Coronavirus & Children

Coronavirus: Children, CHD and Kawasaki Disease

With restrictions easing across Australia and children returning to school, we've had many questions asked of us about #coronavirus and children. Are children with Congenital Heart Disease (CHD) at more risk? What about Kawasaki Disease? Or pregnant women? Our researchers Professor Sally Dunwoodie and Professor Bob Graham answer your questions in our new video

May 12 2020
Update 25 Nov 2021: Information from this article was accurate at the time of publishing and reflected the rules/advice announced by governing bodies at that time.

Video transcript - 12 May 2020

Prof Bob Graham (BG): Welcome to another video on COVID-19 and heart disease, coming to you from the Victor Chang Cardiac Research Institute. Today, it's a great pleasure for me to introduce my colleague, Professor Sally Dunwoodie, who is one of the world's experts on the causes of congenital heart disease. Before we get into that, Sally, there's been a new entity that has come to the fore for people who are being exposed to COVID. It is a disease called Kawasaki's disease.

Can you tell us a little about Kawasaki's Disease and is that a concern?

Prof Sally Dunwoodie (SD): Yes, Bob. Kawasaki disease was first identified in Japan. It's associated with a rash and the high fever and some swelling of the hands and feet. It's basically... You have an inflammation of your blood vessels. Now, there've been some cases associated with COVID-19 around the world and I think, Bob, you know quite a lot more about that.

How has Kawasaki's Disease been linked to COVID-19?

BG: Yes, we've been in touch with our colleagues overseas. There are some 30 cases at the moment in hospitals in London, and it's also been reported in Spain and Italy and Switzerland, so it's probably a real phenomenon, although not all kids so far have tested positive for COVID. Most of them have. That may be a testing issue and it does look like it's COVID associated. Hopefully, it responds as well as most Kawasaki does to aspirin and immunoglobulins. So far there've been no deaths from this disorder in children. Hopefully, we'll be able to treat it as well as we treat regular Kawasaki, which is a very rare condition generally.

Sally, let's move on now to the real topic of this video, which is congenital heart disease and we've got lots of questions about that.

Is my child who has congenital heart disease more likely to get COVID-19, and if they get it, are they more likely to do poorly than someone who doesn't have congenital heart disease?

SD: Of course, this is a real concern for all parents, but especially for parents who have children with congenital heart disease. At the moment there is no evidence that a child born with congenital heart disease, which is a structural defect in their heart and it's repaired by surgery after birth, that they're any more likely of being infected by COVID-19, and as I'm sure everyone was probably aware, that children represent a really small percentage of cases of COVID-19 individuals.

Only about 1% of children... Sorry, I've got that wrong. It's only about 1% of cases that have been identified worldwide at the moment have appeared in children who are 10 years or younger and only 2% of the worldwide cases in individuals who are 20 years and under. So, COVID-19 does not infect children at the same level as it does adults. And there's no reason at the moment to expect that children with congenital heart disease would be any different to any other child.

BG: Sally, how about those who've got, say, a heart disease that has not been fully corrected?

What about children that still have a cyanotic congenital heart disease or an immune problem, such as DiGeorge syndrome or asplenia, where you lack a spleen, or down syndrome or general heart disease?

SD: Bob, yes, a very important question and a very important question for parents. The information that we know about children are they represent a very small proportion of COVID-19 positive cases, and of children who are infected, only 10% of those end up in hospital. And that's just to get some oxygen relief and some care in that way. No different to any other sort of winter virus.

For the majority of congenital heart disease children who've had their hearts surgically repaired, there's no evidence to suggest that they would be more sick having been infected with COVID-19. However, a small number of congenital heart disease patients might have impaired heart function, cyanotic disease as you mentioned, and they can be breathless as well. These individuals possibly would be more affected by COVID-19 infection. What would you say to that, Bob, to this population? Be more careful? Should they alert their doctors ahead of time? What do you think?

BG: Yeah, look, absolutely Sally. I think it's always wise to consult your cardiologist and if you're at all worried and I think they should take special care to try and avoid getting COVID if they can. Sally, now a really difficult one that comes up all the time.

If my child has congenital heart disease, should I allow them to go to daycare or school?

That really is a big question and a big concern for parents. We all love our children dearly and worry about them at every stage of their lives. I think that really it comes down to not all children born with congenital heart disease have the same extent of disease and the majority of cases, the surgical correction is essentially all that's needed for the child. However, there are some cases, the minority of cases, who have obvious poor heart function. For those ones, maybe you need to be more careful. And I really would recommend going to see their cardiologist, because they will know very specifically the condition of your child's heart and would be able to help you devise a way forward through this a difficult time. But again, really the main thing is to try and avoid catching coronavirus in the first place.

What about women who are pregnant, are they at a high risk of getting COVID or having problems when they get COVID, and how about the baby they're carrying?

SD: Well, there's no evidence to suggest that a pregnant woman is more likely to be infected by COVID-19. You haven't heard anything to the contrary?

BG: No. There's very little written about it so far. And all of those cases, most of them who had COVID and are pregnant, have had C-section deliveries. There's no good evidence that there's vertical transmission, that is transmission from mother to baby, either when they're pregnant or after when they're breastfeeding, so that's good news. We don't know what happens if you have a regular vaginal delivery. Hopefully, they won't be at increased risk. But we don't think that pregnancy is a big problem. And there've been women who've had COVID who've given birth and done very well.

SD: Yes. At this point in time, there's no evidence that you are more likely to become infected with COVID-19 if you're pregnant or indeed that it would cause the majority of pregnant women to have more severe symptoms of any kind. But of course, again, it's about being careful, cautious, looking after yourselves so that you don't become infected, and to monitor your symptoms if you're pregnant. And if you have any concerns, you would go to maternity clinics and doctors to get the best advice for you.

When should you get a COVID-19 test and is it easy to do?

SD: As you know, Bob, testing is now more readily available for us here in Australia. Even if we have just mild respiratory symptoms or even now I've heard some asymptomatic, you can go along and be tested. I think we're in a better position than we were a month ago with a lot more testing here in Australia.

BG: Yeah, I know, Sally, you bring up a good point. It's really been an enormous credit to Australia, to the Australian government and the Australian people who have listened to the calls to social distancing. We have absolutely not only flattened the curve, we've crushed it. We have one of the lowest incidents of COVID infections and then COVID death in the world. 270 cases per million infections, and about 3.7 cases per million of death, which each death is tragic. We know that, but still that's enormously better than most other countries in the world, so we can be very pleased and proud of that. And I think parents can rest easy knowing that we do a lot better in Australia than the rest of the world.

How can we best prevent COVID-19 for our families?

SD: I guess the one thing to remember now is as restrictions might be becoming lifted in terms of social isolation and getting back to work a little bit, is to still be really vigilant, because we don't want outbreaks and we want to keep a lid on this. We would recommend that you download the government app to make sure that they can very easily track who you've been in contact with should you become COVID-19 positive. And we really need to protect our healthcare workers as much as we can, because it's an absolute tragedy that they should be losing their lives treating people with COVID-19.

BG: Well, Sally, thank you very much. It's been an honour having you on the program. I should've mentioned that I'm Professor Bob Graham. I'm a cardiologist. I work here at the Victor Chang Cardiac Research Institute and also at St Vincent’s Hospital, Sydney. There are a number of these videos and we thank you for watching. They're available on our website. You can access them very easily if you're interested for things other than congenital heart disease too. Look after yourselves and please maintain the social distancing, hand washing and all those other practices. We don't want you to get COVID, but we're here to help if we can. Thank you very much for watching.