Coronavirus (COVID-19)

Having asthma or allergic disease does not make it more likely for a child to contract COVID-19. From the information we have right now, from places around the world, COVID-19 affects the lungs quite differently than asthma.

Some viruses cause asthma attacks, but this one seems to act differently. Therefore, at this time, we are recommending the same precautions for people with asthma as the general population, including:

• Practice social distancing as recommended by public health officials
• Frequent hand washing/sanitizing, particularly if you have to go out of the house
• If you do go out of the house, make sure to wash your hands thoroughly when you come back home. Change your clothes when you come home, if you can.
• Make sure you have an adequate supply of your asthma medications, and stay on them as prescribed

The one exception is if your child is on chronic oral steroids, or a biologic agent for asthma.

I work in the medical field. Shouldn’t I stay away from taking care of COVID-19 patients because my child has asthma?

• At this time, because children with asthma do not seem to be overall at higher risk of COVID-19 complications, it is not necessary for you to take additional precautions (exception: if the child is on chronic oral steroids or a biologic agent). However, do be diligent about protecting yourself by using all appropriate personal protective equipment (PPE) as recommended, to protect yourself. Remember, since adults seem to get sicker than children, you actually may be at higher risk than your child
• If you work in the medical field, avoid bringing COVID-19 home by changing your clothes, taking off your shoes, washing your hands and face when you get home. Also, avoid taking objects back and forth to work.

I heard that people shouldn’t use steroids with COVID-19. Should I stop my child’s steroid inhaler?

• No, keeping your child’s asthma under control is one of the best ways you have to keep them well through this. We want to avoid you having to go to Emergency department (ED) or need steroids due to an asthma flare, and be exposed there, or have to take oral steroids.
• The concern with steroids and COVID-19 is that when people have tried to use oral or IV steroids as a way to treat the inflammation from COVID-19 itself it doesn’t help and can make the lung injury worse. However, the lung injury caused by COVID-19 is quite different, and oral/IV steroids are a much higher dose than inhaled steroids. We strongly recommend that your child stay on his or her inhaled steroid.

My child has fever and cough; does that mean they have COVID-19?

• Not necessarily. There are other viruses circulating in the community that also cause fever and cough. So, if you see those signs, don’t panic or assume it is COVID-19, but do pay attention closely to symptoms

What do I watch for in my child with asthma?

• You will watch for the same types of signs that you do for asthma. You will watch for bad cough, breathing fast or hard, retractions (skin sucking in when taking a breath), or chest tightness or shortness of breath.
• If you start to see respiratory problems, take your child’s temperature a few times a day to check for fever.
• You will still give albuterol to see if it helps the symptoms. If it does, then follow your Asthma Action Plan.
• If albuterol does NOT help, then contact your asthma provider.
• If you are seeing significant respiratory distress, then go ahead and go to the ED, but know that ED procedures are different now so they may have you wait in the car and come out to you.

COVID-19 is a new virus that has spread across the world, including here in Indiana. We know that this can be a worrisome time for everyone, especially for families caring for children and young adults with blood disorders or cancer. Individuals with bone marrow failure syndromes, cancer, or sickle cell disease have weaker immune systems that may put them at higher risk for becoming infected with COVID-19.

It is important to know there are extra precautions that you can take in order to protect your family member with a blood disorder or cancer.

1. Wash your hands with soap and water for 20 seconds (don’t stop until you finish singing the “Alphabet song”) or use hand sanitizer with at least 60% alcohol.
2. Avoid touching your eyes, nose, mouth, and face.
3. Avoid being close to people who are visibly sick, coughing, or sneezing.
4. Disinfect frequently touched objects and surfaces. The virus can live on these surfaces and get transmitted this way.
5. If you feel sick, call your medical provider FIRST.

Additional resources are linked below with information regarding COVID-19 and how it may impact your family.

COVID-19 and Cancer Survivors: What Do I Need to Know? (Source: Children’s Oncology Group) [Español] [Français]

COVID-19 and Your Child, Teen, or Young Adult with Cancer (Source: Children’s Oncology Group) [Español] [Français]

COVID-19 and Your Child with Sickle Cell Disease (Source: Sickle Cell Disease Association of America)

Please contact your child’s primary treatment team with any questions or concerns you may have.

It’s important to note that the vast majority (80%) of COVID-19 infections are mild, but in some cases it can cause severe lung infection, sepsis, and heart muscle involvement. Due to their congenital heart condition, children and adults with congenital heart disease (CHD) are at risk of getting sicker with COVID-19 than people without CHD. It’s important to try not to panic. The community is well-equipped to handle this. Because of the focus on infection control and prevention for years, we are well-versed in many of the procedures recommended by the CDC at this time.

This includes:

• Supplies and medications. While many of you may not be able to get 90-day supplies of specialty medications, we would recommend refilling as many of your medications as you can to have extra supply on hand. Please answer every phone call that comes in. You don’t want to miss phone calls from pharmacies or your care team. If you have questions about getting additional medication supplies, please contact our team.
• Take precautions to limit droplet and contact acquisition of COVID-19:
  • Indiana is now in a state of lockdown, so you should try to leave your house as little as possible and only to go to essential places, like grocery stores.
  • Maintain a distance of at least 6 feet away from people.
  • Clean your hands as soon as possible after touching unknown surfaces.
  • Avoid touching your nose and face as much as possible, especially after contact with an unknown surface.

We recommend you stick with trusted sources of information, including:

• CDC: Coronavirus (COVID-19) Resources
• Congenital Heart Public Health Consortium

It’s important to note that the vast majority (80%) of COVID-19 infections are mild, but in some cases it can cause severe lung infection. Due to their chronic lung condition, children with cystic fibrosis (CF) are at risk of getting sicker with COVID-19 than people without cystic fibrosis. It’s important to try not to panic. The CF community is well-equipped to handle this. Because of the focus on infection control and prevention for years, we are well-versed in many of the procedures recommended by the CDC at this time.

This includes:

• Supplies and medications. While many of you may not be able to get 90-day supplies of specialty medications, we would recommend refilling as many of your medications as you can to have extra supply on hand. Please answer every phone call that comes in. You don’t want to miss phone calls from pharmacies. If you have questions about getting additional medication supplies, please contact our CF team.
• Take precautions to limit droplet and contact acquisition of COVID-19:
  • Indiana is now in a state of lockdown, so you should try to leave your house as little as possible and only to go to essential places, like grocery stores.
  • Maintain a distance of at least 6 feet away from people.
  • Clean your hands as soon as possible after touching unknown surfaces.
  • Avoid touching your nose and face as much as possible, especially after contact with an unknown surface.

We recommend you stick with trusted sources of information, including:

Cystic Fibrosis Foundation: COVID-19 Community Questions and Answers
CDC: Coronavirus (COVID-19) Resources

See more information from our Cystic Fibrosis Program, including what to expect at upcoming office visits and hospitalizations.

It’s important to note that the vast majority (80%) of COVID-19 infections are mild, but in some cases it can cause severe lung infection, G.I. symptoms or liver disease. Patients with suppressed immune systems may be at higher risk for infections. There are steps you can take to protect your child:

This includes:

• Supplies and medications. While many of you may not be able to get 90-day supplies of specialty medications, we would recommend refilling as many of your medications as you can to have extra supply on hand. Please answer every phone call that comes in. You don’t want to miss phone calls from pharmacies. If you have questions about getting additional medication supplies, please contact our team.
• Take precautions to limit droplet and contact acquisition of COVID-19:
  • Indiana is now in a state of "shelter in place", so you should try to leave your house as little as possible and only to go to essential places, like grocery stores (wearing a mask).
  • Maintain a distance of at least 6 feet away from people.
  • Clean your hands as soon as possible after touching unknown surfaces.
  • Avoid touching your nose and face as much as possible, especially after contact with an unknown surface.
  • Frequently clean surfaces with a disinfectant containing bleach. However, household disinfectants are also effective

Call your child's Riley physician or nurse if you think your child has symptoms of COVID-19.

We recommend you stick with trusted sources of information, including:

• GiKids: COVID-19 Resources
• COVID-19 (Coronavirus): What IBD Patients Should Know
• Guidance for Pediatric Caregivers and Patients for IBD During Covid-19
• NASPGHAN: COVID-19 Resources For Healthcare Providers

It’s important to remember that most people (80%) with COVID-19 infections have mild symptoms, and children overall do much better than adults with this infection. That said, patients with neuromuscular disease, which are diseases of the nerves, muscle or neuromuscular junction, may be at higher risk to contract COVID-19. Talk to your physician to help understand the risk for you or your child.

We recognize this is an especially concerning time for transplant recipients, candidates, and household members. Information regarding COVID-19 is changing rapidly, and it is important to stay informed and be prepared. If your child is doing well at home, routine follow-up visits to your child’s doctor should be rescheduled. If your child is having any type of symptoms, you should call your primary healthcare professional before leaving your home to determine if your child needs to be seen. Our team has the following recommendations for patients and their families.

Transplant recipients or candidates:

• Maintain a minimum two-week supply of all medication, keeping in mind any dosage changes
• Contact your transplant coordinator, if you are experiencing a cough or fever prior to any visit to the hospital for clinic, labs or rehab
• Watch for calls or emails from IU Health team members regarding any change in your scheduled appointments

Transplant candidates on waitlist:

• All patients on the waitlist are encouraged to follow the same recommendations below for post-transplant patients and their household members.

Transplant recipients and household members:

• Postpone all non-essential travel and encourage household members to do the same
• Minimize exposures in public and avoid crowded environments
• Minimize close contact with people (6 feet or more)
• No handshaking
• Cough or sneeze into a tissue or your elbow, dispose of your tissue in trash can immediately and wash your hands
• Wash your hands frequently with soap and water for at least 20 seconds
• Avoid touching your face
• Disinfect frequently touched surfaces often (TV remote controls, light switches, cell phones, etc.)
• Increase ventilation in household by opening windows (if feasible)
• Work from home (if feasible)
• Avoid sick people at home and in public
• If a household member is infected with COVID-19, the infected person and transplant recipient should wear a simple surgical/dust mask and closely follow all of the above. If feasible, alternative accommodations may need to be considered for the transplant recipient while a household member is ill or the ill person should stay in one room with one caregiver to reduce contact with transplant recipient.

Following the recommendations above are crucial to minimize exposure and spread of the COVID-19 among transplant patients and the general population.

We recommend these additional resources for the latest information:

• United Network for Organ Sharing (UNOS): COVID-19 and Solid Organ Transplant