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. 2020 Apr 25;57(4):324–334. doi: 10.1007/s13312-020-1785-y

Novel Coronavirus 2019 (2019-nCoV) Infection: Part I - Preparedness and Management in the Pediatric Intensive Care Unit in Resource-limited Settings

Namita Ravikumar 1, Karthi Nallasamy 1, Arun Bansal 1,✉, Suresh Kumar Angurana 1, G V Basavaraja 2, Manu Sundaram 3, Rakesh Lodha 4, Dhiren Gupta 5, Muralidharan Jayashree 1; Intensive Care Chapter of Indian Academy of Pediatrics
PMCID: PMC7182738  PMID: 32238612

Abstract

First reported in China, the 2019 novel coronavirus has been spreading across the globe. Till 26 March, 2020, 416,686 cases have been diagnosed and 18,589 have died the world over. The coronavirus disease mainly starts with a respiratory illness and about 5-16% require intensive care management for acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. Children account for about 1-2% of the total cases, and 6% of these fall under severe or critical category requiring pediatric intensive care unit (PICU) care. Diagnosis involves a combination of clinical and epidemiological features with laboratory confirmation. Preparedness strategies for managing this pandemic are the need of the hour, and involve setting up cohort ICUs with isolation rooms. Re-allocation of resources in managing this crisis involves careful planning, halting elective surgeries and training of healthcare workers. Strict adherence to infection control like personal protective equipment and disinfection is the key to contain the disease transmission. Although many therapies have been tried in various regions, there is a lack of strong evidence to recommend anti-virals or immunomodulatory drugs.

Keywords: COVID-19, Guideline, Pandemic, SARI, Treatment

Contributors: NR, KN, AB, SKA: substantial contribution to the conception and design of the work (ii) drafting the work (iii) final approval of the version to be published (iv) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; GVB, MS, RL, DG, MJ: substantial contributions to the acquisition and interpretation of data for the work (ii) revising it critically for important intellectual content (iii) Final approval of the version to be published (iv) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding: None

Competing interests: None stated.

References

  • 1.Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (covid-19) outbreak in China: Summary of a report of 72/ 314 cases from the Chinese center for disease control and prevention [published online ahead of print]. JAMA. 2020;10. 1001/jama.2020.2648. Available from: https://jamanetwork.com/journals/jama/fullarticle/2762130. Accessed March 25, 2020. [DOI] [PubMed]
  • 2.Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al. World J Pediatr. 2020. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Coronavirus disease 2019 [Internet]. [cited 2020 Mar 26]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
  • 4.de Wilde AH, Snijder EJ, Kikkert M, van Hemert MJ. Host factors in coronavirus replication. Curr Topic Microbiol Immunol. 2018;419:1–42. doi: 10.1007/82_2017_25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Paules CI, Marston HD, Fauci AS. Coronavirus infections- More than just the common cold. JAMA. 2020;323:707–8. doi: 10.1001/jama.2020.0757. [DOI] [PubMed] [Google Scholar]
  • 6.Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199–207. doi: 10.1056/NEJMoa2001316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Lu X, Zhang L, Du H, Zhang J, Li Y, Qu J, et al. New England J Med. 2020. SARSCoV- 2 Infection in Children. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Lee P-I, Hu Y-L, Chen P-Y, Huang Y-C, Hsueh P-R. JMicrobiol Immunol Infect. 2020. Are children less susceptible to COVID-19? [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426:450–54. doi: 10.1038/nature02145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Mahase E. Coronavirus: covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ. 2020;368:m641. doi: 10.1136/bmj.m641. [DOI] [PubMed] [Google Scholar]
  • 11.Onder G, Rezza G, Brusaferro S. JAMA. 2020. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. [DOI] [PubMed] [Google Scholar]
  • 12.Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Lancet Respiratory Medicine. 2020. Clinical course and outcomes of critically ill patients with SARSCoV- 2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Grasselli G, Pesenti A, Cecconi M. JAMA. 2020. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response. [DOI] [PubMed] [Google Scholar]
  • 14.Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of nine patients treated in Korea. Korean J Radiol. 2020;21:494–500. doi: 10.3348/kjr.2020.0132. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395:507–13. doi: 10.1016/S0140-6736(20)30211-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports-48.Accessed March 29, 2020
  • 17.Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Pediatrics. 2020. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. [Google Scholar]
  • 18.Indian Council of Medical Research. Revised Strategy of COVID19 testing in India (Version 3, dated 20/03/2020). Available from: https://icmr.nic.in/sites/default/files/upload_documents/2020-03-20_covid19_test_v3.pdf. Accessed March 29, 2020
  • 19.World Health Organization. 2020. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases: Interim guidance. 2020. [Google Scholar]
  • 20.Xpert® Xpress SARS-CoV-2. Instructions for Use. USA: Cepheid, California; 2020. [Google Scholar]
  • 21.Indian Council of Medical Research. Press Release on “Fast Track Approval for Indian COVID-19 Testing Kits for Commercial Use.”. 2020. [Google Scholar]
  • 22.The AustralianNew Zealand Intensive Care Society ANZICS. COVID-19 Guidelines Version 1. 2020. [Google Scholar]
  • 23.Xie J, Tong Z, Guan X, Du B, Qui H, Slutsky AS. Intensive Care Med. 2020. Critical care crisis and some recommendations during the COVID- 19 epidemic in China. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Available from: https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf. Accessed March 29, 2020.
  • 25.Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected Interim guidance. WHO/2019-nCoV/clinical/2020.4. Accessed March 29, 2020.
  • 26.Murthy S, Gomersall CD, Fowler RA. JAMA. 2020. Care for Critically III Patients With COVID-19. [DOI] [PubMed] [Google Scholar]
  • 27.Brewster DJ, Chrimes NC, Do TBT, Fraser K, Groombridge CJ, Higgs A, et al. Med J Aust. 2020. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Intensive Care Med. 2020. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID 19 infection: Different points from adults. 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Hongde H, Fenglian M, Xin W, Yuan Fang. Eur Heart J. 2020. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin; p. ehaa190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Zeng J, Liu Y, Yuan J, Wang F, Wu W, Li J, et al. Preprints. 2020. First case of COVID-19 infection with fulminant myocarditis complication: Case report and insights [Pre-print] [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Chan KS, Lai ST, Chu CM, Tsui E, Tam CY, Wong MML, et al. Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: A multicentre retrospective matched cohort study. Hong Kong Med ^J. 2003;9:399–406. [PubMed] [Google Scholar]
  • 34.Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. New Engl J Med. 2020. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30:269–71. doi: 10.1038/s41422-020-0282-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382:929–36. doi: 10.1056/NEJMoa2001191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Vincent M, Bergeron E, Benjannet S, Erickson B, Rollin P, Ksiazek T, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005;2:69. doi: 10.1186/1743-422X-2-69. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Gautret P, Lagiera J, Parolaa P, Hoanga V, Meddeba L, Mailhe M, et al. Int J Antimicrob Agent. 2020. Hydroxychloroquine and azithromycin as a treatment of COVID 19: Results of an open label non randomized clinical trial. [DOI] [PMC free article] [PubMed] [Google Scholar] [Retracted]
  • 39.Wang BX, Fish EN. Global virus outbreaks: interferons as 1st responders. SeminImmunol. 2019;43:101300. doi: 10.1016/j.smim.2019.101300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Zhang L, Liu Y. Potential interventions for novel coronavirus in China: A systematic review. J Med Virol. 2020;92:479–90. doi: 10.1002/jmv.25707. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes on chest ct during recovery from 2019 novel coronavirus (COVID-19) pneumonia. 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.World Health Organization. Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (COVID-19) outbreak [internet] 2020. [Google Scholar]
  • 43.Indian Council of Medical research. Recommendation for empiric use of hydroxy-chloroquine for prophylaxis of SARS-CoV-2 infection [internet] 2020. [Google Scholar]
  • 44.Wang XF, Yuan J, Zheng YJ, Chen J, Bao YM, Wang YR, et al. Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen [English abstract] Zhonghua Er Ke Za Zhi. 2020;58:E008. doi: 10.3760/cma.j.issn.0578-1310.2020.0008. [DOI] [PubMed] [Google Scholar]
  • 45.Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14:72–3. doi: 10.5582/bst.2020.01047. [DOI] [PubMed] [Google Scholar]
  • 46.Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, et al. Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China [pre-print] 2020. [Google Scholar]
  • 47.Chen L, Xiong J, Bao L, Shi Y. Lancet Infect Dis. 2020. Convalescent plasma as a potential therapy for COVID-19[Published online ahead of print] [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Jin Y, Cai L, Cheng Z, Cheng H, Deng T, Fan Y, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version) Military Med Res. 2020;7:4. doi: 10.1186/s40779-020-0233-6. [DOI] [PMC free article] [PubMed] [Google Scholar]

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