UNLV Medicine Newsletter

Volume 10 - July 21, 2020

TRANSFORMING HEALTHCARE

Friends and Colleagues,

Physicians know that colleagues are an important source of knowledge, that the give and take between them on cases often makes a meaningful difference. Time-pressed physicians wish they could reach out even more than they do.

With that in mind, our chair of pediatrics, Dr. Evelyn Montalvo Stanton -- she used what she learned from other physician/scientists at Columbia University’s College of Physicians and Surgeons to become internationally known for her commitment to children with breathing problems -- has begun a UNLV Medicine pediatrics newsletter that will deal with everything from infectious diseases to pulmonology.

It will be sent to pediatricians and family physicians in the Las Vegas Valley.

The first edition, with observations by our pediatric infectious disease specialist, Dr. David Di John, deals with Multisystem Inflammatory Syndrome in Children, which is associated with COVID-19. Dr. Di John’s research during the height of the AIDS epidemic in New York was so well respected that his work was published in the Journal of Pediatrics, Pediatric Infectious Disease Journal and Clinical Pediatrics. Like Dr. Montalvo Stanton, he hopes that the newsletter will serve as a catalyst for even more impactful dialogue between physicians in Southern Nevada.

In today’s newsletter, we trust you’ll get a good sense of why this new newsletter is important.

Michael Gardner, MD, MPH, MMM

President & CEO, UNLV Medicine

Vice Dean of Clinical Affairs

UNLV School of Medicine

Saturday Community Clinic

Seeking Volunteers

Those interested in volunteering for the UNLV Saturday Community Clinic are asked to click on the link below and sign up.

The clinic will take place at the new Federally Qualified Health Center (FQHC), run by the Southern Nevada Health District at 280 S. Decatur.

It will be a joint venture between the

Schools of Medicine, Nursing, Dental Medicine, Social Work, and Public Health, providing accessible and affordable care for the uninsured, underinsured, and Medicaid/Medicare patients as well as those who are dissatisfied with their current primary care physician.

Students, interns, residents and faculty volunteers from all UNLV Health Schools, as well as other interested members of the community, are welcome to participate in the planning, organization and running of the clinic.

It is rare for safety net clinics to schedule patient hours on Saturdays. This will be a valuable service to the community.

We are in the planning stage now and we are looking forward to your input.

Those interested are asked to complete the volunteer survey found here.

Over the next months we will be forming our operating committees,

and holding training sessions and community health discussions.

Although we hoped to open in the fall, with the current COVID-19 surge and the extreme demands placed on our physicians and staff, we will re-evaluate our timeline.

Suffice it to say the clinic will NOT be operational until it is safe for our volunteers.

We look forward to your feedback.

Sincerely,

Dr. Laura Culley, Associate Dean,

Community Engagement

Rare Affliction That Affects Children

May Be Related to COVID-19

Dr. Evelyn Montalvo Stanton and Dr. David Di John are spreading the word about a serious health condition found in children that may be related to the COVID-19 virus.

The reports that began in the spring about complications apparently spawned by COVID-19 -- a seeming connection between the virus and a rare but serious health condition called Multi-System Inflammatory Syndrome in Children (MIS-C) -- have alarmed parents, pediatricians and infectious disease experts throughout the world.

“This whole concept that children didn’t get (serious complications from) COVID has really drastically changed,” Dr. Evelyn Montalvo Stanton, chair of the pediatric department at the UNLV School of Medicine, told the Las Vegas Review-Journal.

According to Montalvo Stanton and a colleague, UNLV Medicine infectious disease expert Dr. David Di John, the complications of MIS-C are significant, including high fever, abdominal pain, vomiting, rash, diarrhea, respiratory symptoms, swollen extremities, lethargy and headache.

“Of the children with COVID-19 I’ve treated, three had to go on ventilators, including one with MIS-C,” said Di John, who said there have been less than a dozen of the MIS-C cases locally so far. “Fortunately, all children have gone home.”

Di John and Montalvo Stanton, along with UNLV medical student Cole Crosby, recently produced a paper on Multisystem Inflammatory Syndrome in Children for a new UNLV Pediatric Subspecialty Medicine Newsletter to be sent to pediatricians in Southern Nevada.

“We want to be a source of good information for the community,” noted Montalvo Stanton, adding that the most solid information possible on children and COVID-19 is particularly critical at this time, with children possibly headed back to school soon.

“We’d like physicians in the community to feel free to call on us for our thoughts and knowledge base,” Di John said.

UNLV Pediatrics has 15 full-time and 1 part-time UNLV School of Medicine faculty, 36 residents and two chief residents. In addition to 7 general pediatricians, there are specialists in pulmonology, neurology, behavioral development, gastroenterology, infectious diseases, adolescent medicine and endocrinology -- the most pediatric subspecialties under one roof in Nevada. Children who need surgery can be referred to the UNLV Pediatric Surgery Clinic led by Dr. Michael Scheidler.

Until the emergence of the inflammatory syndrome, what had been reported about the novel coronavirus and children was much less threatening -- children make up far fewer confirmed cases of the novel coronavirus and generally are less likely to develop severe complications.

" We do not yet know what causes MIS-C. However, we know that many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.” -- Centers for Disease Control

The Centers for Disease Control and Prevention (CDC) found children represent 22 percent of the U.S. population, but only around 5 percent of confirmed COVID-19 cases -- 1.7 percent of cases in the 0-9 age group and 3.8 percent of cases in the 10-19 age group.

Though the CDC reported 29 people under the age of 14, and 142 people between the ages of 15 and 24, have died in the U.S. from the virus during the pandemic (the Southern Nevada Health District reported two children have died from it in Clark County), health experts say underlying health conditions often played a large role in their deaths.

The mystery of what causes MIS-C -- it can cause different organs to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs -- has added to public concern over COVID-19 and children.

“We do not yet know what causes MIS-C,” the CDC says on its website. “However, we know that many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care.”

As of July 15, CDC has received reports of 342 cases and six deaths from MIS-C. Most cases are in children between the ages of 1 and 14 years with the average age of 8 years. To date, the Southern Nevada Health District has reported no deaths from MIS-C.

Di John, the lead writer on the inflammatory syndrome paper, pointed out that many of the symptoms of the syndrome are the kinds of symptoms that pediatricians have often counseled parents on how to manage at home. But now he says symptoms must be looked at through a different lens. “Early recognition by pediatricians and prompt referrals to the emergency department, and to inpatient specialists and intensivists, is essential,” he wrote. “Pediatricians and subspecialists should consider this syndrome, particularly when other microbial causes or diagnoses have not been identified.”

“Management of COVID-19 and MIS-C patients should be multidisciplinary,” Di John wrote, “and will vary depending on manifestations and extent of the illness. Remdesivir and other antivirals may be potentially useful in patients with active COVID-19 disease. Due to the multi-system manifestations of MIS-C, broad-spectrum antibiotics may be beneficial. For children who suffer from subsequent shock or organ failure, the standard of care should be followed. A significant proportion with MIS-C may require intensive care.”

Depending on the severity of their illness, patients are treated in a variety of ways, Di John said, including anticoagulants, IV immunoglobulin (IVIG), steroids, and respiratory support and ventilators. Others receive immunomodulating drugs which affect what doctors call the “cytokine storm,” the severe immune reaction that causes many of a patient’s symptoms.

Di John said that at this time, it is impossible to predict who will develop the syndrome. He noted that one of his patients developed the syndrome a few weeks after testing positive for COVID-19. The Southern Nevada Health District reported that there have been hundreds of children who have tested positive for COVID-19, with few having to be hospitalized.

As difficult as diagnosing and treating COVID-19 and MIS-C sometimes can be, Di John says we shouldn’t expect it to get any easier any time soon.

“Things will be even more challenging in the fall, when influenza season typically begins,” he said.