COVID-19 Update: Treatment Guidelines / Disease in Children / Surgery in Presymptomatic Patients

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The American Thoracic Society has released interim guidance on treating novel coronavirus disease (COVID-19) while cautioning that the available data used to guide the recommendations are limited.

For hospitalized patients with COVID-19 and pneumonia, the group says that hydroxychloroquine or chloroquine may be used on a case-by-case basis, but clinicians must discuss potential risks and benefits of treatment, data must be collected on outcomes, the patient's condition must be severe, and the drug cannot be in short supply.

For outpatients with COVID-19 or hospitalized patients without pneumonia, the group made no recommendation for or against use of hydroxychloroquine or chloroquine. The group also declined to take a position for or against other potential drugs at this time.

They did suggest use of prone ventilation for patients with refractory hypoxemia related to progressive COVID-19pneumonia, and then extracorporeal membraneoxygenation(ECMO) if prone ventilation fails.

In other COVID-19 news:

• A study in MMWR confirms that U.S. children with COVID-19 have a milder course than adults. As of April 2, youths accounted for 1.7% of all confirmed U.S. cases, and three pediatric deaths had been reported. Roughly 73% of pediatric patients reported fever, cough, or shortness of breath, compared with 93% of adults aged 18–64. Similarly, 5.7% of all pediatric patients were hospitalized, compared with 10% of adults.

• In EClinicalMedicine, Chinese researchers report on 34 asymptomatic patients who had elective surgeries during the virus's incubation period. Symptoms quickly emerged after surgery. Some 44% of patients required intensive care for COVID-19. Seven patients died — all had undergone level-3 surgeries (with level 4 being the most difficult). The authors say the findings "suggest that surgery may accelerate and exacerbate disease progression of COVID-19."