Corona Virus Disease 2019 (COVID 19) and Paediatrics Endocrine Disorder:
A statement from the African Society of Paediatrics and Adolescent Endocrinology
COVID 19, is a global pandemic that has affected all continents including Africa. It affects all ages and gender, with mortality highest in extremes of age and in those with underlying chronic medical conditions especially, the hypertensive and hyperglycaemic related conditions. To date, no known curative treatment or licensed vaccines for COVID 19 exist, consequently, supportive care is the mainstay of management.
Children and adolescents with diabetes and endocrine diseases are at higher risk of poorer outcomes if their underlying endocrine condition is not properly managed during the illness. The public health strategies to prevent the spread of COVID 19 has limited access, especially for patients needing lifelong routine medications such as insulin and hydrocortisone.
To respond to this pandemic and to ensure optimal care of children and adolescents with an endocrine disorder including diabetes, the African Society of Paediatrics and Adolescent Endocrinology (ASPAE) makes the following recommendations:
A. Protect children and adolescent against COVID 19
Children and adolescents their caregivers inclusive, should follow recommended guidelines for reducing the risk of COVID 19, this include the following:
- Wash hands for 20 seconds with soap and water or alcohol-based hand sanitizers.
- Sanitize surfaces such as tables, chairs, door-knobs, switches and children play materials with soap and water or alcohol-based sanitizers.
- Maintain social distancing for the purposes of reducing contact with other people.
- Children aged two years and above should wear face clothes, covering their nose and mouth once they are in the community.
- Optimize hydration and nutrition for an enhanced or improved immune system.
B. Suspected case of COVID 19
- Suspect COVID 19, if a child or an adolescent with diabetes or an endocrine disorder has symptoms of fever, and/ or cough, and/or difficulty in breathing; and if the onsets of these symptoms occurred within 14 days of travel to a high-risk community, or contact with a confirmed case of COVID 19.
- Report or refer a suspected case to a COVID 19 Response Medical Team.
- A suspected case of COVID 19 in a patient with diabetes or adrenal insufficiency, requires the sick day protocol to be activated.
- The sick day protocol in Type 1 diabetes includes increased frequency of monitoring blood glucose and ketones. Insulin SHOULD NEVER be stopped rather, adjust it accordingly to ensure good glycaemic control. If the patient has abdominal pain or vomiting diabetes ketoacidosis (DKA) should be ruled out. For more information check the ISPAD guidelines.
- The sick day protocol in Adrenal insufficiency (Addison disease, Congenital adrenal hyperplasia or chronic steroid use) involves doubling or tripling the maintenance hydrocortisone dose. Intravenous route is preferred for patients that present with vomiting.
- Agranulocytosis is a rare complication of antithyroid drug used for Paediatric Grave’s disease. Agranulocytosis may present like COVID 19, a thorough evaluation is therefore needed.
C. Confirmed case of COVID 19
- Till date, no confirmed case of COVID 19 in a child or adolescent with diabetes or any endocrine disorder in Africa has been reported.
- Management of COVID 19 should follow Country specific treatment guidelines.
D. Lockdown in Africa and limited access to physical consultation.
- Access to specialist care can be maintained through phone or video calls or telemedicine where available.
- Patients that must be seen in the hospital must adhere strictly to the general preventive strategies of COVID 19. (See section A)
E. Access to medication and other tools used for treatment
- Care-givers of children and adolescents with diabetes and other endocrine problems should be provided with a list of supplies or medication they will need during the lockdown period.
- Caregivers should be encouraged to obtain, procure and appropriately store supplies or medication, with two-weeks of extra supplies, in a manner that discourages panic buying.
F. Social life of children and adolescents with diabetes and other endocrine problems
- Children and adolescents should be encouraged to learn while at home until schools re-open, and sustain friendship through phone calls and other media.
- Physical activities should be integrated into their daily lives with strict screen time regulations by caregivers.
G. ASPAE members can get involve
- ASPAE members can provide leadership and Policy frame work. This should focus on reduction of direct and indirect effects of COVID 19.
- ASPAE members can participate in various campaigns that can strengthen existing public health approach of reducing the transmission of COVID 19.
- Members can advocate to improve availability and accessibility of essential medicines such as insulin needed for optimal care of children and adolescent with diabetes and other endocrine disorders.
- Telephone or email addresses/contacts for virtual consultation and guidance should be provided by members.
ASPAE EXECUTIVE COMMITEE
- World Health organization. Coronavirus disease 2019 (COVID-19) Situation Report – 99 Available@https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200428-sitrep-99-covid-19.pdf?sfvrsn=119fc381_2
- Owen Dye. Covid-19: Africa records over 10 000 cases as lockdowns take hold. BMJ 2020;369:m1439. Available @ https://www.bmj.com/content/369/bmj.m1439.long
- European Society of Paediatric endocrinology. Covid-19 information for children and adolescents living with endocrine conditions, including type 1 diabetes mellitus. Available @: https://www.eurospe.org/news/item/14064/COVID-19-information-for-children-and-adolescents-living-with-endocrine-conditions-including-type-1-diabetes-mellitus.
- ISPAD Clinical Practice Consensus Guidelines 2018: Sick day management in children and adolescents with diabetes. https://cdn.ymaws.com/www.ispad.org/resource/resmgr/consensus_guidelines_2018_/13.sick_day_management_in_ch.pdf
- European Society of Paediatric endocrinology. Covid-19 information for children and adolescents living with endocrine conditions, including type 1 diabetes mellitus. Available @: https://www.eurospe.org/news/item/14064/COVID-19-information-for-children-and-adolescents-living-with-endocrine-conditions-including-type-1-diabetes-mellitus
- ISPAD. Coronavirus infection (COVID-19) – II ISPAD Summary. Available @: https://www.ispad.org/page/CoronavirusinfectionCOVID-19-IIISPADSummary.
- British Thyroid Foundation. Thyroid disease and coronavirus (COVID-19). Available @ https://www.btf-thyroid.org/news/thyroid-disease-and-coronavirus-covid-19