With the looming threat of the COVID 19 pandemic, paediatricians have been getting frequent queries from parents on the risk of their children getting this new viral infection which is threatening the entire world.
In the coming days, we can expect large number of children to be brought to clinics and hospitals for trivial and major symptoms alike because the fear of unknown diseases is obviously even higher for children.
In the first largest series of cases reported from China, only one child aged 15 years was treated, indicating that there could be a children-sparing pattern in this infection.
In 2003, during the SARS epidemic in Hongkong, among over 1,700 infected individuals, 6.9% were under 18 years of age with a case fatality rate of 0%. Similarly, when the Middle East Respiratory Syndrome (MERS) spread in 2012, also caused by corona virus, only 2% of cases occurred in children.
Coming to the hottest topic, worldwide data suggests that the paediatric population, even in this very-high risk area, appears to be at an unexpectedly low risk to develop COVID 19 infection. It is unclear why this may happen.
Reports from China suggest that infection of children is possible, although apparently extremely rare.
One possible reason is that children have fewer outdoor activities and undertake less international travel, making them less likely to contract the virus.
Are children cross-protected by having met other Coronaviruses? Coronaviruses (CoVs) is one of the common viruses that invade the lungs as rhinoviruses, respiratory syncytial virus (RSV), and influenza, which all have an RNA genome and are very frequent in children. Innate immune evasion links to the innate immune responses elicited by respiratory and other (RNA) viruses. One explanation could be that pneumonia results from virus-induced immune response causing destruction of pulmonary tissue. Such mechanisms could be less effective in children.
The good news so far is that children are apparently at a minimal risk to develop this new disease, and at virtually no risk of a fatal course.
Are children going to have different symptoms and signs in this dreaded disease?
Most infected children have mild clinical manifestations. They have no fever or symptoms of pneumonia with a good outcome. Most of them recover within 1–2 weeks after disease onset. Few may progress to lower respiratory infections.
Children with infection can fall into any of the following 4 categories:
- Asymptomatic Infection 2. Acute Upper Respiratory Tract Infection 3. Mild Pneumonia 4. Severe Pneumonia
William Osler said “The only way to treat the common cold is with contempt.” Ogden Nash defined Family as a “Unit composed not only of children but also of men, women, an occasional animal and the common cold.” Most children in our country and across the world are going to get this Common Cold due to COVID 19 for sure as the pandemic looks unstoppable.
However, we need to remember a few scientific facts in this scenario. Even the most experienced paediatrician cannot distinguish COVID 19 infection from other viral respiratory infections with confidence. Only virus testing will confirm or exclude the diagnosis. Treatment as of today is mainly supportive and symptomatic in the majority of children. A wide variety of drugs is being tried in desperation in critically ill without hard evidence. Vaccine is not yet a reality.
Children may play a major role in community-based viral transmission since quite a few of those infected may be asymptomatic or mildly symptomatic. However, we need to remember that children with chronic diseases, malnutrition, immunodeficiencies may suffer from serious consequences of this seemingly benign viral infection in children.
Balanced diet, oral health, adequate exercise, regular rest, avoiding excessive fatigue, and boosting immunity are the powerful measures to preventing infection, as well as maintaining emotional stability and mental health.
It is necessary to stress that there is a need to practise appropriate hand hygiene and cough hygiene practices meticulously than ever before.
