In the hospital with COVID-19: What does care look like?

As the novel coronavirus has swept the world, doctors have faced two primary challenges – 1) learning about a virus they’ve never seen before and 2) treating patients effectively.

What exactly does care look like for patients, whether at home or in the hospital? Dr. Mark Marinello, medical director of our pediatric intensive care unit, answers some of our top questions.

What do health care providers know about how to care for patients with this specific coronavirus and the disease it causes (COVID-19)?

Although this specific coronavirus is new, doctors are familiar with treating illnesses with similar symptoms that attack the lungs, including serious cases of the flu and pneumonia.

What approaches are medical providers taking to care for patients with COVID-19?

Currently, there's no specific drug known to kill this virus, so health care providers are primarily delivering supportive care aimed at relieving symptoms and keeping vital organ systems functioning while the body fights the infection and heals.

What is supportive care and what warrants receiving it in the hospital vs. at home?

With mild symptoms – fever, cough, muscle aches – supportive care can likely be done at home and consist of:

• Self-monitoring (checking temperature, making sure breathing is normal, taking notice of changing symptoms)
• Resting
• Drinking plenty of fluids
• Seeking medical care if symptoms worsen

Learn more about the symptoms of COVID-19

The virus causes inflammation and swelling in the lung tissue and lower airways, which can lead to coughing and sometimes shortness of breath. People who develop shortness of breath and require oxygen likely need to be admitted to the hospital. Supportive care in the hospital includes monitoring vitals such as temperature, blood pressure and oxygen levels and doing what is needed to keep them as normal as possible. This might include:

• Providing supplemental oxygen through the nose (nasal cannula) or, in more severe cases, with a mechanical ventilator
• Providing fluids through an IV to keep the body hydrated
• Treating other infections or ailments that might be prohibiting the body from effectively battling COVID-19

Are medical teams looking into any other treatment options?

There is a lot of research being done to determine the best strategies to kill the virus and treat the disease. VCU Medical Center has begun offering convalescent plasma treatment, a process that uses the plasma of people who have recovered from COVID-19, which has antibodies to the novel virus, to treat people who are seriously ill. This process is similar to a blood transfusion.

There are also multiple studies underway to look for a specific medicine to treat this virus, as well as efforts to develop a vaccine.

Are there any thoughts among the medical community about why COVID-19 seems to be affecting children less severely than adults?

Children are being infected with COVID-19, however their symptoms are not as severe as those seen in adults. There are several theories – although none has been proven yet. One is that children are often infected with a variety of strains of coronavirus and perhaps their immune systems are more prepared for it.

Another, and more likely, theory is that children do not have a receptor that the COVID-19 virus likes to attach to. As a result, the immune system does not overreact to it, which is what causes the serious symptoms that lead to lung failure.

How is our PICU prepared to care for pediatric patients with COVID-19?

Our PICU has been actively preparing for COVID-19 for the past several months. We have taken a number of measures to ensure we are ready to safely care for all patients who need us, both those with COVID-19 and those who need care for other severe illnesses or injuries.

These measures include:

• Collaborating with national and international leaders about how to care for children with COVID-19
• Creating protocols and guidelines designed to keep our patients safe
• Providing up-to-date information on the ever-changing situation to our physicians, nurses and respiratory therapists
• Training and conducting simulations using the appropriate personal protective equipment
• Increasing our capacity for COVID-19 testing
• Limiting team members on the unit and conducting many patient care discussions and conferences using telehealth
• Following social distancing guidelines to the best of our abilities
• Wearing masks at all times
• Wearing special masks and gowns when caring for patients with COVID-19

Learn more about how CHoR is protecting patients, families and team members at all locations, and find additional coronavirus articles, videos and family resources.