Sandbox: HAR

Presentations

• Presentation of COVID-19 is less severe in children as compared to adults.
• According to CDC, as of April 2, 2020, 1.7% confirmed cases of COVID-19 were reported in children aged <18 years age among the total number of confirmed cases of COVID-19.
• COVID-19 in children could range from asymptomatic presentation to mild to severe disease.

Symptoms

• Fever and Cough are one of the most common symptoms reported in children. One study showed fever is prevalent in 47.5% of children and cough in 41.5% among the 1124 children with COVID-19. According to the CDC, fever, and cough was reported in 56% and 54% of children with COVID 19
• Dyspnea, nasal congestion, pharyngeal erythema, and sore throat are also common presentations in children.
• Gastrointestinal symptoms-The gastrointestinal manifestation in COVID-19 positive children are diarrhea, vomiting, abdominal pain, nausea, and anorexia.
  • Children can present with gastrointestinal symptoms in the absence of respiratory symptoms.
• Cutaneous Findings

Severity of Disease in Children with COVID-19

• Asymptomatic presentation-
  • A large number of children with COVID-19 are asymptomatic.
  • According to one study 14.2% of children were asymptomatic. Another study showed 18% of asymptomatic children with COVID-19.
• Mild Disease
  • Few numbers of children also present with mild manifestations of COVID-19.
  • A study showed 36.3% of children present with a mild form of the disease.
• Severe
  • 2.1% of children present with a severe form of COVID-19 disease.
  • Children with underlying comorbidities are more susceptible to getting severe COVID-19 disease.

Complication 1

Multisystem Inflammatory Syndrome in Children(MIS-C)

• It is a condition that causes inflammation of some parts of the body like heart, blood vessels, kidneys, digestive system, brain, skin, or eyes.
• According to recent evidence it is suggested that children with MISC had antibodies against COVID-19 suggesting children had COVID-19 infection in the past.
• It causes following symptoms
  • Fever lasting 24 hours or longer.
  • Vomiting
  • Diarrhea
  • Pain in the stomach

Skin rash Red eyes Redness or swelling of the lips and tongue Feeling unusually tired Redness or swelling of the hands or feet

COVID-19 and HIV

Overview

• An observational prospective study found out that the incidence of HIV-infected individuals to be affected by SARS-CoV-2 was similar to the general population.
• Specific antiretroviral therapy did not affect COVID-19 severity.
• Immunosuppression(low CD4 cell counts) was associated with COVID-19 severity.
• Patients with HIV infection often have other comorbidities(lung disease, cardiovascular disease) therefore, increasing the risk for severe-COVID-19 disease.

Risk

• At present people with HIV who are at greatest risk of Severe COVID-19 infection are people -
  • who have lowCD4 cell count.
  • not on antiretroviral therapy.

Presentation

• There hasn't been any observable difference in clinical presentation among people with HIV infection as compared to the general population.
• Common symptoms for COVID-19 are
  • Fever or chills
  • Cough
  • Shortness of Breath or difficulty breathing
  • Fatigue
  • Muscle or Body aches
  • Headache
  • New loss of taste or smell
  • Sore Throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Recommendations for Patients with HIV

• Maintain the supply for antiretroviral therapy for a minimum of 30 days.
• Virtual visit and telemedicine should be considered for non-urgent care and non-adherence counseling
• People with suppressed HIV viral load and in stable health, should postpone their routine medical care and laboratory visits to the extent possible.
• If they develop symptoms of COVID-19 like fever, cough, shortness of breath, et they should seek medical advice.