Updated June 24, 2020

Overall, children continue to be a small proportion of reported COVID-19 cases. However, compared to earlier in the pandemic, the proportion of reported COVID-19 cases is increasing in those 0-18 years of age. Currently, children in San Francisco account for 7% of reported cases; children in California account for 5.8% of reported cases, with 70% of these occurring in Latinx children; and children in the United States account for 4% of cases, with 50% of these occurring in Latinx children. The increased burden of COVID-19 in children can be reflective of increased access to testing over time, including testing those with mild or no symptoms. Continued vigilance of the pediatric COVID-19 trends is needed.

Updated June 24, 2020

COVID-19 has been relatively uncommon at UCSF Benioff Children’s Hospital San Francisco. The UCSF Benioff Children’s Hospital San Francisco overall COVID-19 positivity testing rate is about 1%, and the symptomatic rate is 1.5% (0-18 years of age).

Updated June 24, 2020

Uncertainty remains regarding the extent to which children act as a source of spread of SARS-CoV-2. A recent study revealed that there is less expression of the angiotensin-converting enzyme 2 in the nasal epithelium of children than adults (Bunyavanich et al.). Some hypothesized that this may result in reduced risk of infection in children. However, we don’t know if differences in age impact infectivity once they are infected. A German study (preprint, not peer reviewed) analyzed polymerase chain reaction (PCR) testing data from 3,303 patients with SARS-CoV-2 across the life span to assess the relationship between age and viral load (Jones et al.). Two different PCR systems were used, the first (the Roche LightCycler 480 II system) at the beginning of cluster-based testing campaigns, and a second (the Roche cobas 6800/8800 system) after mid-March. The authors established a viral load of >250,000 copies as “infectious” based on prior data comparing viral load and positive viral culture. They found no differences in infectivity by age with the LC480 platform, but samples tested via the cobas system did show a small reduction in infectivity with younger age. 

Conclusion: SARS-CoV-2 viral loads did not differ dramatically across age strata, suggesting that children who do get infected may be as infective as older persons. Further studies using culture-based techniques will help answer this question more definitively.

Updated June 24, 2020

The evidence of a link between SARS-CoV-2 and multisystem inflammatory syndrome in children (MIS-C) is increasingly strong. The first suggestion came simply from the timing of presentation: Increased numbers of MIS-like syndromes were diagnosed in European children weeks after the surge of COVID-19 in adults. In the United States, we have also seen MIS-like cases following surges on the East Coast. And using newly available testing, we are finding that most children with MIS also have antibodies to SARS-CoV-2, pointing to prior infection. However, in areas of lower COVID-19 incidence, we must remain equally alert to the possibility of other infections and inflammatory conditions in children that could look similar and lead to harm if not diagnosed and treated promptly.

Updated June 24, 2020

Two recent studies provide important insight into COVID-19-associated multisystem inflammatory syndrome in children (MIS-C). In one study from the United Kingdom of 58 children with MIS-C, 15 (26%) tested positive for COVID-19 via polymerase chain reaction (PCR), and 87% (40 of 46 tested) tested positive for COVID-19 immunoglubulin G (IgG) antibodies (Whittaker et al.). Twenty-nine (50%) had shock, but there was only one death. Eight (14%) were identified as having coronary artery aneurysms. When compared to a large database of children with Kawasaki disease (KD) and KD shock syndrome in the United States, children with MIS-C and aneurysms were older and had higher markers of inflammation and cardiac injury. Another report of 17 children with MIS-C in New York City found patterns of cytokine expression similar to those reported with KD (Cheung et al.).

Conclusion: These studies suggest MIS-C associated with COVID-19 is similar to KD, but there are some clinical and potentially pathophysiological differences. Additional research will be needed to identify children at risk for coronary aneurysms and optimal treatment.

Updated April 24, 2020

UCSF Benioff Children’s Hospitals in Oakland and San Francisco are continuing to see new referrals both in person and using video visits. We are also performing time-sensitive and essential surgeries and procedures, as well as accepting new surgical referrals for evaluation in all specialties.

The health, safety and well-being of our patients remain our top priorities. Accordingly, UCSF Benioff Children’s Hospitals have infection prevention practices and protocols in place at all of our facilities. To date, we have not seen a surge of COVID-19 pediatric cases. All patients being admitted to UCSF children’s hospitals will receive a COVID-19 screening test even if they are asymptomatic.

To refer a patient, please reach out to us in the following ways:

Oakland: Refer by fax. 

• Referral forms can be downloaded from www.childrenshospitaloakland.org/referralforms.
• Fax all materials to 510-985-2202.
• To check on the status of a referral, call 800-400-7337.
• For same- or next-day appointments, please call the specialty department.

San Francisco: Refer by fax.

• Referral forms can be downloaded from www.ucsfbenioffchildrens.org/referral.
• Fax all materials to 415-353-4485.
• To check on the status of a referral, call 877-822-4453 (877-UC-CHILD).
• For same- or next-day appointments, please call the specialty department.

For additional questions or assistance, please call the Physician Liaison Service at 800-444-2559.

Updated April 29, 2020

Both UCSF Benioff Children’s Hospital campuses will have appointment-only drive-thru testing available for patients. We are offering drive-thru COVID-19 testing for your pediatric patients with symptoms suggestive of COVID-19 who have not been tested recently, and for those who are asymptomatic but have high risks for complications and have been exposed to confirmed COVID-19-infected people. We are proud to serve your patients and support your practice in this challenging time.

Currently, UCSF Benioff Children’s Hospital Oakland is accepting referrals for drive-thru COVID-19 testing at our Teen Health and Primary Care Clinic at 5275 Claremont Ave., Oakland, CA 94607. Walk-in appointments for those without cars are also available.

To refer a pediatric patient for COVID-19 testing at UCSF Benioff Children’s Hospital Oakland, please use this referral form. Patient instructions can be found here.

Currently, UCSF Benioff Children’s Hospital San Francisco is accepting referrals for drive-thru COVID-19 testing by appointment only.

To refer a pediatric patient for COVID-19 testing at UCSF Benioff Children’s Hospital San Francisco, please follow these steps and use this referral form.

Updated April 29, 2020

UCSF Benioff Children’s Hospital San Francisco offers a Pediatric Respiratory Screening Clinic at Mount Zion that is available for referred patients who need an in-person evaluation, including testing for a UCSF network pediatrician who is unable to see this patient in person. To refer a pediatric patient for an in-person assessment, please follow these steps.

Updated May 1, 2020

UCSF Benioff Children’s Hospitals have activated a COVID-19 Peds ID Provider Hotline. The aim of the COVID-19 Peds ID team is be a resource for pediatric COVID-19 questions instead of the infection prevention team. The COVID-19 Peds ID service will provide and document case-specific advice about testing and isolation. Providers can reach this service 24/7 via the Access Center (1-877-UC-CHILD). Please note that this number is for physicians only.

Updated May 1, 2020

Yes. There are new restrictions on nonessential visitors at UCSF Benioff Children’s Hospital San Francisco: A new order from the San Francisco Department of Public Health strictly limits visitors to essential caregivers only. We plan to align visitor restrictions across inpatient, emergency department (ED) and outpatient settings. At UCSF Benioff Children’s Hospital San Francisco, “essential caregiver” has been defined as a single caregiver at the bedside.

For the inpatient setting, families will be asked to identify two caregivers, with only one allowed to visit per calendar day. For hospital stays <7 days, caregivers will be strongly encouraged to choose one caregiver for the entire stay. Caregivers will be restricted to the patient’s room as much as possible; access to communal areas such as the playroom, family resource room, etc., will be limited.

At UCSF Benioff Children’s Hospital Oakland, given different rules, two direct caregivers are permitted to visit, with no other visitors (including siblings) permitted.

Updated June 8, 2020

We are hard at work taking care of all of our children’s hospital patients and want to share with you some of the ways we have adjusted our approach to providing excellent and safe care to our valued patients during this time.  We are expanding our clinic hours and launching an on-line appointment scheduling system to assure your medical cardiac concerns can be addressed immediately, when, where and how you choose. For more information, visit our website.

Below is an update on medical, procedural, and surgical cardiac care and patient appointments at UCSF Benioff Children’s Hospitals Pediatric Heart Center. 

Cardiac Catheterization and Electrophysiology Procedures

Emergent, urgent and elective cardiac catheterization and electrophysiology diagnostic and treatment procedures are available. We will coordinate COVID testing for you several days before the procedure, either at UCSF Benioff Children’s hospitals or a more convenient local testing site, to assure a safe and successful procedure.  For scheduling please call:  

• Oakland: (510) 428-3380
• San Francisco:
  • Catheterization: (415) 353-4704
  • EP: (415) 514-2783

Cardiac Surgical Procedures

Emergent, urgent and elective cardiac surgery procedures are available. We will coordinate COVID testing for you several days before the procedure, either at UCSF Benioff Children’s hospitals or a more convenient local testing site, to assure a safe and successful procedure.  For scheduling please call:  

• Oakland: (510) 428-3380
• San Francisco: (415) 476-3501

Physician Consults

We continue to be an advice resource for community physicians via telephone. To speak with our on-call Cardiologist, please call 877-UC-CHILD.

Patient Appointments

Our providers continue to see new and existing patients, at all of our 21 clinic locations throughout northern California, and are offering the following appointment options:

• In-person visits: For new cardiac concerns or existing cardiac problems outpatient diagnostic studies, including examination, EKG, Echocardiography, Holter/ Zio patch arrhythmia monitoring, pacemaker evaluations, and exercise stress testing evaluation is available. Infection prevention practices and protocols are in place to keep our patients and their families safe at our all of UCSF Benioff Children’s Hospital Pediatric Heart Center locations.
• Telehealth visits: New-patient and follow-up visits are available through Zoom video technology, during which our providers are able to evaluate the critical needs of each patient and plan the best path forward. All referrals are screened by our clinical team to determine urgency and whether a telehealth visit is appropriate.
• Phone visits: For test result communication and follow-up visits only (when the family is unable to access our telehealth system).

Patients, families and referring providers can schedule an appointment or inquire about our services by calling the following numbers:

• General: 877-UC-CHILD (822-4452)
• Oakland: (510) 428-3380
• San Francisco: (415) 353-2008

Updated May 5, 2020

Patient Appointments

Our providers continue to see new and existing patients, with full clinic schedules, and are offering the following appointment options:

• Telehealth visits: New-patient and follow-up visits are available through Zoom video technology, during which our providers are able to evaluate the critical needs of each patient and plan the best path forward. All referrals are screened by our clinical team to determine urgency and whether a telehealth visit is appropriate.
• Phone visits: For follow-up visits only (when the family is unable to use telehealth and an in-person visit is not required).
• In-person visits: For necessary or urgent outpatient diagnostic studies, including MRI, electroencephalography (EEG) and electromyography (EMG). Patients who require an in-person evaluation continue to be seen at our UCSF Benioff Children’s Hospital locations, where infection prevention practices and protocols are in place.

Patients, families and referring providers can schedule an appointment or inquire about our services by calling the following numbers:

• For San Francisco Child Neurology and Neurosurgery practices, call 855-PBC-UCSF (722-8273).
• Oakland Child Neurology practice, call 510-428-3590.
• Oakland Neurosurgery practice, call 510-428-3319.

Physician Consults

We continue to be an advice resource for community physicians via telephone. To speak with our on-call neurologist or neurosurgeon, please call 855-CHO-KIDS (for Oakland) or 877-UC-CHILD (for San Francisco).

Hospital Admissions

Nonessential admissions will be scheduled as soon as feasible in accordance with guidance from our state and local governments and professional associations. For emergency department (ED) visits and essential hospital admissions/transfers, including acute neurologic conditions requiring urgent evaluation and treatment, our neurology and neurosurgery teams at UCSF Benioff Children’s Hospitals are actively caring for patients in our hospitals and available 24/7 as usual.

Resources

For patient telehealth instructions, visit https://videovisit.ucsf.edu/.

Updated May 5, 2020

Our offices at both UCSF Benioff Children’s Hospitals (in San Francisco and in Oakland) are open and conducting virtual visits online for any new referrals and follow-up visits. We are also seeing patients for in-person visits, although limiting the number of patients that we bring into the office during these times. We continue to provide the full range of medical and surgical care for our mutual patients.

In addition, the hospitals are re-opening our operating rooms in a thoughtful manner that minimizes risks to our patients and health care providers.  These strategies include testing all patients for COVID19 before surgery, screening everyone with COVID-related questions when entering the hospital, and providing adequate personal protective equipment for all health care providers, visitors, and patients.

While initially all elective operations had been postponed, we are now beginning to introduce more urgent operations that need to be performed in the next 1-2 months.

The current situation is dynamic and new guidelines are developed daily.  More information is available on the UCSF Benioff Children’s Hospital website.  If you have any concerns about the potential urgency of evaluation and intervention for any child please contact our clinic office at 415-476-4086, or by fax at 415-476-5363.