COVID-19 infection appears to affect children differently —Experts

There is a growing concern that COVID-19 is emerging in children. Although experts are very certain that children are less likely to have its severe outcomes, in this report by SADE OGUNTOLA, they said it may not start with cough, catarrh or sneezing.

 

It has been reported that over the past three weeks, there has been an apparent rise in the number of children of all ages with a COVID-19 related illness requiring intensive care across London and other regions in the UK.

Unfortunately, there is still plenty of confusion when it comes to how the novel coronavirus impacts children. Research suggests that children and infants may be less susceptible to the virus than adults, and one study found up to 90 per cent of children who contract the virus are asymptomatic, although a small number of severe cases have been reported.

Even if many of those cases are mild or asymptomatic, the researchers in a new study warn that, despite social distancing measures, there may be far more children infected with the novel coronavirus in the US than previous thought.

Despite the growing concern of children contracting the virus, a Nigerian polling service, NOIPolls in March found that 26 per cent of Nigerians believe that they cannot catch COVID-19, leaving more Nigerian children exposed to the direct and indirect effects of the pandemic.

In Nigeria, COVID-19 in children may not be a rare thing either. At least its indirect and hidden consequences will have a lasting effect. Many children, for example, have died because they cannot get to a doctor owing to transportation shutdowns. Also, children had missed their vaccination because mothers are afraid to visit the hospital.

Although “the prevalence in children is fewer than that of adults but children can be infected and they can develop complications of COVID-19,” said Dr Bankole Kuti, a consultant paediatrician at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Osun State.

According to him, children can have and have actually died from COVID-19 in China and other countries that have high prevalence although luckily children usually are without symptoms or have mild symptoms of this infection.

For now, most reports say it’s just children that get the infection although its impact cuts across children of all ages, from teenagers to infants. It’s also still a question as to why the vast majority of coronavirus cases in children are mild. But for some, a dangerous complication can emerge.

All over the world especially in countries where the COVID-19 prevalence is so high, cases had been recorded even in newborn babies. However, Dr Kuti said “there is no evidence as of today to show that the virus can pass through the placental to a baby in the womb like HIV.”

A lot of studies in China had shown that the virus is not in the amniotic fluid or in the placenta and as such it cannot cross over to the baby. Nonetheless, he declared that if a woman is infected, she can transmit the infection to the baby by coughing near the baby or through the breast milk.

Children can also have it when they are exposed to droplets of saliva from infected adults or when they come in contact with body secretions such as nasal secretions, cough or sneezing from an infected person.

Dr Kuti, however, stated that children infected with COVID-19, especially younger children can present with nonspecific symptoms such as fever and muscle pain. Some children also have rashes, gastrointestinal symptoms such as vomit, diarrhoea and abdominal pain.

Older age groups and adolescents, he added could, however, have signs and symptoms of COVID-19 adults experience such as cough, catarrh, body aches and fever.

Most of these symptoms of COVID-19 in children are mild and are self-limiting. However, he added, “in a very few percentages of them end up pneumonia or acute respiratory distress syndrome. And as such there might be the need for a ventilator for additional breathing support as in adults.”

Even as the pandemic continues, Dr Kuti said that health workers treating children with gastrointestinal symptoms such as vomiting, diarrhoea or abdominal pain, health workers need to have a high index of suspicion for they may actually have a coronavirus infection.

Doctors from Wuhan, China, who detailed five cases of coronavirus in children who had no initial signs of respiratory illness such as cough in a study published in Frontiers in Paediatrics had suggested that children suffering from sickness and diarrhoea, coupled with a fever or history of exposure to coronavirus should be suspected of being infected with COVID-19.

The research also suggests that the gastrointestinal symptoms first suffered by some children hint at potential infection through the digestive tract, as the type of receptors of cells in the lungs targeted by the virus can also be found in the intestines.

The role of children in spreading the coronavirus has been a key question since the early days of the pandemic. But researchers are divided on whether children are less likely than adults to get infected and to spread the virus. Some say that a growing body of evidence suggests children are at a lower risk.

Other reason that the incidence of infection in children is lower than in adults partly because they haven’t been exposed to the virus as much — especially with many schools closed. And children are not getting tested as often as adults, because they tend to have mild or no symptoms.

Even less understood was why children have milder symptoms than adults when infected, and whether that offer clues to potential therapies. But researchers do agree, however, that children tend to deal with COVID-19 better than adults.

Dr Kuti said that one theory for why most children have milder symptoms of fever, cough, sore throat, runny nose, body aches and sneezing is that children’s lungs might contain fewer or less-mature Angiotensin-converting enzyme II (ACE-2) receptors, proteins that the SARS-CoV-2 virus uses to enter cells.

It is not so much that children are not being as affected, but that something changes as a person gets much older that makes one more likely to be affected.

According to Dr Kuti, some other studies have shown that children still have what is called naïve T cells which are primed up in an organ in the body called primus that help the body to fight off infections.

Primus is highly functional in children unlike in adults. It functions depreciates with age.

To reduce the effect of COVID-19 on Nigerian children, Dr Kuti said  should start by disabusing minds that children are not affected by coronavirus and mothers should be encouraged to seek medical attention early when children are sick rather than avoiding hospitals for fear of COVID-19.

He added, “They have to be covered up; they have to be isolated or protected from being infected by an infected person. Secondly and more importantly, if a huge number of the population is infected, indirectly, children will suffer more from this, than even the adults.”

It could be that the virus affected mostly adults at the moment because there has been workplace transmission and transmission during travel. But nevertheless, avoiding its direct and indirect effects on Nigerian children are still pivotal to an improved health index of the country and its future.

 

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