With ongoing shutdowns and disruptions to daily life, children may be asking many questions about the coronavirus disease 2019 (COVID-19), and what it means for them. Responding to their concerns calmly and truthfully is the key to assuaging their fears, said Dawn Maaks, PhD, CPNP-PC, PMHS, FFANP, during a session at the National Association of Pediatric Nurse Practitioners (NAPNAP) 2020 virtual meeting.

When it comes to handling children’s questions during the pandemic, Maaks said health care providers play a role in providing anticipatory guidance that is developmentally grounded. For example, preschool-age children crave reassurance and do not need in-depth details, while adolescents should be engaged in honest conversations about reducing the risk of contracting COVID-19.

For all ages, Maaks said it is important to be truthful, but answer the question asked instead of complicating the issue.

Discussions with preschool-age children should be fun and reassuring. Instead of dwelling on the lack of usual activities, for example, parents can emphasize games or puzzles that can be played at home and which may not be a part of the usual routine.

When discussing COVID-19 with school-age children, parents should identify their worries, and work to clarify their understandings. If they ask a question, answer that specific fear without overanalyzing it and adding unnecessary details that may confuse them further. Routines are also important, and Maaks recommended establishing a daily routine to ensure children feel secure.

Adolescent children present their own challenges. Maaks said adults should remember that adolescents feel invincible, and as a result may not take the virus and precautions as seriously as they should. To handle this, she suggested instilling a sense of responsibility. Remind teenagers that wearing a mask or taking other precautions are not only for their own safety, but also for the safety of others, such as their grandparents or other family members who may be more at risk.

“So much of what we’re doing with social distancing is about protecting us as individuals, but it’s seriously about protecting our most vulnerable populations,” Maaks said.

Like adults, many children may be experiencing fear and anxiety during the pandemic, Maaks said. When counseling parents on how to handle this, emphasize the importance of a healthy diet, physical activity, adequate sleep, and grounding or mindfulness techniques. Warning signs for anxiety in children can include developmentally inappropriate worries or sadness, altered sleep or appetite, excessive externalizing, or developmentally inappropriate separation anxiety.

“It’s normal to fear bad things happening to people you love in a pandemic, but that shouldn’t be consuming,” Maaks said. “And if it is, that’s a sign the child needs help.”

Maaks D. COVID-19 Pediatric Issues. Presented at: 2020 Virtual Conference on Pediatric Health Care; June 4-6, 2020; virtual. Accessed June 11, 2020.

Articles

With ongoing shutdowns and disruptions to daily life, children may be asking many questions about the coronavirus disease 2019 (COVID-19), and what it means for them. 

Discussing COVID-19 with Children and Adolescents 

The American College of Sports Medicine (ACSM) published a new expert consensus statement that provides guidance on training staff and establishing emergency plans to prevent cardiovascular events at fitness facilities, community and hotel fitness facilities, and sporting event venues, according to a press release.

The paper is an update to previous guidelines released by ACSM and the American Heart Association in 1998.

“Vigorous exercise is a double-edged sword in that it protects against but, in rare instances, can trigger acute cardiac events,” said Barry A. Franklin, PhD, FACSM, co-author and ACSM past president, in a press release. “This ACSM special communication provides health-fitness facility professionals with the latest information on the modulators of exercise risk, and how to reduce them, as well as key elements of a well-organized emergency response system."

The objective of the new statement is to further reduce the rare cardiovascular complications of exercise while removing unnecessary barriers to widespread participation in an active lifestyle, according to the press release. It seeks to minimize screening and other factors that may impede the use or availability of physical fitness facilities compared with the 1998 statement.

the increasingly recognized health benefits of even low levels of physical activity (PA).

cardiovascular events incited by physical activity among healthy adults and those with established cardiovascular disease.

some pre-exercise screening strategies that present a barrier to PA due to requiring additional medical testing for clearance.

immediate assistance provided by nonmedical personnel to help greatly reduce the morbidity and mortality of acute cardiac events (dialing 911, initiating bystander cardiopulmonary resuscitation, etc).

Further, the paper addresses the cardiovascular risks of physical activity, cardiovascular screening of prospective fitness facility members/users, and general recommendations for fitness-related facilities, according to the press release. This includes emergency response, staffing and training, automated external defibrillators, signage, member training, and mass participation sporting events.

“Publishing this updated statement aligns with ACSM’s mission to advance and integrate scientific research to improve education and the practical applications of exercise science and sports medicine,” said Lynette Craft, PhD, ACSM chief science officer and fellow, in a press release.

At the Heart of the Matter: ACSM Updates Recommendations to Prevent Cardiovascular Events at Fitness Facilities. ACSM. Published June 26, 2020. Accessed June 26, 2020.

The paper is an update to previous guidelines released by ACSM and the American Heart Association in 1998. 

ACSM Updates Recommendations to Prevent Cardiovascular Events at Fitness Facilities

Officials with the FDA have approved a 300 mg single-dose pre-filled pen for dupilumab (Dupixent, Regeneron) for certain patients 12 years of age and older who have atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis for at-home administration.

"Chronic type 2 inflammatory diseases such as atopic dermatitis, asthma and chronic rhinosinusitis with nasal polyps can be incredibly complex to manage, leaving patients burdened and apprehensive about their treatment options," said Regeneron president and CEO George D. Yancopoulos, MD, PhD, in a press release. "The Dupixent pre-filled pen was specifically designed to provide patients with an easy-to-use, convenient option so they can feel more comfortable administering their injections."

The dupilumab pen features a hidden needle and single-press auto-injection, along with visual and audio feedback to help with administration. The pre-filled syringe continues to be available in both 200 mg and 300 mg doses for use in a clinic or at home by self-administration, whereas the 300 mg dupilumab pen is expected to be available in the United States by Q3 2020.

Dupilumab has been studied in more than 10,000 patients across 50 clinical trials in various chronic diseases driven by type 2 inflammation. Further, dupilumab is being studied in a broad range of clinical development programs for diseases driven by allergic and other type 2 inflammation, including pediatric asthma, pediatric atopic dermatitis, eosinophilic esophagitis, and chronic obstructive pulmonary disease.

Serious adverse effects (AEs) may occur from dupilumab, including hypersensitivity, anaphylaxis, eye problems, and inflammation of the blood vessels. The most common AEs include injection site reactions, redness, swelling, cold sores of the mouth, itching, and insomnia.

FDA approves new Dupixent® (dupilumab) pre-filled pen designed to support more convenient self-administration. PR Newswire. https://www.prnewswire.com/news-releases/fda-approves-new-dupixent-dupilumab-pre-filled-pen-designed-to-support-more-convenient-self-administration-301080450.html. Published June 19, 2020. Accessed June 22, 2020.

The drug is indicated for certain patients 12 years of age and older who have atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis for at-home administration.

Dupilumab Pre-filled Pen Granted FDA Approval for More Convenient Self-Administration

By Marilyn Bulloch, PharmD, BCPS, FCCP; Fuller Currie, PharmD Candidate 2021; Allison Field PharmD Candidate 2021; and Pierce Gowan PharmD Candidate 2021

Multiple OTC products have been proposed to treat coronavirus 2019 (COVID-19), but their true role remains unclear. Vitamin C and zinc are among the adjuvant treatments being evaluated for patients with COVID-19 due to their various immune-enhancing properties and possible antiviral effects.

Vitamin C, at doses higher than usually seen in outpatient care, has been shown to improve mortality in sepsis and to have positive clinical results in patients suffering from viral infections.

 The exact mechanism of vitamin C’s beneficial effects is unclear; however, it is known that vitamin C is a potent antioxidant with immunomodulatory properties and significantly concentrates in important immune cells.



Studies have shown possible clinical benefits in patients with other viruses, including herpes zoster, varicella zoster, and influenza through an unclear antiviral mechanism.

 It is proposed this may occur with coronaviruses as well.

Zinc is naturally found in the body and is the second-most abundant trace element.

 It has been taken OTC for years to relieve symptoms of viruses such as the common cold or influenza. Unlike vitamin C, zinc’s antiviral mechanism is more established. It inhibits RNA-dependent RNA polymerase necessary for viral replication, including viruses such as influenza and COVID-19.



Although further studies are needed to establish a firm recommendation regarding the use of vitamin C and zinc in the treatment of COVID-19 positive patients, their past success in other viruses and sepsis, ease of access, relatively low price, and strong safety profiles makes them attractive choices as adjuvant therapies.

The data available are primarily limited to hospitalized patients. Whether they will be beneficial in outpatients with less severe disease also remains to be determined. As with so many other aspects of COVID-19, it is important for pharmacists to be aware of the ongoing studies and adapt accordingly as more robust information becomes available.

A version of this article was originally published by Pharmacy Times. Visit 

https://www.pharmacytimes.com/news/evaluating-the-efficacy-of-adjunctive-therapies-used-to-treat-covid-19-the-role-of--vitamin-c-and-zinc

Colunga Biancatelli RML, Berrill M, Marik PE. The antiviral properties of vitamin C. 

. 2020 Feb;18(2):99-101. doi: 10.1080/14787210.2020.1706483. Epub 2019 Dec 23.

Marik PE. Hydrocortisone, Ascorbic Acid and Thiamine (HAT Therapy) for the Treatment of Sepsis. Focus on Ascorbic Acid. 

. 2018 Nov 14;10(11):1762. doi: 10.3390/nu10111762.

Shittu MO, Afolami OI. Improving the efficacy of Chloroquine and Hydroxychloroquine against SARS-CoV-2 may require Zinc additives - A better synergy for future COVID-19 clinical trials. 

. 2020 Ahead of print Jun 1;28(2):192-197.

Evaluating the Role of Vitamin C and Zinc in Treating COVID-19

A new study shows that early signs of being more susceptible to type 2 diabetes (T2D) as an adult can be seen in children as young as age 8 years, decades before it is likely to be diagnosed, according to researchers from the University of Bristol.

Researchers looked at the effects of a genetic risk score for developing T2D as an adult on metabolism, measured from blood samples taken from participants in the study when they were aged 8, 16, 18, and 25 years.

Over 4000 participants were analyzed from the health study, “Children of the 90s,” which was established at the University of Bristol in the early 1990s. Researchers combined genetic information with an approach called metabolomics, involving measures of many small molecules in a blood sample to try and identify patterns that are specific to early stages of T2D development.

“We knew that diabetes doesn’t develop overnight. What we didn’t know is how early in life the first signs of disease activity become visible and what these early signs look like,” said lead investigator Josh Bell, MD, in a press release. “We addressed these by looking at the effects of being more genetically prone to type 2 diabetes in adulthood on measures of metabolism taken across early life.”

The study was conducted among younger people who were generally free of T2D and other chronic diseases to see how early in life the effects of being more susceptible to adult diabetes became visible. Certain types of high-density lipoprotein cholesterol were reduced at 8 years of age before other types of cholesterol including low-density lipoprotein were raised. Inflammation and amino acids were also elevated by 16 and 18 years of age, with these differences widening over time.

“We’re talking about the effects of susceptibility rather than of clinical disease itself,” Bell said in the press release. “This does not mean that young people ‘already have adult diabetes’; these are subtle differences in the metabolism of young people who are more prone to developing it later in life.”

These findings help reveal the biology of how diabetes unfolds and what features may be targetable much earlier on to prevent the onset of disease and its complications, according to the study authors.

“This is important because we know that the harmful effects of blood glucose, such as on heart disease, are not exclusive to people with diagnosed diabetes but extend to a smaller degree to much of the population,” Bell said.

Signs of being prone to adult diabetes are already visible at age 8 years old. University of Bristol. 

https://www.bristol.ac.uk/alspac/news/2020/early-signs-of-diabetes.html

. Published June 19, 2020. Accessed June 22, 2020.

Early signs of being more susceptible to type 2 diabetes (T2D) as an adult can be seen in children as young as age 8 years, decades before it is likely to be diagnosed, according to researchers from the University of Bristol.

Study: Signs of Adult Diabetes Already Visible by Age 8 Years

Sleep problems among children who have a sibling with autism spectrum disorder (ASD) may further raise the likelihood of an ASD diagnosis compared to at-risk children who do not have difficulty sleeping, according to a study from the

Previous research has shown that young children who have a sibling with ASD are at a higher risk for also being diagnosed with the condition, according to a NIH press release. These findings may give clinicians a tool to identify sleep problems early and provide interventions to reduce their effects on the health and development of children with autism. In addition, the findings may provide insight into the potential role of sleep problems in the development of ASD.

Researchers analyzed data from a long-term study of children who do and do not have siblings with ASD. When the children reached the ages of 6 months and 12 months, their parents were asked to respond to an infant temperament questionnaire that asks how much difficulty their child has falling asleep at bedtime and falling back to sleep after waking up during the night. At these time intervals, the children also received MRI scans to track their brain development.

The children were assessed for ASD at 24 months.

Four hundred and thirty-two children participated in the study, and 305 of these participants had a sibling previously diagnosed with ASD. Out of this group of 305, 71 were diagnosed with ASD at age 24 months, while 234 children in this group did not meet the diagnostic criteria for ASD.

One hundred and twenty-seven study participants did not have a sibling with ASD, and none of the children met the diagnostic criteria for ASD.

According to the study authors, high-risk children who met criteria for ASD scored higher for sleep problems at ages 6 months and 12 months compared to the other groups. In addition, these children had more growth in the brain’s hippocampus region from ages 6 months to 24 months compared to the high-risk children without sleep problems. This finding is crucial to the researchers because the hippocampus is involved in storing and retrieving memories, and previous studies in adults have linked insomnia with a smaller hippocampus volume.

The study authors could not determine why sleep problems were linked with larger hippocampus volume in the children who went on to meet ASD criteria. Further, the authors noted that their study could not provide information about the overall quality of the children’s sleep, such as the degree of sleep fragmentation, and sleep duration.

Additional studies with more comprehensive measures of sleep was suggested to further confirm the researchers’ findings, according to the press release.

NIH-funded study links early sleep problems to autism diagnosis among at-risk children. NIH.

https://www.nih.gov/news-events/news-releases/nih-funded-study-links-early-sleep-problems-autism-diagnosis-among-risk-children

. Published May 7, 2020. Accessed May 7, 2020.

Previous research has shown that young children who have a sibling with ASD are at a higher risk for also being diagnosed with the condition.

Study Links Early Sleep Problems to Autism Diagnosis Among At-Risk Children

As people remain under stay-at-home orders around the world, experts are increasingly concerned that vaccine-preventable disease outbreaks could follow the coronavirus disease 2019 (COVID-19) outbreak, due to global interruptions of immunization programs.

Organizations such as the Measles & Rubella Initiative have warned that disruptions in immunization services could lead to outbreaks in many vaccine-preventable diseases, which could then further overwhelm health systems fighting COVID-19.

“Disease outbreaks must not remain a threat when we have safe and effective vaccines to protect us,” said World Health Organization (WHO) Director-General Tedros Adhanom, PhD, in a statement.

Measles is of particular concern. According to a statement from the Measles & Rubella Initiative, as many as 800,000 people may have been infected with measles in 2019, and a resurgence could follow later in 2020 if vaccination rates fall.

The WHO issued a document in April with guiding principles and recommendations for ensuring continued immunizations, including adapting new strategies to protect health workers, caregivers, and patients.

“Immunization is a core health service that should be prioritized for the prevention of communicable diseases and safeguarded for continuity during the COVID-19 pandemic, where feasible,” the statement said.

According to the WHO recommendations, vaccine-preventable disease surveillance should be maintained and reinforced, and should be monitored in tandem with the dynamics of COVID-19. If immunization services are impacted, individual countries should create strategies to catch up and should make plans to anticipate a gradual recovery. These strategies will require tracking and follow-up with individuals who missed vaccinations, assessing of immunity gaps, and re-establishing community demand.

These strategies and decisions will be influenced by local mandates regarding physical distancing and will depend on whether the local health systems have reached capacity. Wherever the capacity is intact and essential health services are still operational, fixed site immunization services and disease surveillance should be continued while maintaining safety procedures. Alternative strategies may be considered in some cases, however, and may include outreach or mobile services.

Finally, in areas where immunization services must be minimized or suspended, the WHO recommendations urged countries to reinstate their services as soon as possible once reduced local transmission of COVID-19 permits health services to resume. If resources are still limited, catch-up activities should prioritize outbreak-prone diseases such as measles, polio, diphtheria, and yellow fever.

“While the world strives to develop a new vaccine for COVID-19 at record speed, we must not risk losing the fight to protect everyone, everywhere against vaccine-preventable diseases,” Adhanom concluded in a statement from the WHO. “These diseases will come roaring back if we do not vaccinate.”

Hard fought gains in immunization coverage at risk without critical health services, warns WHO [news release]. Measles & Rubella Initiative; April 23, 2020.

https://measlesrubellainitiative.org/measles-news/hard-fought-gains-in-immunization-coverage-at-risk-without-critical-health-services-warns-who/

Guiding principles for immunization activities during the COVID-19 pandemic. World Health Organization; March 26, 2020.

https://apps.who.int/iris/bitstream/handle/10665/331590/WHO-2019-nCoV-immunization_services-2020.1-eng.pdf

Organizations have warned that disruptions in immunization services could lead to outbreaks in many vaccine-preventable diseases.

Experts Urge Continued Immunizations During COVID-19 Pandemic

Older adults who consumed small amounts of flavonoid-rich foods, such as berries, apples, and tea, were 2 to 4 times more likely to develop Alzheimer disease (AD) and related dementias over 20 years compared with people whose intake was higher, according to a new study led by scientists at the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HNRCA) at Tufts University.

The study consisted of 2800 people aged 50 years and older. Researchers examined the long-term relationship between eating foods containing flavonoids and the risk of AD and AD-related dementias (ADRD). Although many studies have looked at the association between nutrition and dementias over short periods of time, the study examined the exposure over a period of 20 years, according to the study authors.

Flavonoids are natural substances found in plants, including fruits, vegetables, and plant-based beverages, and are associated with various health benefits, including reduced inflammation.

The researchers found that the low intake of flavanols (apples, pears, and tea) was associated with twice the risk of developing ADRD. Additionally, low intake of anthocyanins (blueberries, strawberries, and red wine) was associated with a 4-fold risk of developing ADRD. Lastly, low intake of flavonoid polymers (apples, pears, and tea) was associated with twice the risk of developing ADRD.

“Our study gives us a picture of how diet over time might be related to a person’s cognitive decline, as we were able to look at flavonoid intake over many years prior to participants’ dementia diagnoses,” said Paul Jacques, senior author and nutritional epidemiologist at the USDA HNRCA, in a press release. “With no effective drugs currently available for the treatment of Alzheimer’s disease, preventing disease through a healthy diet is an important consideration.”

Six types of flavonoids were analyzed and compared in long-term intake levels with the number of AD and ADRD diagnoses later in life. The researchers found that the low intake of 3 flavonoid types was linked to higher risk of dementia compared with the highest intake. For example, low intake was equal to no berries per month, roughly 1½ apples per month, and no tea. Further, high intake was equal to roughly 7.5 cups of blueberries or strawberries per month, 8 apples and pears per month, and 19 cups of tea per month.

Study author Esra Shishtar, said that when looking at the findings, it is easier to see that the people who may benefit the most from consuming more flavonoids are those at the lowest levels of intake, and it would not take much to improve their levels with a cup of tea per day or berries up to 3 times per week.

In addition, Jacques said that 50 years of age, the approximate age at which the data were first analyzed for participants, is not too late to make positive dietary changes.

“The risk of dementia really starts to increase over age 70, and the take home message is, when you are approaching 50 or just beyond, you should start thinking about a healthier diet if you haven’t already,” Jacques said in a press release.

More berries, apples, and tea may have protective benefits against Alzheimer’s. TuftsNow.

https://now.tufts.edu/news-releases/more-berries-apples-and-tea-may-have-protective-benefits-against-alzheimer-s

. Published May 5, 2020. Accessed May 6, 2020.

Researchers examined the long-term relationship between eating foods containing flavonoids and the risk of AD and AD-related dementias (ADRD).

Study: More Berries, Apples, Tea May Have Protective Benefits Against Alzheimer

The rapid increase in telemedicine visits that have been a result of the coronavirus disease 2019 (COVID-19) pandemic may ultimately transform how physicians treat patients going forward, according to a new study.

Journal of the American Informatics Association

, the study describes the rapid expansion of video-enabled visits between March 2 and April 14, 2020. During this time, the researchers found that virtual urgent care visits at NYU Langone Health increased by 683%, and nonurgent virtual care visits increased by 4345% based on daily averages.

The researchers conducting the study were from NYU Grossman School of Medicine, NYU Tandon School of Engineering, and NYU School of Global Public Health.

New York has been one of the epicenters of the COVID-19 outbreak in the United States, yet NYU Langone was also highly prepared to expand their telemedicine services at the time of the outbreak due to the presence of technological tools that had already been integrated across the health system.

“The pandemic created an urgent need to divert patients from inpatient care and prevent the flooding of our emergency rooms beyond capacity,” said Devin Mann, MD, associate professor in the Departments of Population Health and Medicine, senior director for Informatics Innovation and Medical Center Information Technology at NYU Langone Health, and the study's lead author, in a press release. “Through telemedicine, we pushed the frontlines to locations far from our hospitals and doctor's offices. And because NYU Langone invested early in this technology, we quickly leveraged digital health to help hundreds of thousands of patients.”

Previously, telemedicine's growth was slow, and in 2019, only 8% of Americans used telemedicine services, according to the researchers. Although there had been growth in regard to telemedicine’s use in rural settings, there were few reasons for many patients to replace in-person visits prior to COVID-19.

Currently, US insurers have needed to rapidly expand coverage to include all telemedicine visit types, including those from home. Furthermore, states have needed to relax state-to-state licensing requirements so that telemedicine care could be covered by insurance across state lines.

Additionally, the Office for Civil Rights (OCR) at the Department of Health and Human Services, which is responsible for enforcing some of the regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), has allowed the use of consumer audio and video communication for telemedicine visits even if the technologies and their use do not comply with HIPAA requirements. OCR has also stated that it will not impose penalties for noncompliance in relation to the use of telemedicine equipment by providers.

Through the use of NYU Langone's electronic health record system Epic, the researchers compiled data from COVID-19 related telemedicine visits using diagnostic codes that they matched with keywords that described symptoms of COVID-19.

The researchers found that during the 6-week study period:

There were 144,940 video visits involving 115,789 patients and 2656 providers.

In video visits, 56.2% of all urgent care, and 17.6% of all nonurgent visits were COVID-19 related.

Forty emergency medicine providers, managing less than 100 telemedicine visits on a typical day, increased to 289 “surge” telemedicine providers from multiple specialties.

On March 19, NYU Langone Health expanded video visits to all of its ambulatory care settings, which reached more than 7000 visits in 10 days and represented more than 70% of the total ambulatory care provided during this time.

Telemedicine usage was highest among patients aged 20 to 44 years, particularly for urgent care visits. Yet, patients of all ages were also successfully able to use NYU Langone's telemedicine platform.

Patients' satisfaction ratings with telemedicine visits stayed positive, despite the rapid expansion of the program to thousands of new providers in a short period of time.

During this expansion period, the number of providers and patients who used telemedicine for the first time increased significantly. This increase will facilitate a transformation of technologies and work practices across different specialties, according to Oded Nov, PhD, professor and chair of the Department of Technology Management and Innovation at the NYU Tandon School of Engineering, and the study's senior author, in a press release.

“An important question going forward is how much this will continue beyond the COVID-19 pandemic. While we expect patients and providers who got a crash course in telemedicine to continue using it long term, regulators and insurers' decisions will have a major impact,” Nov said.

In order to support the further expansion of telemedicine services at NYU Langone Health and NYU Grossman School of Medicine, each was recently awarded grants from the FCC’s COVID-19 Telehealth Program.

“Our ability to scale and expand telehealth quickly has allowed us to battle overcrowding and human spread of the disease,” said Paul Testa, MD, assistant professor, the Ronald O. Perelman Department of Emergency Medicine and Chief Medical Information Officer at NYU Langone Health, and a study co-author, in a press release. “It also pushes our ability to care for patients beyond any physical boundary, which you can only do digitally.”

Oded Nov, Paul A Testa, Rumi Chunara, Ji Chen, Devin M Mann. COVID-19 transforms health care through telemedicine: evidence from the field.

Journal of the American Medical Informatics Association

Telemedicine transforms response to COVID-19 pandemic in disease epicenter [news release].

. April 30, 2020. sciencedaily.com/releases/2020/04/200430150220.htm. Accessed May 6, 2020.

Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency. Office for Civil Rights. March 30, 2020. hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html. Accessed May 6, 2020.

Virtual urgent care visits at NYU Langone Health increased by 683%, and nonurgent virtual care visits increased by 4345% based on daily averages.

COVID-19 Pandemic Transforms Use of Telemedicine Resources, Potentially for the Foreseeable Future

The National Institutes of Health (NIH) has issued a timely statement emphasizing the importance of asthma awareness and standing with parents, families, advocates, researchers, and health care professionals.

The chronic lung disease causes periods of wheezing, chest tightness, shortness of breath, and coughing, and is a major contributing factor to missed time from school and work, according to a NIH press release. Severe attacks may require a visit to an emergency room visits or end up fatal.

With the coronavirus disease 2019 (COVID-19) pandemic, many people with asthma have developed additional concerns due to the virus’ effect on the nose, throat, and lungs. COVID-19 can cause more asthma attacks and lead to pneumonia or acute respiratory disease.

According to the CDC, people with asthma should continue their current asthma medications and discuss any concerns with their health care provider.

NIH has supported and conducted studies on asthma, with findings in areas such as the relationship between asthma and COVID-19, populations at risk of developing asthma, potential new treatments, genes involved in asthma, and asthma management.

The National Institute of Allergy and Infectious Disease (NIAID) is initiating a home-based study to assess the incidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of COVID-19, in children and their families with the help of a caregiver. In addition, the NIAID will begin an observational study in patients hospitalized for COVID-19 to understand if specific characteristics of the immune response influence or reflect the severity of infection.

Possible new treatments have been tested for neutrophilic asthma, a particularly severe form that responds poorly to the standard asthma therapy of corticosteroids.

The National Asthma Education Prevention Program is coordinating the 2020 focused updates to the 2007 Asthma Management Guidelines designed to improve the care of people living with asthma as well as help primary care providers and specialists make decisions about asthma management, according to a press release. Several topic areas will be addressed, including reducing indoor asthma triggers, treating allergies by exposure to low doses of allergens by mouth or with shots, and using inhaled medications when needed.

NIH statement on World Asthma Day 2020. NIH.

https://www.nih.gov/news-events/news-releases/nih-statement-world-asthma-day-2020

. Published May 5, 2020. Accessed May 5, 2020.

World Asthma Day 2020 Recognizes COVID-19 Pandemic

A study to help determine the incidence rate of the coronavirus disease 2019 (COVID-19) in children and their family members has begun enrolling participants in the United States, according to the National Institutes of Health (NIH).

recommended that future epidemiologic and clinical studies are needed to identify possible preventive and therapeutic strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric patients.

The Human Epidemiology and Response to SARS-CoV-2 (HEROS) study will help determine what percentage of children infected with SARS-CoV-2 develop symptoms of COVID-19. Additionally, the HEROS study will examine whether rates of SARS-CoV-2 infection differ between children who have asthma or other allergic conditions and children who do not, according to the study authors.

The HEROS study team is planning to enroll 6000 people from 2000 US families already participating in NIH-funded pediatric research studies in 11 cities. Both healthy children and children with asthma or other allergic conditions will be able to participate.

The study team will follow the children and their families for 6 months to determine who gets infected with SARS-CoV-2, whether the virus is transmitted to other family members, and which family members with the virus develop COVID-19.

A previous study recently examined upper and lower airway cells for the expression of

, the gene that codes for the receptor that COVID-19 uses to infect cells. The expression of

was lowest in people with high levels of both asthma and those sensitive to allergens, according to the press release.

The HEROS study will help clarify whether reduced

gene expression in airway cells of children with allergic diseases correlates with a lower rate of SARS-CoV-2 infection and COVID-19.

The study will be conducted remotely, with a caregiver in participating families collecting nasal swabs every 2 weeks from the child who is the primary study participants and all other family members who are enrolled. The samples will be mailed to a laboratory for analysis.

In addition, the caregiver will complete questionnaires about each participant’s current symptoms, social distancing practices, recent activities outside the home, and recent exposure to people who are sick.

If any member of the household develops symptoms of a viral illness during the study, the caregiver will fill out another online questionnaire designed to determine the likelihood that the illness is COVID-19. If COVID-19 is likely, the caregiver will collect nasal swabs from all study participants and a stool sample from the symptomatic participant within 24 hours.

The laboratory analyses of nasal swabs will test for SARS-CoV-2 and assess gene expression in the collected airway-surface cells. The study team hopes that the gene expression studies will reveal patterns that correlate with higher or lower risk of infection, COVID-19 symptom development, and SARS-CoV-2 transmission.

A blood sample will also be collected from each study participant every 2 weeks, 18 weeks, and 24 weeks after enrollment by the caregiver, as well as after the family’s first likely case of COVID-19, if applicable. A new device will be used to collect the blood, extracting a small quantity through the surface of the skin. The blood will then be analyzed for antibodies to SARS-CoV-2 once an appropriate antibody test becomes available.

1.     Study to determine incidence of novel coronavirus infection in US children begins. NIH.

https://www.nih.gov/news-events/news-releases/study-determine-incidence-novel-coronavirus-infection-us-children-begins

. Published May 4, 2020. Accessed May 4, 2020.

2.     Murphy, Jill. Lack of data on pediatric patients with SARS-CoV-2, further epidemiologic studies required. Contemporary Clinic.

https://contemporaryclinic.pharmacytimes.com/news-views/lack-of-data-on-pediatric-patients-with-sars-cov-2-further-epidemiologic-studies-required

. Published April 27, 2020. Accessed May 4, 2020.

New Study Seeks to Determine Incidence Rate of COVID-19 in Children

Secretary Alex Azar of the Department of Health and Human Services (HHS) recently announced a $10B rural relief fund for the coronavirus disease 2019 (COVID-19). This funding will offer critical immediate assistance to rural hospitals and health clinics that have been struggling during the pandemic, according to the National Rural Health Association (NRHA).

“The $10B rural carve-out was an important development in stabilizing the operations of rural hospitals,” said Brock Slabach, MPH, FACHE, Senior vice president for member services for the NRHA in an email to 

®. “Since the Public Health Emergency was declared in mid-March, we’ve seen significant surges of COVID-19 related disease as well as precipitous declines volume due to cancellation of elective procedures. These conditions have caused tremendous financial harm to rural hospitals and their ability to sustain their operations.”

The relief money will be distributed on the basis of operating expenses, using a methodology that allocates payments proportionately to each facility and clinic. This method distinguishes the unfortunate financial position of many rural hospitals, with many that are considered unprofitable, according to the NRHA press release.

As the COVID-19 pandemic has spread to more communities, hundreds of rural hospitals, health clinics, and small physician practices are on the verge of closure, according to the NRHA. In a press release, the organization said that the loss of revenue, due to the inability to provide nonemergency care, is destabilizing core primary health care services in rural America.

"Prior to the COVID-19 outbreak, rural providers were already financially fragile, with nearly half of all rural hospitals operating at a financial loss," said the the NRHA statement. "Now, rural providers face catastrophic cash shortages and are forced to cut staff and services and potentially prepare for closure. Rural America cannot combat this virus nor recover from economic devastation without a vibrant health sector. That is why this funding is essential."

$10B rural COVID-19 relief secured by NRHA. NRHA [email]. Sent April 22, 2020. Accessed April 24, 2020.

As the COVID-19 pandemic has spread to more communities, hundreds of rural hospitals, health clinics, and small physician practices are on the verge of closure.

$10B Rural Relief Fund for COVID-19 Providing Assistance to Clinics, Hospitals

An intervention group in a recent study showed that those who received dietary counseling had lower serum cholesterol level and better insulin sensitivity than those in the control group, according to the Special Turku Coronary Risk Factor Intervention Project (STRIP).

The STRIP examined the benefits of promoting cardiovascular health by dietary counseling from infancy to early adulthood. In total, 1116 children and their families from Turku participated in the study, starting when children were 7 months old.

Half of the children were randomly assigned to a group that received dietary counseling promoting a heart-healthy diet, according to the nutritional recommendations. Meanwhile, the other half were assigned to the control group who received only the basic health education given at Finnish maternity and child health clinics and school health care. Regular counseling that started in infancy ended when the participants were 20 years of age.

Regular dietary counseling starting in infancy had a positive impact on the quality of fat in the diet, as well as on the serum cholesterol level, insulin sensitivity, and blood pressure, according to the study authors. Additionally, the clustering of adverse cardiovascular health markers is less common in the group who participated in the dietary counseling compared with the control group.

The participants from the previous study were invited to take part in a follow-up study that took place from 2015 to 2018. In total, 551 people participated in the follow-up. The new study intended to investigate whether the participants in the dietary counseling group continued to have a more heart-healthy diet and lower serum cholesterol level than the control group, according to the study authors.

The results from the follow-up study demonstrated that the diets of the people in the intervention group continued to be more heart-healthy, while sustained beneficial effects were seen in the serum total and low-density lipoprotein serum cholesterol levels, which were still lower in the intervention than the control group. Further, the insulin sensitivity of the people who participated in the counseling was also better than in the control group.

The study authors support the idea that counseling on a heart-healthy diet starting in childhood has a positive impact on cardiovascular health, which is sustained after discontinuation of the active counseling.

Dietary counselling introduced at an early age leads to better cardiovascular health in adulthood. University of Turku.

https://www.utu.fi/en/news/press-release/dietar-%20counselling-introduced-at-an-early-age-leads-to-better-cardiovascular-health-in-adulthood

. Published April 23, 2020. Accessed April 29, 2020.

The STRIP examined the benefits of promoting cardiovascular health by dietary counseling from infancy to early adulthood.

Study: Dietary Counseling Introduced at Early Age Leads to Better Cardiovascular Health in Adulthood

The FDA has approved a supplemental New Drug Application (sNDA) for efinaconazole (Jublia, Bausch Health Companies) topical solution, 10% as a treatment for onychomycosis, a fungal infection of the toenails, in children aged 6 years and older. Efinaconazole was first approved by the FDA in June 2014 for patients 18 and older, according to Bausch Health.

The safety and efficacy of efinaconazole in patients aged 6 to 16 was evaluated in a single-arm phase 4 study of 62 patients with mild-to-severe onychomycosis. Over a course of 52 weeks, the safety of efinaconazole was evaluated in pediatric subjects with at least mild onychomycosis of the toenails, as well as the pharmacokinetics of efinaconazole at 4 weeks in pediatric subjects aged 12 to 16 years with moderate-to-severe onychomycosis of the toenails.

Assessments of efficacy in the study included mycologic cure, complete cure, and clinical efficacy. Efinaconazole was shown to be well-tolerated in the pediatric population, with the most common treatment-related side effect being ingrown nails. The efficacy assessments showed by week 52, with 65% of patients achieving mycologic cure, and 36.7% mycologic cure rate observed as early as week 12. In total, 40% of patients had complete cure by week 52, and half of patients achieved clinical efficacy by the study conclusion.

"Aside from being a cause of discolored toenails, onychomycosis may cause patients to experience nail discomfort in their shoes and during general activity. In certain populations, it can also potentially lead to a secondary infection," said Tracey Vlahovic, DPM, clinical professor, Department of Podiatric Medicine, and adjunct professor, Department of Microbiology, Temple University School of Medicine, in a press release. "The expanded labeling for Jublia further demonstrates the safety and efficacy of this treatment option, which I look forward to adding to my treatment regimen for pediatric patients."

FDA Approves Ortho Dermatologics&#39; Labeling For JUBLIA® (efinaconazole) Topical Solution, 10%, In Patients As Young As Six Years Old [news release]. Laval, Quebec; Bausch Health: April 29, 2020.

https://www.bauschhealth.com/news-room/news-releases/news-details/202004290700pr_news_uspr_____ny92338

Efinaconazole was first approved by the FDA in June 2014 for patients 18 and older.

FDA Approved Efinaconazole for Children with Toenail Fungal Infection

The investigational drug remdesivir demonstrated that a 10-day treatment course achieved similar improvement in the clinical status of patients as a 5-day treatment course. Announced today by Gilead Sciences, these topline results were culled from an open-label phase 3 SIMPLE trial evaluating 5-day and 10-day dosing durations of the antiviral in hospitalized patients with severe manifestations of the coronavirus disease 2019 (COVID-19).

No new safety signals were identified with remdesivir across either treatment group, according to Gilead.

Remdesivir is not approved by the FDA nor licensed or approved anywhere in the world. The drug has not yet been demonstrated to be safe or effective for the treatment of COVID-19.

Remdesivir is not approved by the FDA nor licensed or approved anywhere in the world.

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