Question: My daughter was born in March and immediately diagnosed with a congenital heart defect. She has already had 2 open heart surgeries and needs another next month. She also has a feeding tube. If you haven’t already done one, could you do a daily Q&A on considerations for babies/ kids with underlying health conditions? Thanks!

Answer: You and your baby girl have been through such a challenging time these last six months. My hat’s off to you both. I’ve done several Q&As on COVID and kids (most recently Q&A of 9/2 #Kids and Q&A of 7/24 #Children), but there’s more data now and I don’t believe we’ve talked specifically about kids with underlying conditions. In short, while underlying conditions put infants/children at greater risk of severe COVID-19 outcomes, the risks are still very small.

• The good news is that severe COVID-19 outcomes among children are very rare. The COVKID Project tracks COVID-19 cases, hospitalizations, and deaths among children across the country. As of 14 September, among children and teens there were nearly 3.2 million total cases, 1,332 pediatric intensive care admissions, and 130 total deaths.
• The not so good news is that children with underlying medical conditions might be at increased risk of severe illness, and severe illness disproportionately affects Black, Hispanic, and American Indian children. Two days ago, CDC published a new report on COVID-19 deaths in children nationally, “SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020.” The report examined the demographic characteristics and underlying conditions of those who died. Of the 121 reported deaths as of 31 July, 75% (91) had 1 or more underlying medical conditions. Of all reported deaths, 78% (91) were among Black, Hispanic, and American Indian children. Focusing again more specifically on your circumstances, only 10% (12) of deaths were among infants, and of all 121 reported deaths only 2% (3) had congenital heart disease. So even among infants and children at greater risk, the risk is still very low but clearly not insignificant.
• Turning to pediatric congenital heart disease more specifically — another study out of Europe published in Lancet on pediatric COVID-19 found that of the entire cohort studied (585 children with COVID-19), 4% (25) had congenital heart disease, of whom only 5 needed intensive care. For more on pediatric congenital heart disease considerations, this article from several months ago published in the Journal of the American Heart Association and describes some of the potential vulnerabilities among pediatric patients and this article from June as well as this one from August published by the American Society of Echocardiography provide some specific guidelines for providers assisting pediatric congenital heart disease patients.