COVID-19 ON PEDIATRIC

PATIENTS
PART I

Sources: World Health Organization (WHO) | Centers for Disease Control and Prevention (CDC) | Medscape | Department of
Health | American Society for Microbiology
SOLANO, DEOMICAH D.
10-15
December 18, 2020
Good Afternoon! 👩⚕
 OBJECTIVES OF THE REPORT

§ To describe COVID-19 and its background

§ To present the etiology associated with COVID-19
§ To give an update on the recent epidemiologic reports
§ To explain the pathophysiology behind the disease
 BACKGROUND
DECEMBER 31, 2019 JANUARY 30, 2020 MARCH 11, 2020
WHO initial report WHO – Public Health Emergency Global pandemic
of International Concern (PHEIC)

2019 2020

Source: World Health Organization (2020)

 BACKGROUND

Source: Researchgate - Vidwans, Ruddhida & Babu, Manendra. (2020)

 CORONAVIRUS DISEASE 2019 (C0VID-19)

COronaVIrus Disease 2019 = COVID-19

§ Coronavirus disease 2019 (COVID-19)

- an illness caused by a novel coronavirus now called severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2 formerly called
2019-nCoV.)

Disease: Coronavirus disease (COVID-19)

Virus: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

Source: World Health Organization (2020)

 ETIOLOGY

SARS-CoV-2

Source: Medscape & American Society for Microbiology

 ETIOLOGY

§ Unsegmented, single-stranded, positive-

sense RNA genome of around 30 kb,
enclosed by a 5’-cap and 3’-poly(A) tail.

§ S protein – required for the entry of the

infectious virion particle
§ M protein – most abundant viral protein;
Determines the shape of the viral envelope
§ E protein – smallest among the major structural
proteins
§ N protein - +single-stranded positive sense
RNA genome

Source: Medscape & American Society for Microbiology

 ETIOLOGY
TRANSMISSION

§ Respiratory droplets (5-10 um)

- within a space of 6 ft or 2 meters
- released when a person with infection coughs,
sneezes, or talks.

§ Contact with respiratory secretions and saliva

§ Aerosol (?) – through inhalation of particles smaller

than droplets that remain in the air over time and
distance.

§ Fecal-oral (?)

Source: Medscape – Author Ayesha Mirza, MD Associate Professor of Pediatric Infectious Diseases, University of Florida College of Medicine-Jacksonville
 ETIOLOGY

§ No confirmed cases of vertical mother-to-

fetus intrauterine transmission of the virus

§ To date, SARS-CoV-2 has not been detected

in breast milk.

§ Can remain viable on various surfaces for

hours to days (up to 72 hrs)

Source: Medscape – Author Ayesha Mirza, MD Associate Professor of Pediatric Infectious Diseases, University of Florida College of Medicine-Jacksonville
 EPIDEMIOLOGY

Source: World Health Organization (WHO)

 EPIDEMIOLOGY

Source: Department of Health (Philippines)

 As of Dec. 5, 2020
EPIDEMIOLOGY

Source: Department of Health (Philippines)

 As of Dec. 5, 2020
EPIDEMIOLOGY

Source: Department of Health (Philippines)

 EPIDEMIOLOGY

Source: covid19.gov.ph (Dec. 1, 2020)

 EPIDEMIOLOGY

Source: Centers for Disease Control and Prevention (CDC)

PATHOPHYSIOLOGY
 PATHOPHYSIOLOGY
Binding of inhaled SARS-CoV2 to the ciliated secretory cells Containment of
in the nasal epithelium via ACE-2 the infection with
Asymptomatic viral clearance in
phase about 80% of
patients in 10-14
Viral replication and local propagation with a limited immune
days
response

Involvement of the conducting airways, upper respiratory

tract and migration into the lowest respiratory tract

Invasion and infection of the type II pulmonary alveolar

epithelial cells via ACE-2

Source: American Society for Microbiology

 PATHOPHYSIOLOGY

Release of IL-1, IL-6 (major culprit), IL-8, IL-10, IL-12, TNF-a, Viral replication and release of viral particles
IFN-g and IFN-b, CXCL-10, G-CSF, GM-CSF, MCP-1 and MIP-1a with resulting apoptosis of the host cells
(Cytokine storm)

Continuing viral replication and infection of the

Chemo-attraction for neutrophils, CD4 and CD8 cells along adjacent healthy alveolar epithelial cells, with
with B cell differentiation loss of both type II and type I pneumocytes

Sequestration of inflammatory cells in the lung tissues, with Diffuse alveolar damage with resulting Acute
CD8 mediated cytotoxicity as well as lung injury Respiratory Distress Syndrome (ARDS)
(Host defense and attempt of viral clearance)

Source: American Society for Microbiology

PATHOPHYSIOLOGY
1. After infection, Type II cells release
inflammatory signals that recruit
macrophages (immune cells).

2. Macrophages release cytokines that

cause vasodilation, which allows more
immune cells to come to the site of
injury and exit the capillary.

3. Fluid accumulates inside the alveolus.

4. The fluid dilutes the surfactant which

triggers the onset of alveolar collapse,
decreasing gas exchange and
increasing the work of breathing.

5. Type I and II cells are destroyed, leading

to the collapse of the alveolus and
causing acute respiratory distress
syndrome (ARDS).

6. If inflammation becomes severe, the

protein-rich fluid can enter the
bloodstream and travel elsewhere in the
body, causing Systemic Inflammatory
Response Syndrome (SIRS).

7. SIRS may lead to septic shock and

multi-organ failure, which can have fatal
consequences.
 PATHOPHYSIOLOGY
Potential factors protecting children against severe SARS-Cov-2 infection
POTENTIAL PROTECTIVE FACTOR
Prevention of virus exposure
Appropriate infection handling
Absence of high-risk factors
Source: ncbi.nlm.nih.gov
MECHANISM
§ Early isolation and movement restriction (closing
schools and day-care centers in epidemics)
§ Trained immunity due to live vaccines (BCG, live
virus vaccines); frequent virus infections
§ High ACE-2 expression metabolizing angiotensin-2
§ Lack of immune-senescence
§ Good lung regeneration capacity
§ Absence of ageing related co-morbidities
§ Less degree of obesity, smoking
 God has reason for allowing things to
happen. We may never understand his
wisdom, but we simply have to trust his will.
Psalm 37:5
Thank You! 🤗