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NCPCF advice: Return to school for children with Cystic Fibrosis in light of COVID-19 (CD19-194 / 31.08.20)

Content

• The major risk factor for severe disease associated with COVID-19 is age. Children rarely present with respiratory symptoms requiring hospitalization.
• In a recent small international study the clinical presentation of COVID-19 did not appear to be different in People with Cystic Fibrosis compared to the general population and the authors conclude that People with Cystic Fibrosis should continue to follow general public health advice.
• The Royal College of Physicians in Ireland Faculty of Paediatrics has recently produced some guidance in relation to medically vulnerable children and COVID-19. This suggests that, other than children in a very vulnerable position (such as within a few weeks of  transplantation), children with long term medical conditions should follow standard public health advice in relation to isolation (no need for cocooning) and return to school in line with government advice.
• The policy of the National Clinical Programme for Cystic Fibrosis (NCPCF) and the NCPCF COVID-19 committee, based on information at this time, is that most People with Cystic Fibrosis are in the High Risk category for COVID-19 and only a minority are in the Very High Risk category, as indicated here:
  • People with Cystic Fibrosis whose disease is stable are in the High Risk category.
  • People with Cystic Fibrosis whose disease is unstable or severe (e.g. patients awaiting transplantation) are in the Very High Risk category.
  • People with Cystic Fibrosis can ask their Cystic Fibrosis centre if their disease is stable or unstable.
• Missing school for prolonged periods is likely to have a significant detrimental impact on children from a social, emotional and educational point of view. For the vast majority of children with CF, the National Clinical Programme for Cystic Fibrosis is recommending a full return to school in line with the guidance from the Department of Education. Children with Cystic Fibrosis should continue to follow standard public health advice in relation to social distancing, hand hygiene and respiratory etiquette. 
• The Irish Paediatric and Adult Cystic Fibrosis Centres have assessed many patients virtually over the last few months and will continue to use this method of care, where appropriate. This is in line with public health advice as in all sectors of society to protect the population as a whole, including staff in hospitals. It is not because hospitals are unsafe places.
• It is important that patients are seen in person where the Cystic Fibrosis team decide that it is necessary. Rates of infection in Paediatric and Adult hospitals are extremely low and stringent measures are in place to protect patients, staff and parents so that staff can continue to provide face-to-face care to patients. The National Clinical Programme for Cystic Fibrosis is concerned that, because of worries about COVID-19,  some People with Cystic Fibrosis are not contacting or coming to their Cystic Fibrosis Centre or Shared Care Centre when  they should; this has resulted in significant worsening of their health in some people. People with Cystic Fibrosis should contact their Cystic Fibrosis Centre when they are unwell.
• It is possible that there may be lower rates of spread of common respiratory viruses and Influenza this winter as a result of the national campaigns on social distancing and cough/hand hygiene. It is essential that PWCF receive the seasonal Influenza vaccine, unless there is a specific contraindication; contraindications to Influenza vaccine are very rare.
• These guidelines will be reviewed as necessary as additional information becomes available.