Coronavirus and Children’s Palliative Care

Do you have questions? Do you want to join us for a weekly webinar? Join us for our Global Palliative Care and Covid-19 series being run in conjunction with the IAHPC, WHPCA and PALCHASE.

Details on the topic for discussion each week and the link to join the webinar can be found on the home page of our website.

What is COVID-19?

COVID-19 is a disease caused by a new strain of coronavirus. ‘CO’ stands for corona, ‘VI’ for virus, and ‘D’ for disease. Formerly, this disease was referred to as ‘2019 novel coronavirus’ or ‘2019-nCoV’.

The COVID-19 virus is a new virus linked to the same family of viruses as Severe Acute Respiratory Syndrome (SARS) and some types of common cold.

How is COVID-19 spread?

It mainly spreads from person-to-person between people who are in close contact with one another and through respiratory droplets produced when coughing or sneezing. If these droplets get in the mouths or noses of nearby people or if they are inhaled then this can cause the disease to spread. It is important that you do not touch your face/mouth as it is also possible to get COVID-19 by touching a surface or object that has the virus on it. It is thought that the virus can spread prior to individuals showing symptoms, although it is most contagious when they are sick.

What are the symptoms of COVID-19?

Symptoms can include fever, cough and shortness of breath. In more severe cases, infection can cause pneumonia or breathing difficulties. More rarely, the disease can be fatal. These symptoms are similar to the flu (influenza) or the common cold, which are a lot more common than COVID-19. This is why testing is required to confirm if someone has COVID-19.

Who is most at risk?

Older people, and people with chronic medical conditions, such as diabetes and heart disease, appear to be more at risk of developing severe symptoms. As this is a new virus, we are still learning about how it affects children. We know it is possible for people of any age to be infected with the virus, but so far there are relatively few cases of COVID-19 reported among children. The virus can be fatal in rare cases, so far mainly among older people with pre-existing medical conditions, however we are aware that children receiving palliative care and with chronic life-limiting conditions are extremely vulnerable. This is a new virus and we need to learn more about how it affects children. 

What is the treatment for COVID-19?

There is no currently available vaccine for COVID-19. However, many of the symptoms can be treated and getting early care from a healthcare provider can make the disease less dangerous. There are several clinical trials that are being conducted to evaluate potential therapeutics for COVID-19.

 

 

 

 

 

 

How to avoid catching or spreading coronavirus

  • Wash your hands with soap and water often – do this for at least 20 seconds
  • Always wash your hands when you get home or into work
  • Use hand sanitiser gel if soap and water are not available
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • Put used tissues in the bin immediately and wash your hands afterwards
  • Try to avoid close contact with people who are unwell
  • Try not to touch your eyes, nose or mouth if your hands are not clean.

Advise re Personal Protective Equipment (PPE).

The following is advice from the World Health Organisation with regards to PPE and the use of masks etc. 
 
This is  the public facing information for when to wear a mask – 
This is the country and national technical guidance from WHO:
 

COVID-19 and Children with Comorbidities

The evidence for COVID-19 and children is minimal but is growing. Information can be found here which is updated regularly and includes links to all of the main papers on COVID-19 and children. The Royal College of Paediatrics and Child Health (RCPCH) in the UK are also summarising the evidence for COVID-19 in children which can be found here. A paper was published in JAMA Pediatrics looking at the characteristics of children with COVID-19 admitted to US/Canadian Pediatric Intensive Care Units.

The following paper has been published which showed that severe outcomes from COVID-19 are rare among children, but risk is higher for children who are under 1 month old, male or have pre-existing conditions – COVID-19 in Children and Adolescents in Europe: A Multinational, Multicentre Cohort Study

More recently a paper has been published analysing Covid-19 in children in the UK. COVID-19 in children: analysis of the first pandemic peak in England

A useful guide for parents of children with disabilities has been developed by UNESCO, CDMRP and the Social Justice Department and can be downloaded here. 

There has been some reports of some children experiencing a ‘toxic shock’ type syndrome. This is very rare but has been noted and the Paediatric Intensive Care Society in the UK have published a statement on this. The RCPCH have also released guidance on an approach to clinical management for this. Some papers published on this area include:

COVID-19 and Children’s Palliative Care

ICPCN have worked with colleagues around the world, and with the IAHPC, WHPCA and PALCHASE on Briefing Notes on all aspects of Palliative Care and COVID-19. Four Briefing Notes have been developed on children which include:

The full series of Briefing Notes can be found on the globalpalliativecare website. A webinar was held on Friday 8th May with regards to these briefing notes and can be watched here.

The NHS in the UK have several helpful guides:

  1. The Association for Paediatric Palliative Medicine in conjunction with the NHS have published clinical guidelines for children and young people with palliative care needs in all care settings during the COVID-19 pandemic which are regularly updated and can be downloaded here.
  2. The Novel coronavirus (COVID-19) standard operating procedure: Children and young people with palliative and end-of-life care needs who are cared for in a community setting (home and hospice) during the COVID-19 pandemic and can be downloaded here. 
  3. There are general guidelines for the management of paediatric patients during the coronavirus pandemic in the UK that can be downloaded here. 
  4. There are general guidelines for the management of palliative care in hospital that can be downloaded here.
  5. Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic that can be downloaded here.
  6. How to deliver the news of a death by telephone which can be downloaded here.

COVID-19 and Palliative Care resources

The COVID-19 pandemic has highlighted in many places the great need for palliative care. There are papers and resources available and these can be found on the following websites:

Some of the following papers may also be helpful:

Prevalence and transmission in children

Papers on Palliative Care and COVID-19:

Papers on symptoms in children

General Papers on Children and COVID-19:

Many of the journals, including the Lancet, have dedicated COVID-19 resources pages.

Other resources offering practical tips include:

  • COVID-19: Working with and for Young People. Available hereand summary guidance here
  • Practical Tips on Engaging Adolescents and Youth in the COVID19 Response can be found here
  • COVID19 and Youth Mental Health – Available here
  • Toolkit to Spread Awareness and Take Action on COVID-19 – Available here
  • COVID-19: GBV Risks to Adolescent Girls and Interventions to Protect and Empower Them – Available here
  • Five Actions for Gender Equality in the COVID-19 Response: UNICEF Technical Note – Available here
  • COVID-19 and HIV: Questions and Answers for Adolescents Living with HIV in time of COVID-19 – Available here

ICPCN recommends that all those caring for children with palliative care needs read and adhere to WHO guidelines to control the spread of the virus and protect their children. Below we have provided links to guidelines which can be helpful.

  • The WHO has a one stop shop for COVID-19 related issues
  • The WHO has a webpage with updates on the disease and a short online course: Infection, Prevention and Control (IPC) for novel coronavirus (COVID-19)
  • Comprehensive WHO guidance can be found here
  • WHO infection control guidance can be found here and we encourage everyone to follow this guidance.
  • WHO’s interactive map with updated data or confirmed cases and mortality rates, can be found here. 
  • The WHO’s guide on integrating palliative care and symptom relief into responses to humanitarian emergencies and crisis is a useful resource and can be found here.
  • The WHO’s specific guidelines for healthcare workers can be found here

Different countries and governments are following different policies on dealing with COVID-19 and it is important that individual palliative care providers take note of what their own governments are saying. Some examples from around the world include the following:

One of the challenges of COVID-19 is the impact that it is having and will continue to have, on the provision of health care, for example, the provision of home palliative care, respite care etc. As we hear of new developments we will try and keep this resource page up-to-date through signposting to the experts in the field.

Resources for Children

Several great resources have been developed for children about Covid-19 including storybooks, guides on how to talk to children about Covid etc. Some examples can be found here:

Resources for self care

Webinars

The recordings of the IAHPC, ICPCN, PALCHASE, WHPCA – Global Palliative Care Series Webinars can be found below:

More information and resources are available at globalpalliativecare.org

 

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