General Information for Patients and Caregivers About COVID-19

Coronaviruses are a group of viruses that usually cause the common cold. COVID-19 is an infectious disease caused by the new coronavirus discovered in December 2019.

The COVID-19 virus mostly spreads when people are in close contact with one another. Respiratory droplets released into the air and on to surfaces when an infected person coughs or sneezes is the main way that the virus spreads. People are most contagious when they have symptoms (cough, sore throat, fever). Some spread might be possible before people show symptoms. People can become infected with COVID-19 by touching a contaminated surface or object and then touching their own mouth, nose, or eyes.

Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness similar to the common cold or seasonal flu. The most common symptoms are fever, cough, and tiredness. About 80% of people will have the mild to moderate form of the illness and can recover at home without special treatment. Severe symptoms include trouble breathing, chest pain, and confusion. About 20% of people have more severe illness that can require hospitalization, care in an intensive care unit, or even death.

Children seem to be at lower risk of having a severe COVID-19 illness, but there are some children who are at higher risk. Children with underlying medical problems like heart disease, lung disease (including asthma), cancer, diabetes, or suppressed immune systems may be at higher risk of severe disease. Children may have suppressed immune systems from inherited immune deficiencies, cancer treatment, bone marrow or organ transplantation, HIV/AIDS, or immunosuppressive medications (see below).

Prevention

There are multiple ways to prevent infection. These include handwashing, social distancing, and proper cleaning.

Handwashing
Children and adults should avoid touching their faces. Children and family members should wash their hands often, especially after being in a public place, before eating or touching their face, and after coughing, sneezing, or blowing their nose. Hands should be washed with soap and water for at least 20 seconds, and care should be used to ensure that all surfaces of the hands are washed, including in-between the fingers. Children may find it helpful to sing along to their favorite song while washing their hands. If soap and water are not used, then alcohol-based hand sanitizer (at least 60% alcohol) may be used. Hands should be rubbed together until alcohol dries. Children and adults with skin conditions leading to dry skin should use a moisturizer after handwashing or after using alcohol-based hand sanitizer. Fragrance-free cream or ointment-based (not lotion) moisturizers should be used.

Social Distancing
Social distancing means staying away from groups of people or crowds to prevent spread of the virus. You and your family should stay home as much as possible except for essential reasons. Do not host or attend play dates or parties. Avoid public places, even outdoor parks or playgrounds. If you must go to a public place like a supermarket, only one healthy adult without symptoms should run the errand and they should stay 6 feet away from other people. Anyone who is sick needs to stay home and stay away from others in the home. If they must be around others, they should wear a facemask at all times. Children should be kept away from those who are ill. Follow your state or local guidelines regarding social distancing and covering the face with masks or scarves.

Children should be taught to cough and sneeze into a tissue which should then immediately be thrown in the trash. In situations where a tissue is not available, they should cough and sneeze into their elbow or arm, and not into their hands. Wash hands after sneezing or coughing.

Cleaning and Disinfecting
Frequently washed surfaces should be cleaned and disinfected regularly. Examples include doorknobs, light switches, computer keyboards, phones, faucets, and handles. Cleaning refers to the removal of germs from surfaces while disinfecting refers to using chemicals to kill germs. For best results, soiled surfaces should be cleaned with a detergent or soap and water prior to disinfecting. Most household disinfectants and dilute bleach solutions (4 teaspoons of bleach per quart of water) are effective against coronavirus. Be sure to keep these cleaning solutions away from children.

Vaccines and Treatments
At this time, there are no vaccines for COVID-19. There are many medications being studied for the treatment of COVID-19, but results of scientific studies are still limited.

Immune-Suppressing Drugs

Some children and teens with inflammatory skin disease may be on medications for their condition that can suppress or weaken their immune system. If your child is taking an immunosuppressive and/or biologic therapy, they may be at increased risk of infection and infection severity due to COVID-19. While the benefits of discontinuing these treatments at this time are unknown, the risks of continuing a medication can vary based on how the medicine works, how long it stays in the body, the overall health of the child and the condition being treated.

Little is known about the novel coronavirus and the safety of specific medications. Therapies that lower or change the body’s immune responses work very well for conditions such as psoriasis, atopic dermatitis, morphea, alopecia and other skin diseases. But some of these medicines may also cause concern about the immune system’s response to infection. If your child takes medicine to treat a severe skin disease and you are unsure what to do, it is important to contact your pediatric dermatologist or prescribing health care provider before making any changes. You can discuss the risks and benefits of the medicine and make a plan that is right for your child’s individual situation (whether they are healthy, have been exposed to, or have the coronavirus).

The medicines that may have increased risk in certain cases include corticosteroids (e.g. prednisone, prednisolone, and methylprednisolone), methotrexate, cyclosporine, mycophenolate mofetil, tacrolimus, azathioprine and rituximab. Biologic therapies such as TNF inhibitors (e.g. etanercept, adalimumab, infliximab) interleukin inhibitors (e.g. ustekinumab, secukinumab, ixekizumab) and PDE4 inhibitors (apremilast) may also be of concern depending on your child’s medical situation. Importantly, it may be safer to keep your child on the medicine. Especially if the risk of your child’s skin condition getting worse off the medicine is greater than the risk of COVID-19 infection and severe health consequences of an infection. An expert group of pediatric dermatologists is currently reviewing all of the available data in order to guide rational decisions about medicines for severe skin conditions during the COVID-19 pandemic.

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