Children with congenital heart disease (CHD) are not at an increased risk of contracting COVID-19 and there is no clear evidence indicating that children with CHD who become infected with COVID-19 are at higher risk of complications. The following questions and answers may help you during this outbreak.
What is COVID-19?
Coronaviruses (CoV) are a common and large family of viruses. Coronaviruses can cause a mild illness such as the common cold to a more severe illness such as pneumonia (infection of the lungs). Most people who become ill with a coronavirus will recover on their own with no specific antiviral treatment.
A new strain of coronavirus was identified in late 2019 and has spread across the globe, which has been named SARS-CoV-2. The disease that it causes is named COVID-19 (Coronavirus disease 2019). Because there has been worldwide spread of COVID-19, the outbreak was declared a pandemic by the WHO on March 11, 2020.
Is my child with CHD at higher risk of getting COVID-19?
There is still a lot to be learned about COVID-19. Currently, serious illness in children appears to be less common than it is in adults. At this time, there is no clear evidence to suggest that children with congenital heart disease are at greater risk of being infected with COVID-19, or of serious illness if they get the infection. However, as any viral infection may affect children with certain congenital cardiac defects more significantly compared to healthy children, you and your child should strictly follow physical distancing and immunization measures as outlined by government guidelines.
How do I know if my child has COVID-19?
Your child may have COVID-19 if they have some or all of the following symptoms:
- fever
- cough or sneezing
- sore throat
- difficulty breathing or fast breathing
- body aches
- headache
- chills
- fatigue
- diarrhea and vomiting
- runny or stuffy nose that progresses to one of the above symptoms
- loss of the sense of smell
While fever may be the main symptom, not all children with COVID-19 will have a fever. Some people with COVID-19 have mild symptoms or no symptoms at all. In more severe cases people can have difficulty breathing and pneumonia in one or both lungs.
There is a rare condition that may be related to COVID-19 that develops in children 1 to 2 months after they have had the infection. This condition is called multisystem inflammatory syndrome in children (MIS-C). This condition is caused by inflammation in the body that leads to a prolonged fever in the child. There are effective treatments for this condition. Based on what is known so far about MIS-C, it is not likely that children with underlying medical conditions are at increased risk of MIS-C. Read the article on MIS-C to learn more about this condition.
What are effective measures to prevent COVID-19 spread?
- Vaccination has been shown to be effective against COVID-19 and to reduce the spread of the SARS-CoV-2 virus. Individuals who are eligible to receive the COVID-19 vaccine, including children five years of age and older, should receive the vaccine. Read the article on COVID-19 vaccines to learn more about them.
- Like other respiratory viruses, including influenza, it is recommended that you wash your hands frequently by using alcohol-based hand sanitizer, or by using soap and water for 20 seconds.
- Limit touching your face, nose and eyes.
- Avoid close contact with people who have a fever or cough.
- Practice cough etiquette by keeping a distance from other people, coughing and sneezing into your sleeve, a tissue or a respiratory mask, and practicing frequent hand washing.
Are there any extra precautions that my child or I should be taking?
Encourage your child to wash or sanitize their hands frequently. For older children, you can provide them with a bottle of alcohol-based hand sanitizer. Hand sanitizer can be dangerous if swallowed. Be careful to keep it away from young children.
Avoid having your child be in close contact with anyone who has symptoms of COVID-19. Be vigilant for signs of infection in your child.
Should my child wear a face mask when in public?
In accordance with currently available evidence, in order to limit the spread of COVID-19, the use of a face covering or face mask is currently recommended by Public Health Ontario for all individuals in public indoor spaces.
When visiting SickKids, masks are recommended to children able and willing to wear masks safely – generally children 6 years and older. SickKids is providing masks to all family caregivers and children. Masks will be provided at the Entry Screening desks.
If your child has respiratory symptoms (i.e., fever, cough) and they are at the hospital for assessment, it is important that they wear a mask to avoid spreading infection to others. Your primary care team may also advise your child to wear a mask for other reasons and you should follow this advice.
Should I come to the hospital if I think my child has COVID-19?
If your child has symptoms of COVID-19, contact your primary care team at the hospital before coming. They will help you determine if your child needs to be seen and where you should go.
You should come to the hospital right away if your child has the following symptoms:
- fast breathing or trouble breathing
- bluish skin color
- not drinking enough fluids
- not waking up or not interacting
- being so irritable that the child does not want to be held
In an emergency, please call an ambulance and tell the emergency services team that you are concerned your child may have a COVID-19 infection.
Is testing for COVID-19 available at SickKids?
Testing for COVID-19 is done at SickKids for all children with heart disease undergoing cardiac surgery, as well as some patients undergoing a cardiac catheterization. They will be tested up to 72 hours before undergoing the procedure, even if they do not have symptoms.
If my child is diagnosed with COVID-19, how long will they be sick?
There is still a lot to be learned about COVID-19, especially in children as they generally do not show many symptoms. How long a child is sick will vary from child to child.
What should I do if I am unwell myself, or my child’s sibling becomes unwell with symptoms of COVID-19 infection?
Contact your family doctor or your child’s paediatrician. It is also advised that you practice physical distancing at home as much as possible. You can also refer to the Ontario general guidelines of who should be tested for COVID-19 and ways of accessing testing at covid-19.ontario.ca.
If my child requires assessment for symptoms other than COVID-19 infection what should we do?
Continue to follow the recommendations for getting your child assessed according to your primary care team’s instructions, as you would do normally.
Should I reschedule my upcoming routine appointment?
Cardiac clinic appointments are being reviewed regularly and many upcoming visits may be rescheduled or moved to virtual care by video or telephone, if possible. The cardiac clinic is limiting the number of patients being seen in person. However, medically necessary appointments/testing will continue to take place.
For some cardiac patients, their appointments and tests have been left unchanged and it is still recommended they come to the clinic to undergo essential testing, including ECG and echocardiogram, and be seen by their nurse and/or cardiologist.
Some patients have been recommended to come in for testing only and results will be communicated via a virtual visit (phone or video call). The doctor will ask how your child is doing and will talk about the test results. For other patients there will be a virtual visit only without undergoing any tests.
Some patients may have their visit rescheduled to a later date, after the COVID pandemic settles. Please contact the cardiac clinic for questions regarding your upcoming appointments.
What if my child needs a procedure or surgery?
The Heart Centre at SickKids remains operational and procedures are planned based on urgency. If your child needs a procedure, our teams will do what is needed to preserve the health of your child with heart disease. Throughout the different areas of the Heart Centre, special protection measures have been put in place to keep your child and the staff as safe as possible.
What if the province orders a lockdown and mandates people staying in their homes? Will we be able to get to the hospital?
Even in those countries that have ordered lockdowns, people have still been able to travel for medically necessary reasons.
Is it safe for my child to come to SickKids during the current outbreak?
Yes, the hospital is safe for you and your child to go to for assessment as directed by your cardiologist. At all times SickKids has clear procedures in place for protecting your child from getting an infection when visiting the hospital. During this time additional measures to protect you and your child have been put in place.
Screening takes place by phone even before cardiac patients come to the hospital. All patients and visitors will undergo a screening process at the entrance of the hospital. They will be asked several questions about symptoms, travel and exposure to COVID-19 positive people.
During the cardiac clinic visit, patients will be brought directly into a clinic room as waiting rooms have been closed to maintain physical distancing recommendations.
For patients undergoing testing, they will go directly to 4B and after registration they will also be put directly into a room to have both the echocardiogram and ECG completed. Your child will remain in the same room to be seen by the nurse and/or cardiologist. This will help to keep the process as efficient as possible and minimize exposure to both patients and staff.
Please follow SickKids instruction regarding the number of visitors permitted to accompany your child. Please see www.sickkids.ca/coronavirus for further information.