COVID-19 Resources for Primary Care Providers

Children’s National is enrolling up to 2,000 children and young adults in a study that will examine the long-term effects of COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

The study is designed to enroll children and young adults under 21 years of age who have a confirmed history of symptomatic or asymptomatic SARS CoV-2 infection or MIS-C. Participants who enroll within 12 weeks of acute infection will attend study visits every three months for the first six months and then every six months for three years. Participants who enroll more than 12 weeks after acute infection will attend study visits every six months for three years. The study will also enroll household contacts to serve as a control group, and parents or guardians (one parent per participant) will complete targeted questionnaires. 

Parents can register their child now.

• District of Columbia Department of Health
• Maryland Department of Health
• Virginia Department of Health

Your child has been diagnosed with COVID-19, a viral syndrome which may include symptoms like muscle aches, fevers, chills, runny nose, cough, sneezing, sore throat, vomiting or diarrhea. Most people with COVID-19 have mild symptoms and recover on their own. Resting, staying hydrated and sleeping are typically helpful. Your child is currently well enough to be cared for at home with fluids, medicines for fever, pain, etc.

If your child becomes sicker, like having difficulty breathing, chest pain, being unable to eat or drink, having severe vomiting or diarrhea, or weakness, your child should be re-evaluated. Before visiting your doctor or the emergency department, call ahead to report your child’s symptoms and let them know your child has been diagnosed with COVID-19.

All household members should follow the precautions below:

• As advised by the Centers for Disease Control and Prevention (CDC), stay in your home (home isolation) except for getting needed medical care. Limit contact with others to avoid spreading this infection. Do not go to work, school or public areas. Avoid using public transportation, ride-sharing or taxis. Do not have visitors come to your home.
• As much as possible, your child should stay in a specific room and away from other people in your home. Also, your child should use a separate bathroom, if available, or clean bathroom surfaces after use with household cleaner.
• Elderly people and those with compromised immune systems or chronic health conditions who live in the home should stay elsewhere, if possible.
• Do not handle pets or other animals while sick. 
• Avoid sharing personal household items. Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water.
• Clean all “high-touch” surfaces such as counters, tabletops, doorknobs, bathroom fixtures,toilets, phones, keyboards, tablets and bedside tables every day. Also, clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions.
• Wash hands often with soap and water for at least 20 seconds. If soap and water are not available, clean hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used if hands are visibly dirty.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Cover your mouth and nose with a tissue when you cough or sneeze.
• Throw used tissues in a lined trash can; immediately wash or clean your hands. (as described above).

When to STOP home isolation/quarantine:

Since your child had a COVID-19 test and it is positive you may stop home isolation/quarantine when the following are met:

• 10 days after the first day symptoms appeared AND
• 3 days after your child has had no fever (without the use of fever-reducing medications) and improvement in other symptoms (e.g. cough, sore throat)

Please see the following CDC resources for more information:

• General information: https://www.cdc.gov/coronavirus/2019-ncov/faq.html
• Steps to prevent the spread of COVID-19 if you are sick: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html 
• Information for household members and caregivers of someone who is sick: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html

Key features for Multisystem Inflammatory Syndrome in Children (MIS-C), formerly known as Pediatric Multisystem Inflammatory Syndrome (PMIS) include:

• Can occur in COVID-19 positive and COVID-19 negative patients, as the etiology of the disease may be related to active virus or in the recovery/immune phase (antibody positive)
• May include children with symptoms fulfilling full or partial criteria for Kawasaki Disease (KD) but is not limited to KD-like presentation
• May include children with fulminant shock presentation with hypotension, but also children with milder disease
• Common symptoms include: persistent fever but also variably, rash, mucous membrane changes and gastrointestinal symptoms (abdominal pain, vomiting and diarrhea)
• Common laboratory findings include evidence of dehydration and/or shock, end-organ dysfunction (abnormal LFTs, creatinine/BUN and abnormal laboratory values related to heart function [troponin and BNP]) and inflammation (elevated CRP, abnormal WBC, increased Ferritin), as well as coagulopathy and lymphopenia

View our Ambulatory Evaluation Chart for MIS-C (PDF). 

Providers are urged to consider children with some or all of these findings at risk for development of acute and long term sequelae from this condition such as, rapid decompensation requiring escalation of care and development of coronary artery disease.

A multidisciplinary MIS-C Task Force has been developed by Children’s National to assist in the triage, evaluation and care for children with this condition, including representation of infectious disease, cardiology, rheumatology, immunology, emergency medicine, hospitalist medicine and critical care medicine.

You can email the MIS-C Taskforce. You may also call or page the Infectious Disease attending physician on call. We encourage a low threshold contact the MIS-C Taskforce so that all relevant specialist services can participate in a unified and prompt manner for recommendations for evaluation and care of these patients.

We call your attention to the District of Columbia Department of Health Directive issued May 11, 2020 identifying this illness as a reportable disease. We also published the first report of COVID-19 cases from a single pediatric center in the U.S. in the Journal of Pediatrics. It represents our preliminary characterization of patients in our region who tested positive including those admitted to Children’s National Hospital.

We encourage providers to use these screening tools and protocols, developed by Children's National Infection Control and Primary Care Leadership teams. Last updated on March 23, 2020.

• Arlington County, VA 
• Fairfax County, VA 
• Howard County, MD
• Montgomery County, MD 
• Prince George's County, MD
• Washington, D.C. 

Children's National Hospital and Pediatric Health Network invite you to join a series of town hall meetings which include COVID-19 updates, specialist presentations and a Q&A portion.

Telehealth in Your Practice

We understand that many practices are moving toward a Telehealth environment for what may be the first time, and navigating some of its nuisances can be an adjustment for both providers and families. We encourage you to view our webinars to learn more. In the webinars, we navigate the change over to Telehealth during this health crisis and answer questions from our Pediatric Health Network providers.

• Implementing Successful Telehealth and Telephonic Visits during the COVID-19 Pandemic
• Telehealth Best Practices and Opportunities for Improvement

Tool Helps Conserve PPE

The new PPE Conservation Strategies Tool, developed at Children's National Hospital, helps healthcare centers see the large differences in expected consumption of PPE when choosing between four potential strategies to conserve supplies. Learn more about the tool.

Additional Resources

• Return to Play After COVID-19 Infection (PDF)
• American Academy of Pediatrics critical updates on COVID-19 
• Centers for Disease Control and Prevention
• World Health Organization
• Referring patients for imaging at Children's National (PDF)
• Infection prevention measures for healthcare professionals (PDF)
• COVID-19 coding tips (PDF)
• Myopericarditis evaluation after COVID-19 vaccination (PDF)

• Information from the CDC to share with patients and their families
• Information from Children’s National for patients and families
• Rise and Shine for COVID-19, a Children’s National Hospital site devoted to providing information and resources for children and parents
• A Kid's Guide to Coronavirus (Spanish version)
• A Kid's Guide to Telehealth Visits
• Infographic: Tips for Your Telehealth Visit (PDF)
• The Children's National Art Therapy team is providing mental health support to patients and families through videos and at-home activities
• AAP's family resources on COVID-19
• Working and learning from home during the COVID-19 outbreak: Tips to help families
• Handwashing (PDF)
• Social distancing (PDF)
• Household cleaning (PDF)