Coronavirus (COVID-19) and Complicated Vascular Anomalies

Updated 20 March 2020.

These recommendations may be subject to change and will be updated as needed.

The World Health Organization (WHO) has now officially declared COVID-19 as a pandemic. In most cases, COVID-19 produces a mild respiratory infection, but in a minority of cases, the disease can be more severe and require hospitalization or even ICU care. The following recommendations come from :

ECDC: European Centre for Disease Prevention and Control
https://www.ecdc.europa.eu/en/novel-coronavirus-china/questions-answers

Additional information by country:

* Belgium (SPF Santé Publique/ FOD Volksgezondheid)

https://www.info-coronavirus.be/

* Finland (Sosiaali- ja terveysministeriö)

https://stm.fi/

* France (Ministère des Solidarités et de la Santé)

https://solidarites-sante.gouv.fr/soins-et-maladies/maladies/maladies-infectieuses/coronavirus/

*Germany (the Robert-Koch-Institute)

https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/nCoV_node.html

* Ireland (Government of Ireland)

https://www.gov.ie/en/

https://www2.hse.ie/coronavirus/

* Italy (Ministero della Salute)

http://www.salute.gov.it/portale/p5_11.jsp

* Spain (Ministerio de Sanidad, Consumo y Bienestar Social and Departament Salut de la Generalitat de Catalunya)

https://www.mscbs.gob.es/en/profesionales/saludPublica/ccayes/alertasActual/nCov-China/ciudadania.htm

http://canalsalut.gencat.cat/ca/salut-a-z/c/coronavirus-2019-ncov/

* Sweden (Government Offices of Sweden)

https://www.government.se

* the Netherlands (the National Institute for Public Health and the Environment (RIVM)

www.rivm.nl/en

Also (USA): the Center for Disease Control and Prevention

www.cdc.gov/coronavirus/2019-nCoV/index.html

REGARDING MEDICATION USE BY VASCULAR ANOMALY  PATIENTS

In general: DO NOT stop any medication unless directed to do so by your health care provider.

1. In principle, if you have no disease symptoms and have not been in contact with someone with the coronavirus, you can continue with the medication.
2. If you have a cold, or have been in recent contact with someone who does have the coronavirus, please consult your attending physician.
3. If you have fever and/or respiratory difficulties, stop sirolimus and contact your health care provider.
4. The use of antibiotics can usually be continued, but they can also be stopped in some cases should symptoms of the disease occur.

1. Anti-seizure medications should be continued if you or your child has a positive exposure or symptoms unless advised otherwise by your health care provider.
2. Fevers will lower a seizure threshold, so these medications are important.
3. Discuss with your health care provider prior to or if you/your child has a positive exposure or symptoms.

1. If a child has no underlying heart or lung disease, beta-blockers are not a danger.
2. Beta-blockers are not immunosuppressants, but they can worsen the symptoms of a viral infection such as wheezing. If a child has a fever and/or gastroenteritis, and/or lung symptoms, your health care provider should be called immediately to discuss the continuation of beta-blockers.
3. If in doubt, stop the beta-blocker and seek advice from your healthcare provider as soon as possible.
4. If a patient has a hemangioma in the airway and has been exposed to COVID-19 or has symptoms, the health care provider should be informed immediately.

1. In the scientific (and non-scientific) press there have been rumors that ibuprofen (and perhaps similar substances from the group of NSAIDs = NonSteroidal Anti-Inflammatory Drugs, such as: diclofenac and naproxen) may be unfavorable in combination with an infection with the coronavirus. There is no solid data about this though and the WHO recently retracted its warning about ibuprofen.
2. In case of a proven COVID-19 infection, contact your healthcare provider

Is there a higher risk of serious complications due to COVID-19 for vascular anomaly patients?

In general, there is no concern that people with a congenital vascular anomaly run a higher risk of complications due to COVID-19. However, if the vascular anomaly affects the lungs, the mediastinum, the liver or the kidneys, you might be at a higher risk.

In general, children are relatively spared of symptoms caused by COVID-19 infection, and only very few of the infected children need intensive care admission.

Who is at higher risk for serious illness from COVID-19 and how can this be related to complicated vascular anomalies ?

1. People over 50 years of age.
2. Smokers.
3. People with serious chronic medical conditions such as:
4. Reduced resistance to infection, due to:

• Medication for an autoimmune disease; organ transplantation; hematological disorders; congenital or later-onset immune disorder (immunodeficiency) requiring treatment; chemotherapy and/or radiation in cancer patients; HIV infection.
• Diabetes mellitus.
• Heart Conditions (g. coronary heart disease) and specific issues related to vascular anomalies : pericardial effusions, pulmonary hypertension and / or other cardiac dysfunction from a vascular anomaly.
• Lung Disease (g. asthma, COPD) and specific issues related to vascular anomalies : pulmonary effusion and / or pulmonary involvement or disease from a vascular anomaly, bone disease in the ribs, sternum, upper vertebrae, history of pulmonary embolism, history of multiple pulmonary infections, vascular anomalies that affect the airway, or patients on medication that can worsen respiratory symptoms.
• Hypertension (high blood pressure).
• Acute or chronic liver or kidney disease.
• Cancer.

1. If you (or your child) are sick or hospitalized due to COVID-19 and you have a (complex) congenital vascular anomaly, we recommend the following:
2. lf you are hospitalized, make sure the team discusses your specific case with your vascular anomaly specialist
3. lf you or your child are not able or strong enough to walk (and thus lying in bed and not moving as in normal daily life), and you have a vascular anomaly that puts you at high risk for thrombosis (blood clots), please make sure your treating physicians are aware of this. This also applies if you have a history of blood clots, coagulation abnormalities, large ectatic veins.

If you have ANY doubt about what to do or about the complaints you have: contact your attending physician or, if necessary, your general practitioner.

The vascular anomalies community advocates have jointly collaborated with our medical advisors to develop a FAQ information sheet for COVID-19 information as it relates to our population. Please remember it is for general information purposes only. lt is not intended to be a substitute for professional medical advice, diagnosis or treatment. Specific situations might cause a variance in response, and if you are not sure, always seek the advice of your physician or other health care providers as they are the most familiar with your situation.

COVID-19 information is changing daily. Please consult the pages referenced above for the most current information.