion Medicine Subsection Pediatric Subcommittee and as chair of the American Society of Apheresis Applications Committee Pediatric Subcommittee.  Dr. Delaney is also a scientific member of the BEST Collaborative, an associate editor for the journal Transfusion Medicine and a member of the editorial board of Transfusion.

The mission of the American Board of Pathology, as a member of the American Board of Medical Specialties, is to serve the public and advance the profession of pathology, by setting certification standards and promoting lifelong competency of pathologists. Founded in 1936, the ABPath accomplishes this mission by establishing certification and continuing certification standards, as well as, assessing the qualifications of those seeking to obtain voluntary certification in the specialty of pathology.  Since 1971, the ABPath has appointed test committees for each specialty area of pathology. The committee consists of ABPath trustees and other pathologists, or specialty physicians, who are recognized experts in their respective disciplines.

Groundbreaking at Research and Innovation Campus

Children’s National breaks ground on research and innovation hub

Groundbreaking at Research and Innovation Campus

Pictured, from left to right: Mike Williams, board chair of Children’s National, Mark Batshaw, M.D., chief academic officer and physician-in-chief at Children’s National, Kurt Newman, M.D., president and CEO of Children’s National, Ward 4 Councilman Brandon Todd, Norvell Coots, M.D., president and CEO of Holy Cross Health, and Sarosh Olpadwala, director of real estate, Office of the Deputy Mayor for Planning and Economic Development.

On November 28, 2018, Children’s National Health System marked the official start of construction on its pediatric research and innovation campus with a groundbreaking event. The campus will be distinct nationally as a freestanding research and innovation complex focused on pediatric medicine.

“We had this vision to create a one-of-a-kind pediatric and research innovation campus, which is also a first for Washington, D.C.,” said Kurt Newman, M.D., president and CEO of Children’s National. “If we’re going to help children grow up stronger, then it’s not enough to just provide excellent medical care. We have to work on the research and innovation, which drives discoveries and improves the care for our next generation.”

Children’s National is renovating four existing buildings on a nearly 12-acre portion of the former Walter Reed Army Medical Center campus. This includes a research and innovation building, an outpatient care center, which will include comprehensive primary care services for the community and a conference theatre.

With 160,000 sq. ft. of research and innovation space – and room for expansion – Children’s National will be able to expand its efforts in the high-impact opportunities in pediatric genomic and precision medicine. Developing treatments that can target an individual’s disease more precisely can produce better outcomes with fewer side effects. This focus on personalized research will also improve access at the main hospital by freeing up space for the high-demand critical care services that Children’s National provides.

These efforts will be anchored by three areas of strength at Children’s National: the Center for Genetic Medicine Research, headed by Eric Vilain, M.D., Ph.D., the clinical molecular genetics laboratory directed by Meghan Delaney, DO, MPH, and the Rare Disease Institute headed by Marshall Summar, M.D.

A critical component of the new campus’ success is its proximity to key partners, such as industry, universities, academic medical centers, federal agencies and start-up companies. By working together with these partners, Children’s National hopes to create an ecosystem for nurturing innovation from laboratory discovery all the way through to commercialization.

The new pediatric research and innovation center will also provide an economic benefit of $150 million through its completion date of 2020, providing 350 temporary jobs and 110 permanent positions. The long-term growth, based on an independent study by McKinsey and Company, is exponential and could produce up to $6.2 billion in economic benefit by 2030, based on projected tax revenue and 2,100 permanent jobs, pending future research partnerships.

“Medical advances that effectively treat or prevent disease mean that our children will live fuller, more productive lives,” said Mike Williams, board chair of Children’s National. “That is real economic and societal benefit.”

Catherine Bollard and Hemant Sharma

Nationally recognized immunotherapy and pathology experts take on new leading roles at Children’s National

Catherine Bollard and Hemant Sharma

Catherine Bollard, M.D., M.B.Ch.B., has been chosen to serve as director of the Children’s Research Institute’s Center for Cancer and Immunology Research and Hemant Sharma, M.D., M.H.S., will assume the role of chief of the Division of Allergy and Immunology.

Children’s National Health System recently made several exciting leadership announcements in the allergy, immunology and laboratory medicine fields, furthering the hospital’s ongoing commitment to providing the most comprehensive, innovative care for children.

Award-winning hematologist and immunotherapist Catherine Bollard, M.D., M.B.Ch.B., currently chief of the Division of Allergy and Immunology, has been chosen to serve as director of the Children’s Research Institute’s (CRI) Center for Cancer and Immunology Research (CCIR). CCIR includes more than 50 clinicians and scientists performing groundbreaking clinical and translational research in understanding the origins of, and developing and testing novel therapies for childhood cancers and immunologic disorders. The center receives more than $10 million annually from the National Institutes of Health and other external entities. In her new role on the leadership team of CCIR, Dr. Bollard will lead the advancement and oversight of cancer and immunology research performed at Children’s National.

“All of the progress made in cellular immunotherapy here at Children’s National can be attributed to Catherine and her leadership,” says Mark L. Batshaw, M.D., chief academic officer and director of CRI. “We are confident her impact will extend even further in her new role.”

Meghan Delaney

Nationally recognized laboratory medicine expert Meghan Delaney, D.O., M.P.H., has joined Children’s National as chief of pathology and lab medicine.

Hemant Sharma, M.D., M.H.S., will assume the role of chief of the Division of Allergy and Immunology. In 2008, he joined the faculty at Children’s National and started the Food Allergy Program, which he directs today. His areas of interest include health disparities and community-based management of food allergy. He is also site principal investigator of novel clinical trials of immunotherapy for peanut allergy. He serves on the Medical Advisory Board of Food Allergy Research and Education (FARE), and was the recipient of the 2016 FARE Vision Award for his contributions to the national food allergy community. Dr. Sharma also serves as the site director of the allergy immunology fellowship program with the National Institutes of Health and has won various teaching awards.

In addition, nationally recognized laboratory medicine expert Meghan Delaney, D.O., M.P.H., has joined Children’s National as chief of pathology and lab medicine. An expert in the field of transfusion medicine, Dr. Delaney will lead efforts to unify Anatomic Pathology and Laboratory Medicine into a single division, while advancing cutting-edge practices in the lab to ensure the highest standard of quality and safety for patients. Dr. Delaney joins Children’s National from Seattle, where she held many leadership positions including serving as medical director at the Pediatric Apheresis Program at Seattle Children’s Hospital & Seattle Cancer Care Alliance, the blood bank at Seattle Children’s Hospital and the Immunohematology & Red Blood Cell Genomics Reference Laboratory at Bloodworks Northwest.

“Dr. Delaney brings extensive experience in laboratory medicine innovation and program-building, and we are confident she will make a lasting impact on our patients,” said Jeffrey Dome, M.D., Ph.D., vice president for the Center for Cancer and Blood Disorders at Children’s National. “Her leadership will bolster our commitment to providing top quality care for our patients through advancement of lab medicine research and treatments.”