Coronavirus and children


By Dr B. J. C. Perera
Specialist Consultant Paediatrician

At the very outset, I have to declare that the ONLY purpose, of writing this article is to provide some information to the public and for no other reason, overt or covert. My intentions are identical to the sentiments very clearly expressed by Professor Russell Viner, President of the Royal College of Paediatrics and Child Health of the United Kingdom on March 20, 2020. He has written that his efforts are in making sure that the needs of children and young people are not overlooked as one of his key roles during this disaster caused by a virus.

The current coronavirus catastrophe has been declared by the World Health Organisation (WHO) as a Global Pandemic. To give the technical names of the bug and the illness caused by it, the scientific name of the virus is Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) and the illness caused by it is called Corona Virus Disease-19 (COVID-19).

Up to March 21, 2020, there have been over 275,000 cases of this disease globally with deaths above 11,000 in more than 150 countries. The Sri Lankan authorities are currently involved in a committed and admirable venture to prevent extensive community spread of the disease. It is a time of unprecedented challenges for everybody, most particularly to our health service, and also to the society in general. Life has changed, quite suddenly. Uncertainty feeds anxiety and I do not think anybody can deny feeling overwhelmed at times by the COVID-19 pandemic.

All the scientific information available globally is evolving by the hour and is still in a state of flux. None of the material could be classified as written in stone and may change quite significantly from time to time. Most of the available scientific information is on adults. Many reputed scientific academic journals have fast-tracked the material on the disease and presented them to the scientific community as soon as possible. We now know for sure that the full spectrum of the disease ranges from mild and self-limiting respiratory tract illnesses to severe progressive pneumonia, respiratory failure, adverse multi-organ disturbances, and death.

It is recognised that data regarding the epidemiologic characteristics and clinical features of infected children are still very limited and scarce. It is generally assumed that the virus may be able to infect children to the same extent as adults. There is no reason to doubt this perception. Evidence from China now suggests that this is indeed so and it is also confirmed by the current Italian experience.

However, there appears to be a difference in the level to which the actual disease can produce major complications in children. Young patients do not seem to be affected to the same extent as adults. Yet for all that, there are certain vulnerable groups amongst children as well. These include those who already have some lung and respiratory problems, as well as those with impaired immunity. Those children with pre-existing respiratory disorders, mainly chronic diseases are more susceptible to develop major respiratory complications of COVID-19. Those who have impaired immunity, i.e., a disturbance of the inherent abilities to fight off infections, are also more vulnerable for obvious reasons. We have to be extremely careful with all such susceptible groups of children as most of the children the world over who have exhibited severe disease needing artificial respiratory support have been in such groups.

The authorities have still not seen any evidence of vertical transmission of the virus from the pregnant mother to her unborn baby. Neither has there been any tangible evidence of transmission from the mother to the baby through breast milk. In a similar related vein, there are so far no major concerns regarding the possibility of the virus causing congenital malformations. However, these are very early days and the world authorities need to keep a close eye on these aspects. One theory that attempts to explain the lack of such transmission so far is based on the size of the virus particle. They are spherical particles approximately 125 nanometres in diameter. It is postulated that the pores or openings in the placenta are smaller than this and the virus is therefore not able to get to the foetus. The pores in the milk glands too are smaller than 125 nm and the same contention regarding the lack of transmission through breast milk is thought to apply. However, these are just concepts at present and there is no corroborating robust scientific evidence for these opinions, at least not as yet.

It has to be unequivocally stressed that all of this information does not mean that the general public should assume a state of nonchalance and misplaced complacency regarding paediatric and adolescent COVID-19. Some of this material presented may be reassuring to parents but it must be acknowledged and kept in mind that infected children, even if they are asymptomatic or even if they have mild disease, are likely to shed considerable amounts of the viral load in their bodies to the environment and inanimate objects. Such affected children would be a danger to the community at large. There is evidence that some adult patients who recover show virus shedding up to even three weeks following recovery. There is no reason to believe that it would be different in children and adolescents. Children, being such capricious creatures, are not likely to be all that careful in minimising or preventing transmission of the virus. In such a scenario, it does not give carte blanche permission for parents to go on unnecessary trips, jaunts and vacations with their children. It would be an extremely unwise and most definitely a dangerous pastime to engage in such reckless activities.

Practising the highest standards of infection control at all times is essential to protect everybody in society. Even without considering the children and adolescent groups, such an axiom should be the compelling and overriding responsibility of all citizens of our Motherland. One could not help but just firmly stress this, over and over, again and again.

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