Swiss Re AG · SIX:SREN
Swiss Re — Technical Presentation (February 2021)
18 slides from Swiss Re's technical presentation, Feb 17, 2021
Slide 1: COVID-19 and MIS-C in Children & Adolescents: Reports from the Front-Line
COVID-19 and MIS-C in Children & Adolescents: Reports from the Front-Line HEATHER HAQ, MD, MHS, FAAP FEBRUARY 17, 2021
Slide 2: Texas Medical Center in Houston
Texas Medical Center in Houston
Slide 3: Houston Covid-19 Epidemic Curve
Houston Covid-19 Epidemic Curve https://www.tmc.edu/coronavirus-updates/tmc-daily-new-covid-19-hospitalizations/
Slide 4: Dr. Haq on the acute care pediatric COVID unit
Dr. Haq on the acute care pediatric COVID unit in a large, quaternary children’s hospital in Texas (2020)
Slide 5: COVID-19 in Children
COVID-19 in Children Severe outcomes and death in children and teens are rare. Most children infected with SARS-CoV-2 have no, mild, or moderate symptoms. Because of this, children are often forgotten!!
Slide 6: COVID-19 in Children: Just How Rare?
COVID-19 in Children: Just How Rare? True incidence in children unknown US: Children estimated to account for 1.7-2% of diagnosed cases of COVID; more recent estimates ~8%-10% Racial disparities mirror those of adult populations =298 pediatric deaths in US (CDC Covid Data Tracker 2021)
Slide 7: COVID-19 Hospitalization and Death by Age
COVID-19 HOSPITALIZATION AND DEATH BY AGE Rate ratios compared to 18-29 year olds Comparison Group Comparison DEATH? ests oooooeo ; * Data source: COVID-NET (https://www.cde.gow/coronavirus/2019-ncov/covid-data/covidview/index.htm!, accessed 08/06/20). Numbers are unadjusted rate ratios. ? Data sour
Slide 8: COVID-19 Hospitalizations in Children
COVID-19 Hospitalizations in Children Most common reasons for pediatric hospitalization: Neonatal fever Fever, dehydration Vomiting, diarrhea, dehydration Acute kidney injury COVID pneumonia (risk factors: obesity, reactive airway disease) Viral myocarditis Multi-system inflammatory
Slide 9: MIS-C: Case Definition
MIS-C: Case Definition Case definition (CDC 2021) Fever; PLUS Lab evidence of inflammation; PLUS At least 2 organ systems involved; PLUS Organ systems: heart, lungs, kidney, GI, skin, neurologic, blood/hypercoagulability Current or recent SARS-CoV-2 infection/exposure; PLUS No alternat
Slide 10: MIS-C: Epidemiology
MIS-C: Epidemiology Incidence ~ 2 per 100,000 (Dufort 2020) More common in older children, adolescents; previously healthy Black and Hispanic children disproportionately affected Less commonly reported in Asia Cases lag behind COVID surges
Slide 11: MIS-C: Clinical Presentation
MIS-C: Clinical Presentation Shock (30-75%) Cardiac dysfunction on echo (50-90%) Coronary artery changes Myocardial dysfunction Depressed ventricular function, heart failure Mitral valve regurgitation Pericardial effusion Arrhythmia Respiratory failure (30-50%) Acute kidney injur
Slide 12: Pediatric COVID/MIS-C: Long-term sequelae
??? sequelae Pediatric COVID/MIS-C: Long-term https://www.texaschildrens.org/blog/first-its-kind-covid-19-return-activity-clinic-guides-patient-back-football-field-safely
Slide 13: Most common long-term sequelae in children
and psychologic Cardiac, neurologic, sequelae in children: Most common long-term respiratory, deconditioning, https://www.houstonchronicle.com/opinion/outlook/article/Essay-I-got-COVID-at-summer- camp-and-I-m-still-15841566.php#content
Slide 14: Dual Pandemic: Pediatric Mental Health
Dual Pandemic: Pediatric Mental Health https://www.washingtonpost.com/lifestyle/style/teenagers-covid-pandemic-mental- Emergency room visits for mental health crises for 12- health/2021/02/10/3389983a-39d6-11eb-9276-ae0ca72729be_story.html 17 year olds up 31% in 2020 vs 2019 (Leeb 2020) Suicidal
Slide 15: Dual Pandemic: Pediatric Mental Health
Dual Pandemic: Pediatric Mental Health Suicide Ideation and Attempts in a Pediatric Emergency Department Before and During COVID- 19 Rates of screen results positive for suicide ideation (A) and attempt (B), January to July, ages 11-21 years. (Hill 2020)
Slide 16: Dual Pandemic: Pediatric Mental Health
Dual Pandemic: Pediatric Mental Health https://www.usnews.com/news/health-news/articles/2021-01-06/childrens-hospitals-grapple-with-wave-of-mental-illness Shortage of community mental health resources to meet increased demand → psychiatric hospitals full → admissions to pediatric medical hospitals
Slide 17: A new generation of orphans
A new generation of orphans https://www.wsj.com/articles/a-toll-of-coronavirus-in-new-york-is-a-new-group-of-orphans-11596288601
Slide 18: References
References Centers for Disease Control (2021. COVID Data Tracker: Demographic Trends of COVID-19 cases and deaths in the US reported to CDC. https://covid.cdc.gov/covid-data- tracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fcases- in-us.html#demographics