In the middle of march and now had over 600 children that have come to the hospital with symptoms, about a quarter of those have been admitted to the hospital, so about 150 of those and about a quarter of those or a 1 3 of those have needed our intensive care unit. Host whats the pattern among children, what do you see and how are their symptoms different from adults . Guest we really are seeing several different patterns of disease. So of those 600, the vast majority of them, and this really has been seen in other parts of the country as well, they have mild to moderate illness where they have typical respiratory symptoms either fever or cough and then have runny nose or sore throat so very mild moderate illness. The children admitted fall in several different categories. Some of them have what is similar to what the adults have seen with a severe pneumonia or clotting issues. But then we have another set of children very young who have a neonatal c fever, sepsis type picture. And our third category we have 50 of these children that have come in since the beginning of may with this multisystem inflam story disorder which is a little bit different where they dont have the respiratory symptoms but are coming in with prolonged feefers and other symptoms that show inflammation throughout their body including their heart or coronary artery or other organs. Host since the start of the virus broadly what do you think weve learned and how has your treatment changed in terms of treating children. Guest weve certainly learned much in the adults and children and have very much still we need to fill in the gap. What weve clearly learned is that in the beginning we thought and we heard from other perhaps children were not able to be ineffected or not as much as adults but its clear children are hospitalized at lower rates than adults and is certainly important for everyone listening to know. Though im telling you about these cases the vast majority of children dont end up in the hospital and have a mild to moderate illness. However in the last several weeks and months there is more and more data coming out of many countries including the United States that show clearly children are infected at all ge groups. Even in our own center when we published looking at different age groups 01 or 510 we did not see a difference in the number of infections across the age groups but its the or young who are likely to be hospitalized but its the minority of those children that end up hospitalized. There was a very important last that came out just week out of chicago that looked at the virus that could be recovered from the nose of children in particular Young Children and its there its obviously there at higher levels in some cases than adults. What we dont know yet is how well is that virus thats there transmit to other children and ther adults. Many studies in the United States a study of 6,000 people which will be a cohort of 2,000 families looking carefully at how the virus is transmitted throughout the family, is it going from the adults to children or more likely going from the children to the adults. And also theres really important studies in schools coming out of the united ngdom as well as germany where theyll look at a regular basis the amount of transmission by virus and antibody levels in the students as well as the staff and teachers in those schools. St our guest is dr. Roberto dbiasi Infectious Diseases division chief with the Childrens National hospital in the nations capital. Welcome your comments and questions for dr. Diabia, i. A parent 2027488000 and all others 2027488001. In the Washington Area you see young kids wearing masks. In your view its the proper thing to have kids doing . Guest absolutely. There are certain circumstances that doesnt apply. So if you have for instance a child under 2 years of age its not considered safe to do that or a developmently disabled child that cant keep it on or has problem with their respiratory secretions its not recommended but for other people 2 years of age, otherwise normal children should be wearing their mask and this was highlighted just last week and unfortunately a large outbreak of a camp in georgia. Even that camp took many measures the c. D. C. Recommended and to distance and do as much as they could, the one thing they didnt do is masks and they had, for instance, children in cabins up to 15 ids overnight in cabins. And unable to use masks in congress get settings and a large number of people, almost 50 of the people in the camp became infected. Masks really are very important and weve seen it in adults and now seen it in children as well. And this is going to be a key part of how we think about oing back to school. You mentioned dr. Fauci from his testimony last week before congress, dr. Fauci said kids over 9 years old can transmit the coronavirus as well as adults as some schools reopen. I want to play you the comments of dr. Fauci in questioning from representative maxine aters of california. Now this president who expects us to believe him rather than the medical experts is saying children are almost immune. Is that an expert medical conclusion, dr. Fauci . What does that mean, children are almost immune from this virus. Dr. Fauci generally when you say a person is immune, theyre protected from getting infected and children who get infected. This is not an expert medical conclusion we have documented somewhere . Dr. Fauci if youre talking about a conclusion that children in general are immune, that children do get infected we know that, so therefore theyre not immune. I must say when children get infected that when you look at consequences they do much better because if you look at the hospitalizations children have a much lower rate of hospitalizations than adults. In fact the curve goes way up as you get older and older and when you get to the age group of children, they generally do not get serious diseases much. I understand that and have been listening and understand what youve just described. But what i was asking really is about this president s latest comment that children are almost immune and so i think i ot the answer to that. Host let me ask you about immunity among kid and others, how will we know when immunity presents itself . How will that become apparent in treatment of patients . Guest this is a complicated issue. So the atlanta body test is a test that looks at the Antibody Test is a test that looks at the response of the virus and is going on through multiple groups including our federal government in multiple cities looking at the Community Level in certain cities and looking nationwide to see how many people actually have had evidence of infection, whether or not they realize it. Because another thing weve seen is that up to 40 of people will have no symptoms whatsoever. So what i mean is they dont have any idea, they dont remember having symptoms but we can find evidence from their blood that theyve had an immune response or antibodies. So what is going on right now in Childrens Hospital is a big part of this in d. C. , particularly in the pediatric population. We really have no idea what percentage of children in the city, for instance, new york or in d. C. Where there were large number of cases, what percentage of the children have actually been infected because we know that they are less likely to get severe disease. So the zero prevalence is really going into a population and figuring out how many people have actually been infected. The second part of that thats really complicated and waiting to find out is how long do those antibodies last and are those antibodies even protective against a second infection if this came around again in your community . Host before we get to callers let me ask you one more thing about the severe side effect that happens among a very small number of kids called multiinflammatory syndrome, misc, how prevalent is it and tell us a little bit about its symptoms. Guest as i mentioned at the beginning, this was after we had seen the first wave of infections throughout the United States and really throughout the world, right around the end of april and the beginning of may, our colleagues in europe and then right away right after that in the United States we started seeing this different presentation associated with sars covid19 infection and for the most part these children dont have symptoms of covid, meaning not but we can find evidence with antibodies in their blood that they recently had it. And what these children are coming in with is what we call hyper inflammation or too much you mean immune response. Children, for whatever reason, and we are studying this, is it something about the children, is it something about the virus that has changed, for some reason, that a mean response is not turned up. They show up with prolonged fevers and a variety of organ systems involved, whether that is their heart, their coronary artery, their kidneys, their liver, their skin, redness of their eyes, multiple ways they can present. The good news is there have only been around 300 cases in the United States. All of our colleagues are putting our Heads Together to come up with the best treatment. The good news is they do seem to respond to antiinflammatory treatments. Each hospital is doing a variety of different things. We are going to soon have information about these children six months down the line from all of these different treatments we have been using. Host we have calls waiting on our guest, dr. Roberta debiasi. Good morning in nashville, go ahead. Caller good morning. Old, basicallys the last year of his adolescen ce, sliced a consider him an adolescent, even though he is 21, he got it, his roommate got it. He had four days of fever and maybe six hours of gastrointestinal upset, and then was fine. He is going to have the Antibody Test. He is under the care of our doctor. Hes going to have the Antibody Test in a couple of weeks. Middle of august is what the doctor said. He is being monitored. Of course, he is fine. His school, middle Tennessee State university, he will be a senior this year, they are having inperson classes. I guess my biggest concern is him getting it again and or having some adverse effect in the future. Did something happen in his body that we need to be worried about . Like a said, he is fine, he feels great. He is a very good eater. I think a lot of the information problem with kids has to do with their diet. Far too manyeat carbs, fat, sugar, and salt in america. He is a healthy kid. He is doing well. I guess my question for you is, effects. Affects i know it is hard to say because nobody really knows what will happen to the kids that have had it. I am worried about his internal organs. He did not have the respiratory issues, but is it going to come back . Will you be ok in the future . Will he be ok in the future . Host thanks, derby. Guest you are asking the same questions we ask in our families, communities, and schools. How is this affecting our children and how will we know and when will we know . We all have to remember even though it feels like we have been home forever, as has been going on only for several months. In the d. C. Area, we have only had cases in children from around march. We have less than six months of followup on these children. Like your son, the vast majority of children will be completely fine. Six years fromou now we will not know more and perhaps there may be some side effects. Someone had pneumonia, it could have longterm effects on their lungs. It is also possible they will have no longterm effects. We dont have the answer to that. To tellif people try you they have the answer, it is not true. We do not have enough longterm followup on these children. Children with inflammatory syndrome, we are more focused on their hearts and the coronary arteries because we know from a similar presentation of kawasaki disease that those children can have longterm issues with her heart. That is a very intense area of focus across the world, to follow up very carefully on children with multiinflammatory disease. As a mention, that is a very small number of children, in smaller than the number that have the typical pulmonary disease of covid. Your question about going back to school and you are worried it will come back, it is possible there will be more waves of disease. We are seeing this now. We had this short time where things seemed to settle down on the northeast coast. But now we are seeing large numbers of increases across the south, southwest, california, and out west. Point of how we decide when it is appropriate to go back to school. The very first thing we need to look at is the local situation. I mean the county, the district even, because looking at a state is not helpful. It can be vastly different what is going on in her parts of different states. The schools are working closely with the Health Departments and jurisdictions. That is the first step deciding whether we can take the step one decision to have inperson classes. An editorial cartoon over the weekend capturing perhaps some of the dilemma parents face. Damned ifyou do and you dont. Megan is on the line. I want to give my sincere apologies to the woman whose son was affected. I hope everything works out well. We live in hempstead, maryland. We have people leaving states like new york and florida, hotspots, and they are coming to different states even though they were supposed to put mandatory restrictions. Going back to school i do not believe is a wise thing to do. I dont to get has to do with their diet. Children are less immune to getting this. For children to go back to school when they dont have a vaccination is not recommended. I know a lot of people want to get back to life and work, we all do, but just going back to school in person is not good. The woman that called him before, her son gets it again, he may get worse because we have no clue what this virus is doing. About 25 of the teachers are 55plus. People fauci said, most in the Older Age Group get severe problems even if they do not have underlying conditions. Host we will hear from dr. Debiasi. Guest great points. I want to touch on a couple of them. The first is the concept of, should we not go back to School Period . This is a really important point almost everyone agrees on. In an ideal world, we know it is better for children to be in school. It is not just for academic reasons. There is a host of reasons going to school is important. There are social implications that are not theoretical damage. We have already seen this. When we weigh the risk and , it is notgoing back like just staying home is a harmless thing to do and we cannot just compare that to the potential risk of going back. We have had huge increases in anxiety, depression, concerns about suicide, children being targeted on the internet with pornography because people know they are at home. We have children who have special needs not getting access to care. Occupational therapy, physical therapy, hearing interventions. Children that are arelopmentally delayed not getting their individual educational plans met. 12 million children do not have access to food in our country and they depend on the school to get that food. We have a whole host of reasons. We could talk for an hour just about this. All i am saying is that does not mean we say everyone must go back to school. What it does mean is we have to carefully weigh the known harm against the potential risk. And that risk is vastly different in different communities. For instance, in maine, there is basically no circulation. Weigh their theres ait in maine, very low risk of transmission because of their community. The caller mentioned new york. There was a large outbreak. Right now, model is new york as a model. You have hardly any transmission going on they have hardly any transmission going on. In virginia, we have higher circulation than new york. This is key. People have to know that the locales are very specific where there is a hotspot or large amount of transmission. We measure this by a variety of things. It could be the number of cases over seven days per the population. It could be how overwhelmed hospitals are. It could be the percent positive of tests coming up. It is clear there are many parts of the country where things are under control and there are many parts of the country where they are not in control. We cannot use a onesizefitsall approach to bringing kids back to school. Host obvious the, you are at a specialized hospital. Do you ever feel overwhelmed at Childrens National . Did you ever have issues with equipment, personal protective equipment, related to things like that . Guest we are very lucky in the washington, d. C. , region, we learned from what happened in new york because the huge wave that overwhelmed the Health System more and other parts of the country to do very significant shutdown measures. That really did flatten our curve in the d. C. Area. We have had lots of cases but they did not all come within a twoweek period. We did not get overwhelmed. We were quite busy but we had enough personal protective gear. Did not get overwhelmed, including at Childrens Hospital. We were able to absorb some of the i. C. U. Load from of the younger adults, up to 35 years of age, we were taking care of some of those patients. We did not have a situation. But that is a direct effect of people taking this seriously and not allowing the number of cases to get markedly out of hand like we are seeing in some parts of the south right now. Host not surprisingly, everybody is on our parents line. Donna is in vero beach, florida. Go ahead. Caller i wonder if there has ever been data taken on these children of whether they have had all of their childhood inoculations because it seems to me because they have had inoculations recently, they are kind of covered somewhat for all diseases. And i have another part to my question. What happened to the home testing kits the president promised us in april . Host ok, donna. Guest the first question about vaccinations, unfortunately, vaccines for different pathogens, for instance against the pneumonia bacteria, will not protect you against a viral pneumonia like influence or covid. Protectivity. Ross we have not seen that children with no vaccines are likely to get covid. Conversely, we have fully vaccinated children, the vast majority of kids that get this disease, they are not less likely to get covid. There is not a crossreactive productivity you are suggesting might exist. What was the second part . Host she asked about the availability of