How might coronavirus affect children with chronic illness and other health conditions?

Current information suggests that children are unlikely to become severely ill with the coronavirus (Covid-19). However, children with certain underlying conditions may be at higher risk, specifically those children with problems that impact the heart, lungs or ability to fight infection.

Examples of conditions include:

  • Chronic lung disease-cystic fibrosis, primary Ciliary Dyskinesia (PCD), bronchiectasis, difficult asthma, oxygen dependant chronic lung disease and tuberculosis
  • Children on home ventilator support 
  • Complex heart disease
  • Respiratory complications of neurodisability (including muscle disorders)
  • Children considered to have underlying life-limiting illness
  • Immunodeficiency conditions
  • Organ transplant, lung transplant and bone marrow stem cell transplant
  • Current/recent (within six months) cancer chemotherapy/immunotherapy treatment 
  • Children with inflammatory bowel disease and rheumatologic conditions who are taking medications that lower the immune system.

What medications can cause weaken immune system?

  • Prednisolone, high dose inhaled corticosteroid, cyclosporine, MMF, Gamma interferon, Tacrolimus, sirolimus, Rituximab, Azathioprine, 6- Mercaptopurine, Methotrexate, Infliximab and Adalimumab.

Conditions

Asthma

If your child gets an asthma cough and you are unsure whether your child’s cough is a symptom of Covid-19or related to asthma, please speak to your GP, use the online 111 service or call 111 to ensure that your child gets the right care.

Keep following the asthma action plan to manage asthma. If your child is having an asthma attack, call 999 for an ambulance as usual, and tell them your child has Covid-19 symptoms.

If your child has severe asthma

Severe asthma is hard to treat, and often the symptoms are not well controlled, even with high doses of medicines.

Having severe asthma is likely to put your child at higher risk of complications from Covid-19 you should follow the advice above, and try to be extra careful about avoiding unnecessary contact with other people.

Read more about managing asthma.

Rheumatological conditions

  • Is my child / young person specifically at risk as they are on immunosuppressant medication for their Rheumatological condition?

Being on some medications, particularly steroids and /or biologics (such as etanercept / adalimumab / tocilizumab / abatacept / infliximab / rituximab) does cause a greater amount of immunosuppression and therefore may increase risk, although the greatest risk actually comes from being exposed to the virus, which is why the hygiene measures are so important. Many patients are on methotrexate. Whilst this does not cause as much immunosuppression, much of this advice would also apply to them.

Description: medication

Should my child / young person stop taking medication?

No. Current advice is to continue taking all medication as prescribed. Stopping may cause a flare-up of disease requiring more intensive treatment. Contact your paediatric rheumatology team if your child is currently on steroids for possible dose adjustment.

Stay on your medication.

  • If you are taking a mesalamine, these are all safe and are not immune suppressant medications.
  • While taking these medications, you do not need to take extra precautions beyond the recommended personal hygiene.
  • If you are taking steroids (prednisone/prednisolone) for any reason, be sure to take extra precautions and talk to your healthcare provider, as steroids can suppress your immune system.
  • Immunomodulators like thiopurines (azathioprine, 6-mercaptopurine, cyclosporine, methotrexate) tend to inhibit the body’s immune response to viral infections.
    • Do not stop taking these medications. If you have concerns, talk to your provider.
  • Biologics/Biosimilars including infliximab are immune suppressing drugs.
    • Do not stop taking these medications.
    • Talk to your healthcare provider before making any adjustments to these medications.
  • If your medication requires an infusion please do not skip these appointments. It’s important to stay on your medication and go to infusion appointments as scheduled. If you have concerns about visiting an infusion centre:
    • Talk to your doctors, and discuss your concerns.

Read more about what IBD patients should know.

Primary immunodeficiency

Children who have primary immune deficiency diseases are different from the general population. Some children don’t have a typical fever response to infections.

Chronic lung conditions

Evidence has shown that people with chronic lung conditions including cystic fibrosis and PCD seem to be at greater risk of serious illness from Covid-19 .

  • Follow the general healthy precautions and social distancing as advised by the Government.
  • There is no evidence that wearing surgical masks provides personal protection. However, you may be asked to wear a mask when attending hospital, as this relates to protecting others.
  • If you develop cold or ‘flu-like’ symptoms (muscle aches, fever etc), speak with your respiratory team about starting a recommended back-up antibiotic treatment. We advise storing spare dry powder antibiotics or antibiotic tablets at home to start promptly, if needed.
  • Stock up on supplies.

Read more from Cystic Fibrosis Trust.

Congenital heart disease

The Government has stated that patients with ‘chronic heart disease’ are likely to be at increased risk of severe illness from coronavirus. While technically all children with heart problems have ‘chronic heart disease’, most are at no greater risk than the general population and the general Government recommendations should be followed.

It is possible that such children might be more at risk of becoming unwell, including patients:

  • with a single ventricle, Fontan circulation or Glenn shunt;
  • who have cyanosis (low blood oxygen levels);
  • who have heart failure/cardiomyopathy requiring medication;
  • who take regular medicines to improve heart function;
  • with pulmonary hypertension or Eisenmenger syndrome;
  • with tetralogy of Fallot, an atrioventricular septal defect or a large ventricular septal defect that has not yet been operated on;
  • with Di George syndrome if the immune system is affected.

Read advice from Leeds Congenital Hearts.

Epilepsy

Epilepsy is a “family” of many different disorders that lead to seizures. Some people will have easily controlled seizures, have no other health problems, and become seizure-free on medications. Or they may have epilepsy with occasional seizures but no other health problems. For these people, the available data suggests that just having epilepsy alone

  1. does not increase the risk of getting Covid-19 and
  2. does not increase the severity of Covid-19

Some people with epilepsy regardless of seizure control have other health conditions that put them at higher risk from Covid-19. They may be taking medicines to control seizures that also affect their immune system (for example, ACTH, steroids, immunotherapies). Or they may have other neurological or developmental issues that affect their immunity. People in these situations are at greater risk of developing more severe symptoms with viral illnesses.

Read more from Epilepsy action.

 

Diabetes

Are children with diabetes more likely to develop Covid-19?

  • Type 1 diabetes in itself is not associated with worse disease in children.

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