Hospitals are high-risk facilities for COVID-19 due to the number of patients. But within these facilities, specific areas are considered hotspots for the virus. According to a recent study, pediatric dialysis units can be hotspots after patients and healthcare workers tested positive.
Pediatric dialysis units as hotspots for the spread of COVID-19 was determined by researchers at Indiana University (IU), a public research university in the US. Their findings showed that the units could harbor the SARS-CoV-2 virus and infect patients and assigned medical staff. But the findings also showed that knowing hotspots could potentially help track where the virus might spread inside hospitals. They published the results in the journal JAMA Network.
Pediatric Cases of COVID-19
When SARS-CoV-2, the virus of COVID-19, emerged in China, the pathogen caused illness among adults. At first, the disease was thought to be more severe in young and older adults while less impactful among children. During that time, the research community was confused about higher cases of COVID-19 in adults. Preliminary findings suggested the influence of chronic conditions and the strength of the immune system. The more preexisting conditions there were and the lower the immune system was, the greater the odds of severe symptoms and premature death.
Several weeks later, the spike of confirmed cases worldwide forced countries to implement mandatory quarantine measures, while provideing the research community with more usable data. An association between a strong immune and COVID-19 surfaced, wherein a healthy patient could develop a complication called cytokine storm syndrome. As their body fought the novel infection, their immune system could potentially flood the organs with inflammatory chemicals. The immune-related complication was not detected among pediatric patients. Studies published at the time suggested that the premature immune systems in children could not result in the same phenomenon.
Recently, some children diagnosed with COVID-19 developed hallmark symptoms of a known condition: Kawasaki disease or KD. The unique inflammation in KD was observed in certain pediatric patients, however, it was quickly determined to be different. The distinction led to a new syndrome called multisystem inflammatory in children (MIS-C). This has been the inflammatory complication exclusive in pediatric cases, as opposed to cytokine storm syndrome among adult cases.
According to the Centers for Disease Control and Prevention, a US agency, the cases of COVID-19 among children remained lower compared to adults. In the US, the agency estimated pediatric cases, aged younger than 18 years, accountedfor 2% of all confirmed cases. In China, the estimated pediatric cases, younger than 19 years, was 2.2% of all cases. In Italy, 1.2% of all confirmed cases were patients aged 18 years or younger. In Spain, 0.8% of all confirmed cases were patients younger than 18 years.
So far, MIS-C is seen more in Europe and the US. While there is no concrete explanation yet on the geographical association, research is ongoing to further understand this new syndrome caused by COVID-19.
In a published study in the journal Pediatrics, authors investigated 2,135 nationwide case series of pediatric patients. These patients were reported by the Chinese Center for Disease Control and Prevention with COVID-19, from January 16, 2020 to February 8, 2020. Out of that, 34.1% were laboratory-confirmed cases and 65.9% were suspected cases. The average age of all patients was seven years, but the interquartile range was from 2 to 13 years of age. Among 2,135 pediatric cases, 56.6% were males and over 90% had mild, moderate, or no symptoms at all. The authors concluded that pediatric susceptibility to COVID-19 was not influenced by gender. While children were unlikely to develop severe symptoms than adults, infants were found highly vulnerable.
Pediatric Dialysis Units Hotspots for Coronavirus Spread
At IU, researchers determined that pediatric dialysis units could secretly spread COVID-19 among patients and medical staff. The key reason behind that was the limit on social distancing efforts. Whether they liked it or not, doctors and nurses had no choice but to get close to patients since dialysis could involve complicated intravenous procedures. Also, the units admit pediatric patients who might require close monitoring during the entire session.
"There are unique exposure challenges in dialysis units that limit social distancing efforts, including open bay formats and rotating nursing assignments. Dialysis units find threat among many infectious diseases and COVID-19 is dangerous to patients receiving dialysis," said Dr. David Hains, the lead author of the study and professor of pediatric nephrology at IU.
In the study, researchers obtained samples from participants comprised of 13 patients, 9 nurses, 2 nurse practitioners, 10 doctors, and 4 other hospital staff in a freestanding outpatient five-bed/three-isolation room pediatric dialysis unit at Riley Hospital for Children. The samples obtained were measured for antibody levels to confirm the presence of SARS-CoV-2. The researchers based their study on the dialysis units in Wuhan, China, which were reported to have a high incidence of COVID-19. Researchers wanted to confirm if the virus could truly reside in pediatric dialysis units and spread it to others.
Aside from samples, participants assigned in those units were monitored for COVID-19 symptoms. Physical clinical signs and temperatures were assessed to determine if anyone was symptomatic. A week before the study, on March 25, 2020, one patient had a fever and generalized symptoms that might be COVID-19. Via reverse transcriptase-polymerase chain reaction or RT-PCR test, the patient was found positive of SARS-CoV-2. Additional PCR tests sustained positive status on days 7 and 14 until April 11, 2020.
The study participants were measured for antibody levels on days 7, 14, and 21. Results confirmed that two healthcare workers tested negative between day 0 and 7, despite exhibiting fever and upper respiratory tract symptoms. On day 21, 11 healthcare workers and 3 patients tested positive. However, none of them developed symptoms between days 7 and 21.
Researchers concluded that tracking the health status of the staff in those units ultimately saved lives. First, those who tested positive were quarantined immediately. Second, the immediate quarantine action crippled the start of an outbreak. And third, the prevention of an outbreak averted COVID-19 infection among pediatric dialysis patients and assigned medical staff.
Their study could enlighten hospitals worldwide in tracking the likely source of transmission from within. It could also help monitor pediatric dialysis patients for COVID-19 and motivate the proper separation of different patients. Potentially, the method may thwart the cross-contamination between pediatric patients with and without COVID-19.