{"id":3459,"date":"2020-04-29T12:14:00","date_gmt":"2020-04-29T17:14:00","guid":{"rendered":"https:\/\/blog.unmc.edu\/infectious-disease\/?p=3459"},"modified":"2026-03-20T13:43:05","modified_gmt":"2026-03-20T18:43:05","slug":"the-weekly-corona-with-dr-raquel-lamarche-5","status":"publish","type":"post","link":"https:\/\/blog.unmc.edu\/infectious-disease\/2020\/04\/29\/the-weekly-corona-with-dr-raquel-lamarche-5\/","title":{"rendered":"The Weekly Corona with Dr. Raquel Lamarche"},"content":{"rendered":"<div class=\"panel body-content\"><div class=\"panel__container\"><p>As our institution, state, country, and the world grapple with the impacts of SARS-CoV-2, causing COVID-19, there are lots of ongoing discussions about coronaviruses. Dr. Raquel Lamarche is a PGY1 Internal Medicine\/Pediatrics resident at UNMC, who will be sharing her thoughts and information she learns about COVID-19. You can follow Dr. Lamarche on Twitter <a href=\"https:\/\/twitter.com\/LamarcheRaquel\" target=\"_blank\" aria-label=\"@LamarcheRaquel, opens in a new window\" rel=\"noopener noreferrer\">@LamarcheRaquel<\/a>. This week Dr. Lamarche discusses a pediatric Infectious Diseases primer on SARS-CoV-2.<\/p>\n<hr>\n<p>Children are not tiny adults; thus, it is not surprising that many infectious diseases affect children differently from adults.<\/p>\n<p>We don\u2019t know why COVID-19 appears to be less frequent and severe in children compared to adults. Some considerations include a less vigorous immune response to the virus in children, potential viral interference in the respiratory tract of young children leading to a lower viral load, and perhaps the receptor for SARS-CoV-2, the angiotensin-converting enzyme 2 receptor, is expressed differently in the respiratory tract of children compared to adults. As the pandemic progresses, we expect to learn more from data being published.<\/p>\n<p><strong>Some Epidemiology<\/strong><br \/>\n\u2022 In a <a href=\"https:\/\/pediatrics.aappublications.org\/content\/early\/2020\/03\/16\/peds.2020-0702.1\" target=\"_blank\" aria-label=\"case series of 2000 children, opens in a new window\" rel=\"noopener noreferrer\">case series of &gt;2000 children<\/a> from China, there was no statistically significant difference in incidence between girls and boys; another case series reported a <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMc2005073\" target=\"_blank\" aria-label=\"higher COVID-19 case rate in boys (61%) compared with girls (39%), opens in a new window\" rel=\"noopener noreferrer\">higher COVID-19 case rate in boys (61%) compared with girls (39%)<\/a><br \/>\n\u2022 It appears that <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/apa.15270\" target=\"_blank\" aria-label=\"children are less affected by COVID-19, opens in a new window\" rel=\"noopener noreferrer\">children are less affected by COVID-19<\/a> than adults. This could reflect a lack of widespread availability for SARS-CoV-2 testing or the fact that children are less likely to be tested due to milder disease.<br \/>\n\u2022 <u><a href=\"https:\/\/www.degruyter.com\/view\/journals\/cclm\/ahead-of-print\/article-10.1515-cclm-2020-0434\/article-10.1515-cclm-2020-0434.xml\">Coinfection of SARS-CoV-2 and multiple respiratory pathogens <\/a><\/u>can occur in children<br \/>\n\u2022 Children account for <a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/cases-updates\/cases-in-us.html\" target=\"_blank\" aria-label=\"1 to 5 percent of diagnosed COVID-19 cases, opens in a new window\" rel=\"noopener noreferrer\">1 to 5 percent of diagnosed COVID-19 cases<\/a>.<\/p>\n<p><strong>Transmission <\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/raquel-gonzo.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-3473\" src=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/raquel-gonzo-224x300.jpg\" alt=\"A colorful drawing of The Muppets character Gonzo in a suit with wide, expressive eyes and a surprised expression. Text reads Strange times beside the character.\" width=\"224\" height=\"300\" srcset=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/raquel-gonzo-224x300.jpg 224w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/raquel-gonzo-768x1027.jpg 768w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/raquel-gonzo-766x1024.jpg 766w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/raquel-gonzo-120x160.jpg 120w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/raquel-gonzo.jpg 864w\" sizes=\"auto, (max-width: 224px) 100vw, 224px\" \/><\/a>Large droplets: this type of transmission can be prevented using face masks<\/li>\n<li>Fomites: (objects on which the virus containing droplets have settled) the virus may remain on surfaces for up to 4 days.<\/li>\n<li><a href=\"https:\/\/www.medrxiv.org\/content\/10.1101\/2020.03.23.20039446v2.full.pdf+html\">Aerosols:<\/a> it appears that the virus may also be aerosolized, with a UNMC study finding evidence of (noninfectious) viral particles in the air<\/li>\n<\/ul>\n<p><strong>Pregnancy and newborns<\/strong><\/p>\n<ul>\n<li>Data in pregnancy is minimal. The <u><a href=\"https:\/\/www.archivesofpathology.org\/doi\/abs\/10.5858\/arpa.2020-0901-SA\">most extensive case series had 38 cases<\/a><\/u><\/li>\n<li>Currently, the virus is not definitively known to be transmitted vertically.<\/li>\n<li>Of note, there <em>are<\/em> <u><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2763853\">isolated cases<\/a><\/u>&nbsp;of <em>potential<\/em> vertical transmission as demonstrated by baby\u2019s elevated IgM against SARS-CoV-2 (IgM does not cross the placenta). The latter is relevant because infants seem to be one of the most vulnerable groups for severe disease in the pediatrics population.<\/li>\n<li>SARS-CoV-2 does not seem to be transmitted through breast milk. However, droplet transmission <em>can<\/em> occur through close contact during feeding.<\/li>\n<li>Healthy pregnant women seem to have the same risk as adults who are not pregnant; however,&nbsp;<u><a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/need-extra-precautions\/pregnancy-breastfeeding.html\">the CDC warns that contracting the coronavirus while pregnant could make you more vulnerable to severe respiratory problems<\/a><\/u>. This is because pregnant women already have a physiologic restrictive lung disease and relative immunocompromised state.<\/li>\n<li>One unknown is the impact on women who get sick early in pregnancy and their developing fetus. This is a new virus and nobody who was in the first trimester when they developed COVID-19 has delivered yet.<\/li>\n<\/ul>\n<p><strong>Symptoms and signs in children<\/strong><\/p>\n<p><u><a href=\"https:\/\/pediatrics.aappublications.org\/content\/early\/2020\/03\/16\/peds.2020-0702.1\">In case series of &gt;2000 children from China<\/a><\/u>:<\/p>\n<p>\u2022 4% of virologically confirmed cases had asymptomatic infection [<em>this rate could be underestimating the accurate scale of asymptomatic infection because many asymptomatic children are unlikely to be tested. On the other hand, children with congenital and chronic diseases are living longer in the US, which means we might have a larger population that is potentially vulnerable to symptomatic and severe disease<\/em>]<br \/>\n\u2022 Among <span style=\"text-decoration: underline\">symptomatic children<\/span>, 5% had dyspnea or hypoxemia, and 0.6% progressed to acute respiratory distress syndrome.<br \/>\n\u2022 Some children presented with <span style=\"text-decoration: underline\">only<\/span> gastrointestinal symptoms<br \/>\n\u2022 It appears that children generally have a significantly milder disease<\/p>\n<p><span style=\"text-decoration: underline\">One caveat about this observational study:<\/span><br \/>\n\u2022 Out of the 2135 cases, 66% were \u201csuspected cases\u201d (not test confirmed) defined as a child who was exposed to COVID-19 within the last 2-weeks, or lived in an epidemic area, had 2 of the following conditions: (1) fever, respiratory, digestive symptoms (eg, vomiting, nausea, and diarrhea), or fatigue; (2) laboratory test white blood cell count was normal, decreased, or had a lymphocyte count or increased level of C-reactive protein; or (3) abnormal chest radiograph imaging result. <em><strong>Children often get sick multiple times per year with many of the above findings, completely unrelated to COVID-19 &#8211; could some of these &#8220;suspected cases&#8221; have had symptoms caused by other viral illnesses?<\/strong><\/em><\/p>\n<p>In a <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6914e4.htm#T1_down\" target=\"_blank\" aria-label=\"US case-series (n=296), opens in a new window\" rel=\"noopener noreferrer\">US case-series (n=296)<\/a> the most common symptoms in children were:<br \/>\n\u2022 Fever (56%), Cough (54%), and Shortness of breath (13%)<br \/>\n\u2022 Less common symptoms: myalgia, fatigue, sore throat, rhinorrhea, nasal congestion, headache, diarrhea, and vomiting<br \/>\n\u2022 73% of pediatric patients had symptoms of either fever, cough, or shortness of breath compared with 93% of adults aged 18\u201364 years<\/p>\n<p><a href=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-3452 alignleft\" src=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-193x300.jpg\" alt=\"Abstract watercolor painting with swirling blue and pink shapes. The composition has a dreamy, ethereal feel, with thin, flowing lines.\" width=\"193\" height=\"300\" srcset=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-193x300.jpg 193w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-768x1196.jpg 768w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-1315x2048.jpg 1315w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-657x1024.jpg 657w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-986x1536.jpg 986w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-120x187.jpg 120w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-congenital-3-scaled.jpg 1643w\" sizes=\"auto, (max-width: 193px) 100vw, 193px\" \/><\/a>In another <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMc2005073\" target=\"_blank\" aria-label=\"series of 171 children, opens in a new window\" rel=\"noopener noreferrer\">series of 171 children<\/a> with confirmed SARS-CoV-2 infection,<br \/>\n\u2022 42% had fever, median duration of 3 days (range 1-16 days)<br \/>\n\u2022 49% had cough, and 16% were asymptomatic<br \/>\n\u2022 19% had upper respiratory infection, but 65% had pneumonia.<br \/>\n\u2022 29% had tachypnea, 42% had tachycardia on admission, and 2.3% had O2 sat &lt;92% during hospitalization<br \/>\n\u2022 77% of children with COVID-19 were in contact with a family member with confirmed SARS-CoV-2<\/p>\n<p><strong>Newborns and infants<\/strong><\/p>\n<p>In<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/32301967\" target=\"_blank\" aria-label=\" young infants, SARS-CoV-2 can cause fever without any other manifestations, opens in a new window\" rel=\"noopener noreferrer\"> young infants, SARS-CoV-2 can cause fever without any other manifestations<\/a>, including respiratory symptoms and signs.&nbsp;A <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMc2010614\" target=\"_blank\" aria-label=\"3-week old baby boy, opens in a new window\" rel=\"noopener noreferrer\">3-week old baby boy<\/a> who tested positive for SARS-CoV-2 and developed hypercarbic respiratory failure. He had an otherwise negative sepsis workup.<\/p>\n<p><strong>Deaths in children with COVID-19<\/strong><br \/>\nAlthough <a href=\"https:\/\/nypost.com\/2020\/04\/23\/infant-killed-by-coronavirus-went-out-looking-like-a-princess\/\" target=\"_blank\" aria-label=\"severe cases of COVID-19, opens in a new window\" rel=\"noopener noreferrer\">severe cases of COVID-19<\/a> in children,<a href=\"https:\/\/www.detroitnews.com\/story\/news\/local\/detroit-city\/2020\/04\/19\/5-year-old-first-michigan-child-dies-coronavirus\/5163094002\/\" target=\"_blank\" aria-label=\" including fatal cases, opens in a new window\" rel=\"noopener noreferrer\"> including fatal cases<\/a>, have been reported, most children appear to have a mild or moderate disease and recover within one to two weeks of disease onset.<\/p>\n<p><strong>Laboratory findings<\/strong><\/p>\n<p>Laboratory findings in children with confirmed infection from Wuhan <a href=\"https:\/\/www.nejm.org\/doi\/suppl\/10.1056\/NEJMc2005073\/suppl_file\/nejmc2005073_appendix.pdf\" target=\"_blank\" aria-label=\"were variable, opens in a new window\" rel=\"noopener noreferrer\">were variable<\/a>.<br \/>\n25% had white blood cell count &lt;5.5 x 109\/L (5500\/microL)<br \/>\n3.5 % had lymphocyte count 46 pg\/mL)<br \/>\n20% had elevated C-reactive protein was elevated (&gt;10 mg\/L)<\/p>\n<p><strong>Radiographic findings<\/strong><\/p>\n<p>Radiographic findings may be present before symptoms. <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMc2005073\" target=\"_blank\" aria-label=\"CT chest abnormalities noted, opens in a new window\" rel=\"noopener noreferrer\">CT chest abnormalities noted<\/a> were:<br \/>\n33% ground-glass opacity<br \/>\n19% patchy local shadowing<br \/>\n12% bilateral patchy shadowing<br \/>\n2% interstitial abnormalities<\/p>\n<p><strong>Risk factors for severe disease<\/strong><br \/>\n\u2022 It appears that infants &lt;1 year of age and children with certain underlying severe conditions are at higher risk for severe disease.<br \/>\nThe most commonly reported underlying conditions were:<br \/>\n\u2022 Chronic pulmonary disease like asthma<br \/>\n\u2022 Cardiovascular disease<br \/>\n\u2022 Immunosuppression (cancer, chemotherapy, radiation therapy, hematopoietic cell or solid organ transplant, high doses of glucocorticoids)<br \/>\n\u2022 Based on data extrapolated from adults, other medical conditions that may increase the risk of severe disease in children include CKD undergoing dialysis, chronic liver disease, pregnancy, diabetes mellitus, and severe obesity.<\/p>\n<p><a href=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-3474\" src=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child-300x300.jpg\" alt=\"Illustration of Grogu wearing a mask, pointing forward. Text reads Keep Distance We Must in bold, block letters.\" width=\"300\" height=\"300\" srcset=\"https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child-300x300.jpg 300w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child-800x800.jpg 800w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child-150x150.jpg 150w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child-768x768.jpg 768w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child-1024x1024.jpg 1024w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child-120x120.jpg 120w, https:\/\/blog.unmc.edu\/infectious-disease\/wp-content\/uploads\/sites\/54\/2020\/04\/Raquel-the-child.jpg 1181w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a>Many of these risk factors are similar to adults. But while much of the conclusions about risk may be extrapolated from adults, children still appear to be affected differently than adults, and this is probably a good reason why more widespread testing, especially in children, may be a good idea, particularly as we look toward the fall and reopening of schools.<\/p>\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Dr. Raquel Lamarche is a PGY1 Internal Medicine\/Pediatrics resident at UNMC, who will be summarizing updates about SARS-CoV-2 and hopefully make information easier to digest, with additional outlines of implications for graduate medical education. This week Dr. Lamarche discusses a pediatric Infectious Diseases primer. You can follow Dr. Lamarche on Twitter @LamarcheRaquel. <\/p>\n","protected":false},"author":562,"featured_media":3388,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_s2mail":"","footnotes":""},"categories":[135,141,138],"tags":[143,136,142,137],"class_list":["post-3459","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-covid-19","category-pediatric-id","category-weekly-corona","tag-children","tag-coronavirus","tag-pedsid","tag-weeklycorona"],"_links":{"self":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/3459","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/users\/562"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/comments?post=3459"}],"version-history":[{"count":16,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/3459\/revisions"}],"predecessor-version":[{"id":6523,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/3459\/revisions\/6523"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/media\/3388"}],"wp:attachment":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/media?parent=3459"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/categories?post=3459"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/tags?post=3459"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}