dr hatem el bitar covid19 presention for pediatric د حاتم البيطار

1. New methods to prevent covid19 transmission in pediatric health care settings By DR HATEM ELBITAR Health care Consultant 01005684344

2. Let us start with some statistics about the 2nd wave of covid 19 and spread of virus globally

4. Number of deaths : source john Hopkins university public health sector

5. Washington post : CDC director warns second wave of coronavirus is likely to be even more devastating

9. 1. What is SARS-CoV-2? What is COVID-19? Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the name given to the 2019 novel coronavirus. COVID-19 is the name given to the disease associated with the virus. SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans. •

10. 2. Where do coronaviruses come from? • Coronaviruses are viruses that circulate among animals, with some infecting humans. Bats are considered natural hosts of these viruses, and several other species of animals are also known to act as sources. For instance, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is transmitted to humans from camels, while Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1) is transmitted to humans from civet cats. •

11. 3. Is this virus comparable with SARS or with the seasonal flu? The novel coronavirus detected in China in 2019 is closely related genetically to the SARS-CoV-1 virus. SARS emerged in late 2002 in China, and caused more than 8 000 cases in 33 countries over the course of eight months. In the first eight months of the COVID-19 pandemic (from 31 December 2019 to 31 August 2020), there were over 25 million cases worldwide and more than 840 000 deaths.

12. 4. How does the virus spread? SARS-CoV2 spreads from person to person (human-to-human transmission) through direct contact. It is currently estimated that, in the absence of physical distancing and other preventive measures, one infected person will on average infect between two and three other people.

13. 4. How does the virus spread? The virus is transmitted mainly via respiratory droplets and aerosols when sneezing, coughing, or interacting with others in close proximity (usually less than two metres. These droplets can be inhaled or can land on surfaces that others come into contact with and are then infected when they touch their nose, mouth or eyes. The virus can survive on surfaces from between several hours (copper, cardboard) up to a few days (plastic and stainless steel). However, the amount of viable virus declines over time and may not always be present in a sufficient amount to cause infection.

14. The incubation period for COVID-19 (i.e. the time between exposure to the virus and the onset of symptoms) is currently estimated to be between one and 14 days. We know that the virus can be transmitted when people who are infected show symptoms such as coughing. A person who is infected can also transmit the virus up to two days before they show symptoms; the extent to which such asymptomatic infections contribute to the overall transmission is not currently clear.

15. 5. When is a person infectious? The infectious period may begin up to two days before symptoms appear, but people are most infectious during the symptomatic period, even if symptoms are mild and non-specific. The infectious period is estimated to last for eight to 10 days in moderate cases, and up to two weeks on average in severe cases.

16. 6- Transmission in children Available evidence to date indicates that children most probably contract COVID-19 in their households or through contact with infected family members, particularly in countries where school closures and strict physical distancing has been implemented

17. Studies on children’s infection of covid19 -In a publication from Italy, exposure to SARS- CoV-2 from an unknown source or from a source outside the child’s family accounted for 55% of the cases of infection -the probability of infection in children was 0.26 times lower than in elderly people (≥ 60 years of age)

18. A recent report from US provides additional evidence of the role of children and adolescents in transmission. This study reported an overall attack rate of 44% among attendees (i.e. children, adolescents and adults) of an overnight camp ,The age-stratified attack rates were 51% among those aged 6-10 years.

19. 44% among those aged 11-17 years and 33% among those aged 18-21 years . Asymptomatic infections were observed in 26% of those with available test results and symptom data. These findings indicate that children and adolescents can spread efficiently the virus, particularly in an indoor and overnight setting. - - -

20. Another Study from Germany showed that in symptomatic children, initial SARS-CoV-2 viral loads at diagnosis are comparable to those in adults , and that symptomatic children of all ages shed infectious virus in early acute illness. In this study, also infectious virus isolation success was comparable to that of adults. The youngest patient from whom SARS-CoV-2 was isolated was a seven-day old neonate

21. –In another publication, it was also shown that there is no significant difference between viral loads in persons 1-20 years of age in comparison to adults 21-100 years of age. Further, another study suggests that the viral load in children below 5 years of age with mild to moderate COVID-19 symptoms is higher compared to older children and adults

22. 7- Transmission risks in different settings Several outbreak investigation reports have shown that COVID-19 transmission can be particularly effective in crowded, confined indoor spaces. Transmission can be linked with to specific activities, such as singing in a choir .

23. In a 2.5 hour choir practice in Washington, US, there were 32 confirmed and 20 probable secondary COVID-19 cases among 61 participants (85.2%).the duration of the indoor activity and the increased production of respiratory droplets through loud speech and singing, likely increased the risk of transmission.

24. Poor ventilation in confined indoor spaces is associated with increased transmission of respiratory infections and COVID-19 in particular . In a restaurant outbreak of 10 cases in three families in Guangzhou, China, transmission was attributed to the spread of respiratory droplets carrying SARS-CoV-2 by the airflow generated by the air-conditioning. -Well-maintained and ventilation,air conditioning systems may have a complementary role in decreasing transmission in indoor spaces by increasing the rate of air change, decreasing recirculation of air and increasing the use of outdoor air

25. Treatment • At the beginning of the coronavirus pandemic, many patients with severe courses of the disease received artificial respiration (intubation) at an early stage and died all the same. Now, however, intensive-care physicians have moved away from standard ventilation, because lung specialists have stressed that artificial respiration under positive pressure can do more damage than good to the lungs. •

26. Treatment • As long as patients are able to breathe on their own, they now receive oxygen without being connected to a respirator. Intubation is used as an option only in an extreme emergency. In many cases, when the kidneys are severely damaged by COVID-19, dialysis is also necessary. Intensive care now also takes other damaged organs more into account. The healing process can be accelerated in specialized clinics by the administration of antibodies from the blood of cured COVID-19 patients. These antibodies take up the fight against the virus in the body of the patient who received the donated blood. • •

27. No convincing drugs yet is the only pharmaceutical drug that has been shown to shorten the course of the disease. This is why it is the market. on Provided But it is not a miracle cure. It shortens the healing process by a few days in patients who receive oxygen, but it does not improve their chances of survival. other drugs that are already on Doctors are also trying to use to combat the coronavirus. These include the the market dexamethasone inflammatory - anti and the malaria Avigan inhibitor The efficacy and safety of the first . hydroxylchloroquine drug two drugs has not yet been conclusively proven, and there are about the third. strong doubts even Remdesivir , the RNA polymerase

28. How far along is vaccine development? • At least 160 vaccine projects have now been launched worldwide (as of June 29, 2020) according to the German researching pharmaceutical companies. These are essentially divided into three vaccine types: attenuated vaccines, inactivated vaccines and gene-based RNA vaccines. tuberculosis vaccine addition, there is a In been approved. This does not directly target SARS-CoV-2, but strengthens the basic innate immunity of humans. Researchers at the Max Planck Institute for Infection Biology in Berlin are currently trying to improve this vaccine genetically. • that has already •

29. information from the WHO, five vaccines were in Phase 1 human trials worldwide at the end of June 2020. Such trials test the safety of the vaccine. Seven are in combined Phase 1/ Phase 2 testing, where the immune response is also tested, and is already in Phase vaccine to prove its effectiveness against the pathogen in practice. According to only one , where the aim is 3

30. When will the vaccine finally come? • Optimists hope that on the market by the end of the year. Others are talking about next year. In fact, it is not yet possible to say whether and when a vaccine against SARS-CoV-2 that is suitable for many people will be available on the market. a usable vaccine will be

31. When will the vaccine finally come? • If a vaccine is approved, mass production will be another challenge. Gene-based RNA vaccines, which can be produced relatively quickly, would have an advantage here. Pharmaceutical companies that are specialized the production of vaccines, Institute of India, are already preparing larger capacities, even though they do not yet know which active substance they will eventually produce. • in such as the Serum

32. Children & teens can get COVID-19 While fewer children have been sick with COVID-19 compared to adults, children can be infected with the virus that causes COVID-19, can get sick from COVID-19, and can spread the virus that causes COVID-19 to others. Children, like adults, who have COVID-19 but have no symptoms (“asymptomatic”) can still spread the virus to others. •

33. Children & teens can get COVID-19 • Most children with COVID-19 have mild symptoms or have no symptoms at all. However, some children can get severely ill from COVID-19. They might require hospitalization, intensive care, or a ventilator to help them breathe. In rare cases, they might die. •

34. • CDC and partners are investigating a rare but serious medical condition associated with COVID-19 in children called Multisystem Inflammatory Syndrome in Children (MIS-C). We do not yet know what causes MIS-C and who is at increased risk for developing it..

35. Babies under 1 year old might be more likely to have severe illness from COVID-19. Other children, regardless of age, underlying medical conditions the following with might also be at increased risk of severe illness compared to other children: Asthma or chronic lung disease Diabetes Genetic, neurologic, or metabolic conditions Heart disease since birth Immunosuppression (weakened immune system due to certain medical conditions or being on medications that weaken the immune system) Medical complexity (children with multiple chronic conditions that affect many parts of the body who are often dependent on technology and other significant supports for daily life) Obesity

36. The most common symptoms of COVID-19 in children are fever and cough. Fever or chills Cough Nasal congestion or runny nose New loss of taste or smell Sore throat Shortness of breath or difficulty breathing Diarrhea Nausea or vomiting Stomachache Tiredness Headache Muscle or body aches Poor appetite or poor feeding, especially in babies under 1 year old

37. What you can do Monitor your child for COVID-19 symptoms every day Pay particular attention to: Fever (temperature 100.4 °F or higher) Sore throat New uncontrolled cough that causes difficulty breathing (for a child with chronic allergic/asthmatic cough, see if there is a change from their usual cough) Diarrhea, vomiting, or stomachache New onset of severe headache, especially with a fever

38. Keep track of who your child comes into close contact with If your child or you were around someone who has COVID-19, someone from the health department contact tracing may contact you for Speak with them and follow their advice. Take precautions to protect your child if you are sick with COVID-19 - If you are sick with COVID to help prevent spreading the virus to precautions your child and others. . 19 , you can take

39. If a parent or a sole caregiver has COVID-19 Everyone in the home should preventive actions Those in the home who are sick with COVID-19 should follow CDC’s guidance for when it is safe to end your isolation and are sick If a child’s parent or caregiver is sick with COVID- 19, follow the steps below to help protect the child from infection. practice everyday . what to do if you .

40. Older children The child should avoid physical contact with the sick parent or caregiver until all sick people ended their home isolation have For the child to safely have no interaction with the parent or caregiver, the child should be old enough to legally be home alone and mature enough to care for themselves. .

41. Younger children If the parent or sole caregiver will be caring for the child while sick, they should contact the child’s healthcare provider for advice on how to best protect the child from infection. Young children should be supervised at all times. If the parent or the sole caregiver is too ill to care for the child, they should see if there is a caregiver outside of the home with whom the child can stay. The caregiver should not be someone at higher risk for severe illness who is child has likely been exposed to the virus. The caregiver will need to help the child quarantine for 14 days since they last feet way from someone for a total 6 (within close contact had of 15 minutes or more) with the sick person. from COVID - , as the 19

42. Children staying in the home with the sick parent or caregiver If a child needs to stay in the home with you (the parent or caregiver who is sick): Both you and the child should wear a mask while in the same room. Note that masks should not be placed on: Children younger than 2 years old Anyone who has trouble breathing or is unconscious Anyone who is incapacitated or otherwise unable to remove the mask without assistance

43. CDC GUIDELINES FOR PREVENTION OF COVID 19 WITH CHILD HOUSEHOLD Wash your hands water for at least 20 seconds. If soap and water are not available, use hand sanitizer containing at least 60% alcohol and rub your hands together until they are dry. frequently with soap and

44. CDC GUIDELINES FOR PREVENTION OF COVID 19 WITH CHILD HOUSEHOLD Try and if safe. Increase ventilation by opening a window in a room that you are in. to stay 6 feet away from the child, if possible

45. Disinfect any items child. Do not disinfect food that you bring to the child. that you need to bring to the