September 3, 2020

Dear BC heart families,

We know that the last six months have been a difficult time for families bringing up children with heart disease. Many families are looking for some guidance in regards to COVID-19 and keeping their heart child safe as we approach the start of the school year.

Every child’s situation is unique, but we wanted to get the most common questions answered by the cardiology team at BC Children’s Hospital.

If you have additional questions, please contact your child’s doctor.

We will get through this together. Be kind, be calm, be safe!

1. Is my child immunocompromised due to their heart condition, and does this put them at increased risk for getting COVID-19?

The vast majority of babies and children with congenital heart defects (CHDs) are not immunocompromised and therefore are not at greater risk for contracting COVID-19. Some children with CHD have other associated syndromes or conditions, such as asplenia, that can affect their immune function, but this is not directly related to their cardiac condition. If your child has an immune disorder, it is best to ask your pediatrician for specific advice, as each child’s situation will be unique.

2. I’ve read that people with underlying heart disease are at greater risk for severe illness. Does this hold true for kids with CHD? How about kids with heart rhythm issues?

The good news is that the evidence so far is that children with CHDs and/or heart rhythm issues who do contract COVID-19 do not fare any worse than their peers.  In fact, COVID-19 causes much more mild illness than other better-known respiratory diseases (such as influenza) in the vast majority of children.

3. Are cardiac patients at greater risk for multisystem inflammatory syndrome (MIS) than other children? And is the consequence of MIS in children (MIS-C) more severe for kids with cardiac conditions?

No—we don’t have any evidence that children with CHD or those with a history of Kawasaki Disease (KD) are at increased risk of MIS-C.  In BC, we haven’t had any cases of MIS-C to date.

MIS-C has been in the news recently after Dr. Henry spoke about the condition during the COVID-19 BC update on August 27. She described eight cases that have been reported and investigated since the beginning of the pandemic in BC.  However, after extensive investigation, these children did not have evidence of recent COVID-19 infection nor of close contacts with COVID-19.

While MIS-C can result in serious illness, it is exceedingly rare. The recent reports of “suspect” cases did not have any link to COVID-19. The report of “suspect” cases in BC may sound alarming at first, but it speaks to how carefully the public health office in BC is monitoring the pandemic in our province. The signs and symptoms of MIS-C overlap with several other conditions, including Kawasaki Disease, and reporting any and all cases in this category of illnesses means that we are casting as large a net as possible so that nothing flies under the radar. This approach allows the public health office to quickly identify any patterns of illness and adjust its guidance if necessary, while also contributing to the worldwide understanding of this rare condition.

4. How do I decide whether my child should return to school/daycare?

This is a question that is keeping parents across the country up at night. This anxiety is understandable, and it can be heightened for heart parents whose children have been through so much already and are still under the care of our cardiac team.

The vast majority of children who contract COVID-19 have very mild illness and recover at home.  Other infectious illnesses that children are exposed to at school every year are more likely to result in severe illness than COVID-19.  As such, most families are encouraged to send their children to school, as there are many important benefits to attending school, including education, physical activity, social interaction with peers, etc.

Some families may have particular circumstances where COVID-19 could be more serious for other family members (e.g., elderly grandparents living in the house, another family member who is immunocompromised).  In these cases, the concern of children being exposed to COVID-19 at school and bringing it into the home must be considered and weighed against the benefits of attending school in person.  Consulting with your GP or pediatrician may be worthwhile in these cases.

We are extremely fortunate in BC to have the world-class leadership of Dr. Henry and her team of public health experts to guide us through this pandemic. The cardiology team at BC Children’s Hospital (BCCH) relies on this guidance to instruct how we do our day-to-day work in the hospital and how we counsel our heart families to navigate through this stressful time. We’ve included links to the BCCDC website and the BCCH website below, and recommend that you visit them for more information to guide your decisions.