June 15, 2020

The following is based on information from a story published in TMC and a series of interviews conducted with Dr. Daniel Penny, chief of pediatric cardiology, Dr. Eyal Muscal, chief of rheumatology, and Dr. Lara Shekerdemian, chief of critical care.

In recent weeks, health experts in the United States and abroad began to notice a troubling rise in multisystem inflammatory syndrome in children (MIS-C), a condition in which various organs — such as the heart, lungs, kidneys, brain, skin, eyes, esophagus, stomach and intestines — become inflamed. Earlier this month, the Centers for Disease Control and Prevention (CDC) issued a health advisory to warn doctors about the illness, cautioning them to be on the lookout for a constellation of symptoms, including fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes and lethargy.

Although the exact cause of MIS-C is still unknown, experts are assessing the association between MIS-C and COVID-19, as many children diagnosed with the syndrome have been infected by or previously exposed to SARS-CoV-2, the virus that causes COVID-19.

This lag between the primary infection and the inflammatory response is what is interesting,” Penny said. “What it appears to indicate is that this is not a manifestation of the primary infection with SARS-CoV-2 itself, but rather the body’s inflammatory response to the infection.”

Texas Children’s is treating children and young adults with the syndrome and Penny is leading a cardiology clinic dedicated to those who have previously had SARS-CoV-2 infection in order to make sure that the handful of patients the hospital has already treated is not just the tip of the iceberg.

“Even if they weren’t extremely unwell in the first place,” he added, “we are bringing back these children for cardiology assessment with a cardiography in order to make sure they don’t have abnormalities of the coronary arteries that haven’t manifested clinically at this stage but could be problematic in the longer term.”

Not all children with MIS-C exhibit the same symptoms, the CDC noted, but doctors and parents should be vigilant of emergency warning signs, such as trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face and severe abdominal pain.

Symptoms associated with MIS-C were first reported by clinicians in the United Kingdom in late April and have since been identified in other European countries and the United States, starting in New York, the American epicenter of the coronavirus outbreak. At least 17 other states have reported cases of MIS-C, including Texas, California and Washington.

Doctors believe that MIS-C is caused by an overactive immune system in response to COVID-19, leading to abnormal inflammation throughout the body. Most children recover from MIS-C after being treated with immunoglobulins to reset the immune system, steroids and immunosuppressive drugs, such as anakinra and tocilizumab; however, in rare cases, the illness can lead to death.

Understandably, this is very worrying to parents and Texas Children’s has received many questions and concerns about MIS-C. The following are some of those questions and our answers. We are sharing them with our employees because many of you are parents yourselves and might have some of the same concerns.

What are the early signs and symptoms of MIS-C and is there anything parents should be looking out for during the early stages of this condition?

Dr. Muscal: Based on experiences in Europe and the East Coast, so the places in the world that have had a head start on us here in terms of the multi-system inflammatory type of syndrome, it appears as if kids often have unrelenting fever that doesn’t really respond to traditional anti-inflammatory measures. And then, usually, a variety of other problems such as abdominal pain, vomiting, inability to keep fluids down, and then usually a variety of issues like rash, sometimes red eyes, and a general appearance of ill appearance. It appears that those are some of their early symptoms. As a child’s become more ill, perhaps he or she will have chest pain or have more difficulty with their breathing.

How common is MIS-C in children, how long does it last and how serious can it actually get?

Dr. Muscal: It appears that MIS-C is pretty uncommon, actually rare, according to some of the other cities that have had cases for a longer period. Some of the experts in New York city believe that less than 1% of the children that actually are exposed to the coronavirus and get COVID-19 seem to develop this more serious post-infectious process. It can last for days or even a couple of weeks as kids recover from it. It appears to be in many cities with more cases, that most of the cases are treated quickly and are not that serious. Though there are kids that end up in the intensive care unit and unfortunately, exceptionally rare, kids that pass away.

What ages are most typically affected, and how old are the oldest children who do get MIS-C?

Dr. Muscal: So again, with the last six weeks of knowing more about this condition, it appears that even if children have some of the features of another entity called Kawasaki disease, they appear to be a little bit older. So perhaps even teenagers that are getting this, whereas Kawasaki disease is usually a disease of early childhood. It does appear that perhaps young adults can also have features of this syndrome. Unfortunately, many adult physicians have never seen Kawasaki disease and it could be that they’re not aware of some of these signs and symptoms.

Does it seem to be that children with underlying illnesses are more prone to get MIS-C?

Dr. Penny: We don’t believe that this condition is more common in children with preexisting conditions. So what it seems to be is that a child gets the coronavirus infection, and then they get this overactive immune response to the infection. And that’s what results in this syndrome. And so this does not appear to be more common in children who have underlying diseases, such as congenital heart disease.

If a child has congenital heart disease, let’s say a relatively simple defect like an ASD or even something more complex, are they going to be at higher risk of getting MIS-C?

Dr. Penny: We haven’t seen any patients with congenital heart disease who’ve developed MIS-C in our hospital, and I think it’s quite rare throughout the world. I don’t see any reason to believe why children with congenital heart disease will be at more risk of developing the syndrome in the first place. And also, if you have well compensated heart disease, I also don’t believe there should be any particular risk to a patient if they did happen to get the condition in the setting of congenital heart disease.

What is the difference between MIS-C and Kawasaki disease? And does this new syndrome seem to only affect kids who have COVID-19?

Dr. Penny: So MIS-C refers to this syndrome that we see in children, particularly related to coronavirus infection. And that’s according to the recent CDC definition, and this is really specific to coronavirus infection. But we do see similar conditions in other situations. What we see in patients with Kawasaki disease is that, that they get dilated coronary arteries. These abnormal coronary arteries are also seen in some patients with MIS-C. Typically, though, it doesn’t seem to be as common in MIS-C as in Kawasaki disease. One of the other differences between MIS-C and Kawasaki disease is Kawasaki disease tends to be clustered in much younger children. Whereas MIS-C, as we said earlier, can affect older children and even adults.

How many cases of the syndrome do you think we’ve had in Houston so far? And do you expect these cases to rise as they have in other cities on the East Coast?

Dr. Shekerdemian: We have seen a handful of patients with MIS-C at Texas Children’s. We don’t have an exact number because we obviously investigate many more than we end up diagnosing according to the strict criteria. It would certainly be less than 10. And the question about expecting them to rise, it’s a difficult one to answer. I think what we’re seeing in terms of the density of MIS-C around the world, not just in the US, very much mirrors the density of primary COVID-19 infection in those cities. So luckily Houston was not hit anything like as badly or hard in terms of severe COVID-19 infection. I think that would really speak to the fact that, while we’re seeing patients present with MIS-C, it seems to be a steady number. We’re not seeing a huge explosion and, touch wood, we hope that’s going to continue.

Do you think patients who have MIS-C, in general, are they still contagious with coronavirus?

Dr. Shekerdemian: That’s a really important question. We believe that the majority of them will not be contagious at the time that they develop the MIS-C. The typical presentation is around the four week mark, after a primary COVID-19 infection. And the vast majority of children at that stage, or anybody contracting COVID-19, would likely be non-contagious. Of course, we do test them with nasal swabs, as well as the typical antibody tests that are required to confirm the diagnosis. So I think it’s reassuring to a point that most children are not contagious, but we do screen them just in case they’ve still got signs of any active COVID-19 disease.

Is it safe to send children back to daycare or school once they reopen?

Dr. Shekerdemian: To be perfectly honest, there isn’t a simple answer to that. As COVID-19 stays in the community, we have to be hyper vigilant. What I would want to know before sending a child or a loved one to a school or daycare or summer camp is, what sort of screening; the numbers of children or adolescents in a specific space; the respect for social distancing, for hygiene, for hand-washing, etc. and how they’re going to screen any care takers or any workers in those environments, I would hope, on a daily basis; and feedback constantly to parents and to caregivers to reassure them and provide constant updates.

The world looks very different than it did just months ago. The outbreak of the COVID-19 pandemic has added a layer of uncertainty and stress to Texas Children’s providers, patients and the community. In response to this crisis, the Texas Children’s Psychology Service has expanded access to its programs and services to ensure our patients and providers receive the mental health support that they need.

On March 23, Psychology launched video visits and completed over 120 e-Health visits in the first week alone. One week later the volumes had doubled and have been climbing ever since. By the end of April the service was 17 percent above budgeted appointments for the month. Since launching e-Health visits in March, Psychology received 127 COVID-specific referrals and completed over 2,942 video visits which included both COVID and non-COVID related appointments thanks to the service’s e-Health capabilities.

“We owe the successful transition to e-Health in Psychology to our clinic staff and providers,” said Manny Hill, practice administrator for Psychology. “Their adaptability and steadfast commitment to our patients allowed us to completely change our care model in such a short amount of time.”

Supporting our patients

Beginning in March, Psychology added COVID-Related Psychological Distress e-Health appointments for patients seen at any location throughout the Texas Children’s system. This includes children and adolescents experiencing difficulties with anxiety, stress, or mood, as well as preschoolers with behavioral difficulties.

“We know that uncertainty, disrupted routines, social isolation, and parental stress impact children of all ages,” said Dr. Karin Price, chief of Psychology at Texas Children’s. “Our goal is to ensure that any child experiencing distress related to COVID-19 has access to a mental health professional who can support coping and resilience during this unprecedented time.”

Any providers who encounter pediatric patients with these concerns should place an Epic order for Referral to Psychology. Any patients referred for “COVID Related Distress” will be contacted for scheduling within 48 hours of referral.

Supporting our patient care providers

The Psychology Section has also partnered with the Practitioner Health and Well-Being Committee to launch the PARALLEL Program for Peer Support. This program is focused on providing emotional respite and support for frontline health care workers at Texas Children’s. The PARALLEL Program offers an opportunity to be coached in managing work-related stress brought on by the COVID-19 crisis. Dr. Gia Washington leads the program as Texas Children’s chief well-being officer.

“It has been a blessing to participate and support co-workers through the PARALLEL program,” said Carolina Coronel, a provider supporting the PARALLEL program. “A few minutes listening to someone can make a big difference in their lives; we all cope differently, but we all are meant to be social beings. This program has brought what many of us have been seeking: being heard.”

If you are a Texas Children’s Hospital Medical Staff provider and would like to access this support, please contact the Well-Being phone line at 832-822-9355 between the hours of 8 a.m. and 5 p.m., Monday thru Friday and request to speak with a PARALLEL Provider. You can contact the Well-Being phone line for support as often as you need to during management of the COVID-19 crisis.

“While the COVID-19 health pandemic can be overwhelming at times, our response to the stress will make us stronger as One Amazing Team,” added Price.

June 7, 2020

Every year, the Department of Organizational Resilience holds a Hurricane Preparedness Bridge Event on The Auxiliary Bridge to offer tips on how to get ready for the year’s hurricane season, which runs from June 1 to November 30.

Due to COVID-19 and the safety measures Texas Children’s has put into place to protect our staff, patients and families during the pandemic, this year’s event has been moved online via Microsoft Teams Live. Scheduled from 10 a.m. to 1 p.m. for Thursday, June 11, the event will include presentations from Texas Children’s Wellness Team and Employee Assistance Program, Texas Children’s Social Work Team, Texas Children’s Amateur Radio Team, Texas Children’s Decontamination Team, Organizational Resilience Team, Harris County Flood Control District, and the National Weather Service.

All presentations will repeat every 15-20 minutes with question and answer sessions. National Weather Service and Harris County Flood control district have two schedule sessions each.

To join the event, click here:

Social Work

Amateur Radio

EAP/Wellness

Organizational Resilience

Decontamination Team

Harris County Flood Control District Session 1: 10:30 a.m. to 11 a.m.

Harris County Flood Control District Session 2. 12:30 p.m. to 1 p.m.

National Weather Service Session 1. 10:30 a.m. to 11 a.m.

National Weather Service Session 2. noon to 12:30 p.m.

There will be a virtual bridge event bingo game. Each presenter will end their presentation with a key word. You will write the key word down for that spot on the bingo card. When done, write your name and email address on the bingo card and email it in for a prize drawing. Instructions are on the card. Click here to view the bingo card.

The Department of Organizational Resilience also is offering virtual hurricane preparedness presentations to requesting departments. This year, these presentations will be given virtually via Microsoft Teams. To request a presentation, please email EmergencyMgmt@texaschildrens.org.

For more information on how you can prepare for this year’s hurricane season, click here.

May 26, 2020

While we continue to safeguard our patients, families and staff from COVID-19, we must also make necessary preparations for this year’s hurricane season. According to StormGeo, Texas Children’s Meteorological data provider, the 2020 Hurricane Season, beginning June 1 and ending November 30, is expected to be above normal, producing up to eight hurricanes, four of which are predicted to be major storms.

Preparing for this year’s hurricane season will look much like it has in the past, but with a few tweaks due to the additional safety precautions and protocols we have in place due to the ongoing COVID-19 pandemic. These tweaks as well as tips on how to prepare yourself and your family for this year’s hurricane season are below.

“We understand that everyone is already in a heightened level of awareness and preparedness due to COVID-19. Hurricane season is something that occurs every year and we as an institution are consistently prepared and resilient no matter what it may bring,” said Aaron Freedkin with Emergency Management. “Texas Children’s has thorough hurricane plans in place and we are working to incorporate all appropriate COVID-19 precautions. Most importantly, we are confident that our One Amazing Team will rise to the occasion if we need to activate these plans.”

Employee Disaster Roster

First and foremost, we need employees to register for a team within the Employee Disaster Roster by June 12. Important considerations specifically for 2020:

  • Staff who are flexed down to zero hours will not be required to register at this time
  • Team selections should not be based on an employee’s current or future “flexed down” status
  • Staffing decisions will be based on business and clinical requirements at the time of the disaster declaration

If you have not already done so, please go to the Employee Disaster Roster in MOLI and make your 2020 selection for the Prep Team, Ride-Out Team, and/or Relief Team.  Any exemptions must be entered into the system and approved by your supervisor. Please contact the Organizational Resilience Department at EmergencyMgmt@texaschildrens.org with questions.

Ride-Out

As mentioned above, the size of the Ride-Out Team this year should it be called to action could be significantly smaller than in the past due to decreased clinical activity and heightened safety precautions. In addition, Texas Children’s has historically provided on-site accommodations for Ride-Out Team members. These accommodations will still be available; however, they will take social distancing into account. Organizational Resilience is working with Infection Control, Facilities and the Incident Command Planning Section Leadership to finalize these considerations and determine how they will be implemented.

Preparedness Presentations and Bridge Event

Normally, Organizational Resilience gives in-person hurricane preparedness presentations to requesting departments. This year, these presentations will be given virtually via Microsoft Teams. To request a presentation, please email EmergencyMgmt@texaschildrens.org.

The annual Hurricane Preparedness Bridge Event will also be virtual this year via Microsoft Teams Live. The event, scheduled for June 11 from 10 a.m. to 1 p.m., will include presentations from Texas Children’s Wellness Team, the Employee Assistance Program and the National Weather Service. Additional information about the virtual event will be communicated soon.

Personal Preparedness

When a storm or hurricane threatens, the best thing you can do is be prepared. That means getting your home and belongings ready to withstand wind and water, and ensuring the safety of your family, pets and loved ones. Once all of this is done, you can focus on helping our patients and families continue to receive the medical care they need. Here are some simple steps to help you get prepared.

Evacuation

  • Sign up for emergency alerts. You can find them at ready.gov/prepare.
  • Check with Texas Department of Transportation or Office of Emergency Management for evacuation routes near you.
  • Know where your nearest emergency shelters are. Download FEMA’s app at fema.org/mobile-app.
  • Keep your gas tank full and buy extra gasoline for your vehicle or generator. Be sure to store it safely in approved containers.

At Home

  • If necessary, board up your windows.
  • Keep gutters and drains free of debris.
  • Install “check valves” in sewer lines to prevent floodwater from backing up into your drains.
  • Set your freezer and refrigerator to the coldest setting to make food last as long as possible without electricity.
  • Put containers of water in your freezer to fill up any extra space.
  • Fill bathtubs with water which can help with cleaning and flushing toilets.
  • Bring in all loose objects from your yard and patio.
  • Charge your cellphone and an extra battery. Buy a car charger if you haven’t already.
  • Program emergency contacts into your phone.
  • If you have an emergency generator, test it to make sure it works properly. Buy extra cans of gasoline in case of power loss after a storm.

Protect Important Documents

Store the following documents in clear, portable, airproof and waterproof containers:

  • Passports and Social Security cards.
  • Prescription information and immunization records.
  • Customer service phone numbers and account numbers for banks and credit cards.
  • Birth, marriage and death certificates.
  • Insurance policies, contracts, deeds, stocks, bonds and other valuables.

Communication

  • During and after a crisis, people can become separated and communication lines can become jammed. Avoid chaos by developing a plan beforehand.
  • Establish a place to meet near home.
  • Select a friend or relative who lives outside the region to be your contact.
  • Take a cellphone charger when you evacuate.

Pantry

  • Water – Buy and store plenty of extra water.
  • Food – Purchase enough for at least three days.
  • Utensils -Don’t forget a hand-held can opener.
  • Fuel – Have wood, charcoal or propane handy.
  • Pets – Make sure you have extra food and water for your pets.
  • Medication – Refill prescriptions and have other regularly used medical supplies on hand.

Disaster Bag

If you are called to one of our locations to help keep operations up and running during a storm, you will want to take a piece of home with you to make your stay as safe and comfortable as possible. That’s why having a disaster preparedness bag ready to go is important. Here are some of the things you should pack.

  • Your Texas Children’s/Baylor employee badge
  • Sleeping bags or linens, blankets, and a pillow
  • Change of clothing, uniforms, undergarments and sleepwear
  • Comfortable shoes and socks
  • Personal toiletries, towels and washcloths
  • Prescription and over-the-counter medications
  • Cash and small change
  • Nonperishable* food, special dietary requirements and snacks
  • Bottled water
  • Diversional activities (no electronic devices)
  • Phone, charger and list of important phone numbers
  • *Examples of nonperishable food items include:
    • Bottled water, Gatorade, box juices
    • Peanut butter
    • Nuts
    • Granola bars
    • Any type of breakfast bar
    • Baked beans
    • Tuna or other canned meats
    • Jerky
    • Crackers
    • Fruit cups
    • Fresh fruit, e.g., bananas, apples
    • Puddings
    • Hard candies
Update Your Information

Making sure your contact information is up to date in MOLI is key to receiving essential communications during a hurricane or other emergency. You don’t want to miss out on key information. To update your information, click here.

For more information, go to Texas Children’s Emergency Management page on Connect.

May 18, 2020

 

In less than a year, the Member Services team at Texas Children’s Health Plan has completely transformed the way they work, the way they win, and the way they are regarded across the system. A true Cinderella story.

Once known for struggling to meet performance expectations, Member Services now shines in team spirit, employee performance, and the delivery of services to members and providers.

April 2020 marked the most successful performance month for the department in over four years – an accomplishment that is beyond remarkable considering the changes they’ve faced during the current global pandemic.

A comparison of May 2019 and April 2020 demonstrates a number of key accomplishments including but not limited to an increased answer rate of 19 percent, decreased abandonment rate of 7 percent, and a decreased rollover rate of 22 percent to our back up vendor.

“I am so proud of my team and what we have been able to accomplish together. Most importantly, I am especially pleased that our improvements are having a positive impact on the members and providers that depend on us,” said Opera Wagner-Ross, director of Member Services.

Wagner-Ross, who joined the Health Plan in May of 2019, is the undeniable linchpin who has made this transformation possible; however, she doesn’t see it that way. She readily credits her team and the incredible leadership she has received from Richelle Fleischer, senior vice president; and Mark Mullarkey, president of Texas Children’s Health Plan and executive vice president of Texas Children’s Hospital.

“Even the best leaders benefit from good leadership,” she said. I feel incredibly lucky to have the opportunity to work with both Richelle and Mark. They are both dynamic leaders with high expectations. I have learned a great deal over the past year and feel lucky to be a part of the team.” Wagner-Ross went on to say that having great coworkers and a friendly dose of competiveness is also a great motivator. She credits the Claims department at the Health Plan as being an inspiration and a motivator.

“April Riggs, director of Claims, and her team have been very successful in turning things around in the Claims Department. She has been a great partner in that she challenges me, holds me accountable, and can be counted on to make me laugh when faced with challenging situations. She’s the best!”

So how did they do it? How exactly did they spark this kind of change within the department?

Here are the major keys:

  • A defined career path for members of the team. By creating a clear career path, employees understood what their options were for growth. With increased opportunity for growth, department retention improved.
  • An increase in the number of Spanish speaking agents. A large percentage of health plan members speak Spanish; however only 16 percent of our agents spoke the language. Today, that number sits at 46 percent.
  • Appropriate span of control for managers. With a more appropriate span of control, managers are now able to provide better support, coaching and accountability to their teams.
  • Improvement in the training of employees. Staff members received an increased amount of training including a special course taught by the Patient Experience staff, which specifically focused on customer service.
  • Allowing data to drive change. Whether it was a process to improve, a system to introduce or a technology to enhance, all decisions were made based on information.
  • Improvement in the quality of all phone calls. Increased quality review and monitoring of phone calls and improved handling of escalations with a focus on customer satisfaction.
  • Celebrating the small wins. The team looks for every reason to celebrate and highlight accomplishments.

Wagner-Ross says that as a leader she really doesn’t have a secret sauce. She simply believes in finding the right people and always looking for opportunities to improve.

As the COVID-19 pandemic continues to dominate the news and impact our normal way of life, there is one thing that has not changed – our commitment to ensuring our patients and families have convenient access to the care they need, when they need it, while also continuing to protect their health and safety.

As we begin to adapt to this new normal, more in-person visits are being converted to video or phone appointments. Texas Children’s e-Health team, in collaboration with multiple departments across the system, has rapidly expanded and enhanced these e-Health services to make it easier and more convenient for patients to connect with a Texas Children’s provider without leaving their home.

In less than three months, the organization has seen a rapid growth in e-Health visits across the system. On March 2, Texas Children’s completed 39 video and telephone appointments. As of May 8, our providers had completed 72,285 telephone and video visits across Texas Children’s Hospital, Texas Children’s Pediatrics, Texas Children’s Urgent Care, Texas Children’s Health Plan and Texas Children’s® Anywhere Care. Along with this impressive milestone, over 1,000 providers have been trained to provide care through video visits to their patients across the system.

The Health Plan’s e-Health platform, Texas Children’s® Anywhere Care, which has been a major focus in the organization’s e-Health efforts, has seen an uptick in patient visits. Since launching the platform last summer, over 1,520 video appointments have been completed. A total of 750 e-Health visits were completed from March 1 to May 5 of this year.

“Our recent successes are attributed to the collaborative efforts that went into building the infrastructure that has enabled us to expand our e-Health capabilities more broadly across the system,” said Laura Laux Higgins, director of strategic projects in Information Services and member of the e-Health Executive Steering Team. “Not only did we investigate the technology solutions and invest in them, we had a team of e-Health experts in place across information security, EPIC, MyChart, billing, compliance, legal, credentialing, risk, and administrative and physician leadership who were able to help us move forward quickly because of the work they had done over the past year.”

With the demand for e-Health services on the rise due to COVID-19, Texas Children’s Heart Center, like many other subspecialties across the system, are leveraging the mutual benefits of e-Health services.

Shortly after the COVID-19 pandemic set in and local, state and federal governments asked non-essential businesses to close and residents to stay home, the Heart Center worked swiftly with physicians and staff to engage e-Health services for new and existing patients 6 months old and older who did not need to be seen in person.

Within about a week, the Heart Center was booking about half of its appointments at the Texas Children’s Medical Center Campus via video or phone. Although that number has decreased since Gov. Greg Abbott has started to reopen parts of the state, the Heart Center is still using e-Health services and is dedicated to the virtual patient care model for the foreseeable future.

“Our will to continue to work hard and keep our patients, families and staff safe has never been stronger,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “e-Health is a way we can continue to serve our patients without putting them at unnecessary risk.”

All potential e-Health appointments at the Heart Center are reviewed by a pediatric cardiologist or advanced practice provider to determine whether it is clinically appropriate for a child’s appointment to be completed using one of these modes of virtual visit. If the cardiologist considers that a child’s appointment can be completed in this way, the clinic staff will contact the child’s family to provide more details and guide them through the new system.

Dr. Jeffrey Kim, director of the Arrhythmia and Pacing (Electrophysiology) Service at Texas Children’s Hospital, said his patients are good candidates for e-Health visits because they typically don’t need surgical intervention. For about a month during the pandemic, Kim said almost all arrhythmia and pacing patients were utilizing e-Health visits. Now, about half are using the service.

“Patients are very appreciative of the virtual visits,” Kim said, adding he conducted an appointment with a patient while they were standing in the middle of a field on their ranch. “They are thankful they don’t have to come in and expose themselves if they don’t have to.”

In addition to safety, Kim said e-Health services can be used to treat people in areas where there are limited pediatric cardiology services. Patients in these areas might not be able to drive into places like Houston for an appointment forgoing care altogether or seeking it in less-than-ideal places. e-Health would bring the visit to them, allowing our experts to reach more children and families.

“e-Health has a lot of benefits and possibilities,” Kim said. “I’m excited to see how it develops.”

May 13, 2020

So far, children have been relatively spared from the COVID-19 pandemic. Recently, however, the World Health Organization launched an investigation into a potential link between the disease and a severe inflammatory response that’s being seen in a small number of children across the world.

The symptoms have many of the characteristics of Kawasaki disease, an inflammatory condition experts at Texas Children’s have treated for decades. Our cardiologists, hospitalists and experts in inflammatory diseases, such as rheumatologists and immunologists, see about 100 children with Kawasaki disease each year.

“We believe our expertise in cardiology and rheumatology combined with our vast experience in critical care, patient isolation and infectious diseases will serve us well if we’re required to run toward this new COVID-associated problem,” said Chief of Pediatric Cardiology Dr. Daniel Penny. “We are ready for this.”

Penny, Chief of Critical Care Dr. Lara Shekerdemian, Chief of Rheumatology Dr. Eyal Muscal, and Special Isolation Unit Medical Director Dr. Amy Arrington answer some top-of-mind questions about this new condition, how it’s affecting children and how Texas Children’s can help.

What is Kawasaki disease?
Dr. Penny
Kawasaki disease is a condition that was first described in Japan by Tomisaku Kawasaki in 1967. The first cases outside of Japan were reported in the mid-1970s. About three-quarters of cases occur in children under the age of 5 years and it is more common in boys than girls. Although it may be more frequently found in Asian-American children, it does occur in children of all ethnicities.

What are the signs of Kawasaki disease?
Dr. Penny
The common features of Kawasaki disease are high fever, rash on the chest, back and abdomen, red eyes or conjunctivitis, swelling and inflammation of the mouth, lips and throat, enlarged lymph glands in the neck, and redness and swelling of the hands and feet. Abdominal pain can also occur and appears to be common in recent reports of this condition associated with COVID-19. One particularly important complication of Kawasaki disease is that it can result in damage to arteries, including the coronary arteries, which supply the heart muscle itself. This results in the weakening of the arterial wall causing it to balloon out in a so-called aneurysm. Sometimes clots can form in these aneurysms which can block the artery. While in most children the aneurysms resolve over time, in some, scarring and narrowing can remain. If the artery blocks, it can lead to a heart attack. Another important complication of Kawasaki disease is that it can result in inflammation in the heart muscle directly, which can also impair its function.

What is the relationship between COVID-19 and Kawasaki disease?
Dr. Penny
What is becoming apparent is that the onset of this Kawasaki-like syndrome in a community appears to lag behind the appearance of COVID-19, which supports the idea that it is not the infection itself, but rather the body’s response to it that’s important. This condition was recognized earlier in Europe than in the U.S., where the onset of the community infection was later. What is also intriguing is that the incidence of Kawasaki disease in Japan, where the incidence is usually highest, does not appear to have increased during the coronavirus pandemic. This could potentially mean the precise genetic mechanisms which predispose to usual Kawasaki disease may differ from those for COVID-associated Kawasaki disease. In some children, it appears that the abnormal immune response results in severe multiple organ failure with circulatory collapse, or shock, so what we are really seeing is a spectrum of related conditions, which are all likely to result from an abnormal immune response to a primary infection with COVID-19.

How big of an issue is this?
Dr. Shekerdemian
Right now we don’t have an accurate picture of quite how big a problem this is or how big it’s actually going to be. But obviously as we gain more information from overseas and now from the United States, we’re becoming hyper vigilant so that we don’t miss potential cases that are coming in our direction. Last week, the UK reported around a dozen cases, and every day we’re hearing of more reports from the European epicenters, typically the United Kingdom and Spain. And now over the past few days from the east coast of the US as well.

What types of symptoms do these children have?
Dr. Shekerdemian
Children with this new inflammatory syndrome can present with fever, inflammation, abdominal pain, diarrhea, but sometimes they’re very sick and they have what we call shock. And this means that the heart and circulation can be affected as well. It’s important to know that not all children are critically ill, but we do know that in the extreme, some have required intensive care and very intensive therapies, and even life support.

What types of treatments are there for these patients?
Dr. Muscal
We treat severe inflammation and Kawasaki disease with a few approaches. One is getting the right experts involved to ensure that we make the right diagnosis. And then there’s a variety of interventions and medications we use to dampen the immune response. One of them is called intravenous immunoglobulins from pooled donors. And then there’s a variety of other medications like steroids, like we use for asthma, or other medications we use in rheumatic diseases to turn off the inflammation and sustain the normal immune response.

How prepared is Texas Children’s to care for one of these patients?
Dr. Shekerdemian
At Texas Children’s, we have all of the right specialists ready to care for these patients. If a child like this came to our Intensive Care Unit, we would bring together intensive care specialists, cardiologists, surgeons, and specialists in rheumatology, infectious diseases and immunology. That really gives us a wonderful team to investigate and treat the children as aggressively as needed to ensure they have the best possible outcome.

How would Texas Children’s Special Isolation Unit be used?
Dr. Arrington
Five years ago during the unprecedented Ebola outbreak in the US, Texas Children had the foresight to create a very special, one-of-a-kind pediatric bio containment unit to care for any child with any highly infectious pathogens, such as SARS, Ebola or, now COVID-19. The unit has HEPA filtration, special visualization with large windows, cleanable surfaces and pass through boxes, its own laboratory and its own autoclaves for biohazardous trash. The unit is run by a team of nurses from all over the organization, as well as physicians and advanced practitioner providers. We also have laboratory personnel, respiratory therapists, and even security staff trained to take care of these patients and their families. Between the unit itself, the team that runs it and other expert resources throughout our system, Texas Children’s is incredibly prepared to give children with this condition or others caused by highly infectious pathogens the highest quality of care.