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FAQs on Covid-19 in Children- A doctor`s Perspective

Dr Nagendra Chaudhary

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first reported in December 2019 from Wuhan, Hubei province, China and has now spread to the whole globe. The World Health Organization (WHO) has declared a global pandemic on March 11, 2020.

1.    What are the clinical presentations of Covid-19 in children?

Like most of the viral infections, the incubation period of COVID-19 is 1-14 days, with an average of 3-7 days. This means, on average, it takes 3-7 days for the child to be symptomatic. The majority of children present with cough, throat pain/congestion and fever. The child may also present with diarrhea, vomiting and fatigue. Later on, the child may complicate to pneumonia presenting with fast breathing.

2.    What should you do once you suspect a person with Covid-19?

Any person with fever, cough or respiratory distress with history of contact to COVID-19 patient or recent travel to Covid-19 endemic areas (hot spot areas) should be suspected of Covid-19.

As soon as you suspect the disease in the person, he/she should be kept in isolation, and his nasopharyngeal/throat swab should be sent for RT-PCR to detect the virus. The person should be kept in isolation until the reports are available. One should start immediate infection prevention control (IPC) measures. Standard precautions such as hand hygiene (handwashing and hand rubbing with sanitizers), use of personal protective equipment (PPE), gloves and masks by the health care personnel, safe waste management and cleaning and disinfection of equipment must be followed as per the guidelines issued by the government.

In the meantime, the healthcare personnel should also be isolated, and their swabs too must be sent once they are taking the care of Covid-19 suspect cases. Isolation should be done until their reports are available. Once the reports of health care personnel are negative, they need not be isolated further. But in case the reports are positive, the person should be kept isolated and seek medical advice in COVID dedicated hospitals. 

3.    What treatment should be given to the child diagnosed with Covid-19?

As there is no standard therapy for Covid-19, the cornerstone of management is supportive therapy. All Covid-19 diagnosed cases need to be admitted in a COVID dedicated hospital (as per the present protocol which may change later on)

COVID positive with no symptoms-
    Isolate them for at least two weeks or until their last swab is negative (to prevent the transmission to others)
    A proper diet containing adequate nutrition and calorie with vitamins. Plenty of fluids. 
    Try to alleviate anxiety.

COVID positive with mild symptoms-
    Follow all the points as given for “COVID positive with no symptoms”.                              +
    Fluid and electrolyte management (if oral intake is inadequate).
    Oxygen supplementation, if respiratory distress (fast breathing, retractions).
    If a secondary infection is suspected, start antibiotics and treat pneumonia.
COVID positive with severe symptoms- 
    Admit in pediatric ICU (PICU).
    Respiratory support- Intubation and ventilatory support.
    If required, start inotropes.
    IV antibiotics if an infection is suspected. 
    Can consider drugs as Hydroxychloroquine, remdesevir, lopinavir, ritonavir (still trials are undergoing, so no specific drug has been approvedto date for the management).

4.    How can a person prevent himself and the child from coronavirus infection?
    Regular hand washing and hand rubbing with alcohol-based sanitizers which help to kill the virus that may be present on the hands. 
    Maintain at least 1 metre (3 feet) distance between yourself and others. Following this simple measure prevents from breathing in the infected droplets if present in the environment. 
    Avoid going to crowded and public places.
    Avoid shaking hands. Greet from a distance by other means like nodding
    Avoid touching eyes, nose and mouth because your hands may be contaminated, and the virus can enter inside your body. 
    One should follow good respiratory hygiene. Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then, dispose of the used tissue immediately and wash your hands.
    Stay home and self-isolate even with minor symptoms such as cough, headache, mild fever, until you recover. If you need to leave home, wear a mask so that you do not infect others. If you need to seek medical advice, prefer the telephone as far as possible. 

5.    How fatal is the disease?
Covid-19 is also like other viral illnesses like influenza, which we have been living for more than 100 years. The Covid-19 disease is much milder in children and young adults in comparison to the elderly. About more than 90% of children have no symptoms or are mild to moderate. Only about 6% of children have a severe type of the disease. In adults, 18-20% can have severe illness and rest have a mild form of the disease. 

6.    What measures should you take when a Covid-19 positive mother delivers a baby? Can she breastfeed the baby?
First of all, strict infection control measures should be followed by all the birth attendants. If possible, mothers with Covid-19 should be separated from their newborns upon birth. These newborns should be kept in an area that is separate from other infants. Families who opt to keep the newborn near the mother should be educated concerning the potential risks of coronavirus transmission.
Coronavirus has not been detected in mother`s milk (till April 2, 2020 data). Therefore, mothers with Covid-19 may express breast milk after appropriate hand and breast hygiene, which can be fed to the newborn by healthy caregivers.

Message to the public- 

One should not be worried but should have faith in himself with positive thoughts. We should not forget the 1918 pandemic (Spanish flu) caused by H1N1 (influenza virus), which killed about 20-40 million people around the globe then. The virus had two more pandemics after that, and the last pandemic was in 2009. But, as we already have a vaccine against it, it could not have much damage to humankind.
Various vaccines and treatment trials are also going on against SARS-CoV-2, and we hope we will have it soon. Therefore, until any specific treatment or prevention measures (vaccine) is available, all we need to do is protect ourselves from our changing lifestyles and behaviours. We should follow all the guidelines of remaining clean, not exposing others and focussing on his diet and exercise. Social distancing and frequent hand washing should be practised strictly as it helps in breaking the chain of transmission of the virus. If one follows all these measures, one is ultimately going to win the war against Covid-19.

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