Hi Everyone! Just a brief update to wrap up the week. Earlier today the World Health Organization (WHO) held a media briefing on COVID-19 which I am sharing below. (I have tried to make a habit of tuning in live while I am working from home.) This is a great way to keep up to date with numbers and facts in a time where there is a lot of information out there on COVID-19. Distinguishing fact from fiction can be challenging and these briefings definitely help.
Dr. Tedros Adhanom Ghebreyesus, Dr. Maria D. Van Kerkhove, and Dr. Michael J. Ryan take an hour a few days a week to brief on the latest updates surrounding COVID-19 and answer questions regarding current management and cases worldwide.
One of my favorite comments was by Dr. Michael J. Ryan:
“We should commend countries that are testing. And we should not punish countries for getting larger numbers. We should recognize when countries recognize reality. We should reward countries and governments for looking. If we create a situation where we overreact to the daily number then there is a disincentive to actually test. Countries who test and find cases and do lots of testing and know where the virus is should be commended.”
-Dr. Michael J. Ryan
In the US our cases still continue to rise. As of Friday evening, according to the CDC the US had 85,356 cases under investigation with a total of 1,246 deaths. Looking at the data reported to the WHO by the CDC (seems to be a 1-2 day lag) this week there appeared to be a couple hundred deaths a day reported. Worldwide, the number of cases has surpassed 500,000 cases.
However, part of this rise, as pointed out by Dr. Ryan is due to increased detection from better testing and when cases are identified, we know where the virus is.
In the Peds ICU world the VPS Map Shown below has become a platform for us to share our data on pediatric patients with COVID-19, including their age, respiratory support, and comorbidities.
As you can see from the data above, there are 11 reported COVID-19 positive patients in Peds ICUs that are reporting data, with a majority of those patients over 2 years old. As of this evening 70% of those patients are currently being mechanically ventilated, and no positive COVID-19 pediatric patient reported to VPS is currently requiring the oscillator or ECMO. About 80% of the patients have pre-existing comorbidities. There have been zero deaths reported in Peds ICUs reporting to VPS, although there is report of a death in a 17 yo boy in California. Read the New York Times article here.
If we follow the same trend of pediatric cases as seen in China, we can expect to see the rise in cases, especially pediatric ICU cases, and we want to be best prepared to handle them. Today our anesthesia team and critical care team developed an airway plan for intubation of PUI or COVID-19+ patients. Find it here.
Chloroquine, antivirals, and other treatments have reported as possible treatment options, but the data has not yet been definitive. While we plan to address the treatment options over next week, I wanted to wrap up today’s post with where the WHO is on treatment recommendations. Today a patient in Norway was the first to be enrolled in the SOLIDARITY trial which includes more than 45 countries around the world and will “dramatically cut the time needed to generate robust evidence about what drugs work.” This trial, as described by Science Magazine, will randomize patients to one of four drug regimens (see image below for a great image):
- Remdesivir
- Chloroquine
- A combination of the HIV drugs lopinavir and ritonavir
- Combination listed above plus interferon-beta
Thanks for following along! Feel free to contact us here with comments or questions. Next week we’ll address the studies behind chloroquine, and the data behind ACE/ARBs and COVID-19.
Stay Safe this Weekend!
COVID-19 RESOURCE SITE FOR PEDS CRITICAL CARE AT MCW 
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