Children And Covid-19

Speaker 1: 00:00 Rady children's hospital confirmed this week. It's treating his first pediatric coronavirus patient. As we've heard from the beginning of this outbreak, people over 65 and adults with underlying health conditions run the greatest risk of serious illness from covert 19 but there are exceptions including one 25 year old San Diego who has died of the disease to assist in the outbreak. Rady has made some of its beds available to those up to age 26. KPB has health reporter, Terran mento asks Dr. Mark Sawyer and infectious disease specialist at radius, why the virus isn't typically hitting the youngest patients as hard. Speaker 2: 00:41 What do we know about why it's affecting younger people differently? Speaker 3: 00:46 The simple answer is we don't really know why. Um, there are a number of hypotheses that are going to have to be studied. It may be more than one thing sort of happening all at once. So for example, young children in general do better with infections, most infections than adults, particularly older adults, seniors who have underlying health conditions. And that may simply be that most children don't have underlying chronic conditions. And so they're starting off healthy. And can withstand the impact of infection like this cobot infection better than older adults can. But I suspect it's more than that. The disparity between involvement in illness and in children is so much different than it is in older adults that there's probably a fundamental virologic reason or or physiologic reason why children are not getting severely infected. So among the things that have been discussed, this virus attaches to various specific receptors on your cells and those receptors have different distributions and those distributions may change over time as you age. So children may just not have the receptors in their lung at the same amount as adults do, and that just makes them less susceptible to infection. And the other big area of hypothesis is that the immune response is different. In young children, they may not Mount as brisk and an overly brisk response that some adults seem to be nodding to this infection. Speaker 2: 02:23 If we are noticing that there's a difference between the way that younger people handle or respond to this virus is they're going to have to be a way, a different way or a different approach to treat someone who, if you had a younger patient versus someone up to the age of 26, would that determine a different approach to treatment? Speaker 3: 02:43 I don't think so. From what we understand about this illness and the major treatment is to support people through the period where their lungs are compromised from the viral infection. And there are certainly many other infections that do that in children. So we are used to providing that kind of support. So at this point, I don't think we understand enough about the immune response that would indicate we're going to treat young children any differently than we do adults. But hopefully we're not going to see very many because of this phenomenon. Speaker 2: 03:14 One of the things that recently happened was there was a reported death of an infant and Illinois, um, that I'm sure is raising a lot of people's concerns as we hear that now. I think that they are, I'm working to determine what the exact cause of death. They haven't completely attributed it to Corona virus, but when, when people hear that they get really alarmed, you as, as a doctor, what do you, what do you think when you hear that and what are you waiting to hear about? Speaker 3: 03:41 Yeah, of course that's always tragic when a young baby dies, but there are lots of reasons that that could have happened independent of the fact that that baby apparently was infected with the Corona virus. So just because you're infected with something doesn't mean it's causing your major problems at that time. And we are quite reassured in the pediatric community by all of the data that have come out of China and Italy in New York city and Seattle communities that have started ahead of San Diego in this outbreak. And in all of those places, very small numbers of children that have ended up in the hospital much less severely. You know, Speaker 2: 04:22 there has been a lot of research coming out from, as you mentioned, all of the locations and clearly you're reading it, absorbing it, and paying attention to it. What has been some of the most fascinating, surprising or significant findings that have come out very quickly over the course of this outbreak? Speaker 3: 04:39 Right. And, uh, you know, in addition to the age difference that we've already talked about, one thing that's really a little bit unusual with this infection is that people who do get severely yell seem to do that after a battle. We have symptoms, so they start off with respiratory symptoms that are not particularly severe. They seem to be doing all right for as long as seven days or even longer. And then suddenly they get really sick. And that would suggest that the, that there may be something to do with the immune response, which sometimes takes days to rep ramp up as it's responding to a new infection. Uh, and so I'll be interested to find out what the immune response turns out to be as we're able to study it more carefully. Speaker 2: 05:24 Yeah. I, I recall reading that with SARS and we know that this Corona viruses, SARS Kovi too with SARS, people were described as you know, getting ill then almost getting better and then having a real quick turn for the worst. Is that kind of, would you characterize it the same way or is it just kind of a slow progression downward? Speaker 3: 05:45 No, as I understand and again, and we've yet to see any patients with that severity of Randy children. So I have no personal experience, but as I read the reports, that does sound like what has been happening. Patients who've been doing well or maybe even improving and people thought they were on the downslope getting better and suddenly they take a turn for the worst and that apparently can happen within hours. So that's quite unusual for most infections. Speaker 2: 06:12 There's a lot of concern regionally, statewide, nationally about ventilators and about bed capacity. How worried are you about that for this as a region? Speaker 3: 06:24 Yeah, it's a great question and I think that's sort of why people are so worried. There are lots of unknowns and whenever there are unknowns, the natural human tendency is to sort of over-exaggerate or worry about the worst case scenario. But my observation at this point in time is that in San Diego we have reacted ahead of time given the number of cases that we've had in San Diego compared to other communities. I do expect those numbers will go up, but I do not expect them to go up to the level that they did in New York, for example. So I think San Diego is well prepared. I do know that the health department and the County medical society and all of the major institutions have really gotten together and compared notes and compared resources. And as I, we've already discussed, radius said we'll take young adult patients if that will help. So I think we're in pretty good shape. You're in San Diego as long as people continue to follow the social distance Speaker 2: 07:23 you just brought up New York. Um, and obviously that's a city that's far more populated than San Diego. Um, but they did create some, um, you know, reactions and responses, some guidelines and orders, uh, to slow the spread and help flatten the curve. And up in LA, you know, statewide, we took some actions. Those are going to trickle down to LA and they're also locally taking actions there, but we're still seeing cases rise there at a much quicker rate than San Diego and in New York. So what did we actually do differently? Um, then those cities that we can say that we won't see that here Speaker 3: 08:01 based on the understanding of how this virus is spread. If you can, can disperse your community and not cluster together, you're gonna blend any outbreak. So, uh, I don't actually know the timing in Los Angeles, in Seattle, in New York, in terms of when things were implemented, but my sense is that they were implemented quite early here in San Diego, measures like closing the schools and shutting down restaurants to take out only. So I think we, we were lucky in that we could see what was happening in those other cities that started before us, and we reacted more quickly than they were able to, as an as we got a better picture of this whole outbreak and how it plays out in any individual city. Uh, you know, our leadership said to, we better do something now to prevent that from happening in San Diego. Speaker 2: 08:53 That was Dr. Mark Sawyer speaking with KPBS health reporter. Terran mento.