COVID19_Flashcards

Question 1

Is COVID-19 a notifiable disease?

Answer 1

Yes, COVID-19 is a notifiable disease.

Question 2

When should patients with possible SARS-CoV-2 be tested?

Answer 2

Patients with possible SARS-CoV-2 should be tested if they have a new continuous cough, temperature of 37.8°C or higher, or loss of/change in normal sense of smell (anosmia) or taste (ageusia).

Question 3

Do children with mild to moderate COVID-19 routinely need admission or investigations?

Answer 3

No, children with mild to moderate disease do not routinely need admission or investigations such as blood tests and radiology.

Question 4

When should testing for SARS-CoV-2 also be considered?

Answer 4

Testing should also be considered in people with acute respiratory infection, clinical or radiological evidence of pneumonia, influenza-like illness, acute worsening of underlying respiratory illness, fever without another cause, onset of delirium in older people, or immunocompromised person with possible atypical COVID-19 presentation.

Question 5

Which age groups of children are at lower risk of severe COVID-19?

Answer 5

Children are at lower risk of severe COVID-19, particularly those under 1 year and those aged 10-24 years.

Question 6

What is the vaccination guidance for children over 5 years old for COVID-19?

Answer 6

Children over 5 can be vaccinated, with the full course requiring 2 doses at least 8 weeks apart.

Question 7

Should chest x-rays and CT scans be routinely conducted for children with COVID-19?

Answer 7

No, chest x-rays and CT scans should not be conducted routinely, even if children require oxygen on admission, and should only be used to answer a specific question.

Question 8

What is the initial oxygen therapy for hypoxic children with COVID-19?

Answer 8

Hypoxic children with COVID-19 should initially receive low flow nasal cannula oxygen, with escalation decisions made by a senior team member.

Question 9

When should CPAP be considered for children with COVID-19?

Answer 9

CPAP should be considered to prevent deterioration.

Question 10

When should dexamethasone be considered for children with COVID-19?

Answer 10

Dexamethasone (or hydrocortisone/prednisolone as alternatives) should be considered if supplemental oxygen is required or if the patient has a level of hypoxia requiring oxygen but is unable to have or tolerate it. Specialist advice is required for all children aged 5 years and under.

Question 11

When should remdesivir be considered for children with COVID-19?

Answer 11

Remdesivir requires specialist advice and a 5-day course is considered for hospitalised children at least 4 weeks old and at least 3kg needing supplemental oxygen.

Question 12

When should ITU escalation be discussed for children with COVID-19?

Answer 12

ITU escalation should be discussed by the senior teams.

Question 13

When should antibiotics be started for children with COVID-19?

Answer 13

Antibiotics should be started if a secondary bacterial infection is suspected or if children are unusually sick at admission and there should be a source of infection identified.

Question 14

What is multisystem inflammatory syndrome in the context of COVID-19?

Answer 14

Multisystem inflammatory syndrome is a complication of COVID-19 seen in the paediatric population.

Question 15

What is the management for multisystem inflammatory syndrome in children with COVID-19?

Answer 15

Management for multisystem inflammatory syndrome requires admission, close monitoring, and discussion with HDU/PICU. See RCPCH guidelines for more details.

Question 16

summarise COVID19 Management

Answer 16

COVID-19 (RCPCH guidance)
 Notifiable disease
 SARS-CoV-2 test
o Patients with possible SARS-CoV-2 should be tested:
 Individuals with new continuous cough/ temperature 37.8°C/ loss of, or
change in, normal sense of smell (anosmia) or taste (ageusia)

 Children with mild to moderate disease do not routinely need admission or investigations such as blood tests and radiology (this will be most children)
 Testing should also be considered in:
o People with acute respiratory infection, clinical or radiological evidence of
pneumonia, influenza-like illness, acute worsening of underlying respiratory illness, fever without another cause, onset of delirium in older people or immunocompromised person with possible atypical COVID-19 presentation
 Children are at lower risk of severe COVID, those most at risk are < 1 and 10-24 years of age

Management
 Vaccination – children over 5 can be vaccinated, full course requires 2 doses at least 8
weeks apart
 Radiology
o Chest x-rays and CT scans may reveal findings even in asymptomatic children,
and the individual relevance of these may be unclear
o They should not be conducted routinely, even if children require oxygen on
admission, and should only be used to answer a specific question
 Isolation
 Oxygen
o Most children, even those with lung involvement, are unlikely to develop respiratory failure
o Children should initially receive low flow nasal cannula oxygen if they are hypoxic, with decision to escalate to be made by a senior team member
 CPAP to be considered to prevent deterioration
 Dexamethasone (or hydrocortisone/prednisolone as alternatives)
o If supplemental oxygen required or if patient has a level of hypoxia requiring oxygen but is unable to have or tolerate it.
o Specialist advice required for all children aged 5 years and under  Remdesivir
o Specialist advice required
o 5 day course is considered for hospitalised children at least 4 weeks and at least
3kg needing supplemental O2.
 ITU
o Escalation discussed by the senior teams
 Antibiotics
o Started if a secondary bacterial infection is suspected (~15% of children).
o Also considered if children are unusually sick at admission, and there should be a
source of infection identified
 Multisystem-inflammatory syndrome
o Complication of COVID-19 seen in paediatric population
o Requires admission, close monitoring + discussion with HDU/PICU o See RCPCH guidelines