Covid-19 Infection in children: What should we worry about?
Date of Publication: March 30, 2020
The total number of Covid-19 cases globally stands at 638, 146 with 30,039 deaths. The disease, which started Wuhan in the Hubei Province in China, has torn through the entire world with more than 180 countries having seen at least one case. In Africa, 46 countries have reported 4760 cases with 146 deaths. In Uganda 33 cases have been confirmed, and of these 3 are children aged 8 months, 10 years and 16 years. The disease is caused by the novel virus SARS-COV-2 and presents with flu like symptoms such as cough, fever and a dry cough but some patients have reported irritation in the eyes, mild diarrhea and joint pains.
The disease is usually mild in children below the age of 10 years and carries a low risk of dying. Persons 30 years and older, particularly those with underlying debilitating health problems experience severe forms of the disease. In a retrospective study conducted in Wuhan that looked at pediatric patients, young children were more at risk of serious illness than older children. The proportion of severe and critical cases was 10.6 % for children younger than 1 year, 7.3% for those 1 to 5, 4.2% for those 6 to 10, 4.1% for those 11 to 15, and 3.0% for those 16 to 18. Only one child died, and most cases were mild, with much fewer severe and critical cases (5.9%) than adult patients (18.5%).
Despite these findings Dong.Y, et al noted that children of all ages and both sexes were clearly at risk due to the Covid-19 as stated that "Although clinical manifestations of children's COVID-19 cases were generally less severe than those of adult patients, young children, particularly infants, were vulnerable to infection,".
Dong.Y et al write that the less severe presentation may be attributed to less exposure or sensitivity to COVID-19, different immune response mechanisms, or higher levels of antibodies to viruses than in adults due to broader exposures to respiratory infections in winter.
In Africa where children are allowed to get exposed to various microbiomes and presumably have an expanded load of gut microbiota, they are expected to have a more robust immune system. However, children could be a potential driver of the CoVID-19 since they may be asymptomatic careers. This risk makes good arguments for social distancing and removal of children from crowed places like schools, to contribute to slowing the rate of infection (flattening of the curve). The risk of infection in utero with Covid-19 is extremely rare but still exists. The current concern remains the children with underlying conditions who are likely to have severe disease if they get infected with Covid-19.
As the world continues to struggle with controlling the pandemic, the gains made in improving the health of children should not be lost. We should ensure that every child is born safely and reaches their 5th birthday through availing them with clean water, food, shelter, freely available vaccines and education. Older children should be protected to reach their second decade of life, which is their adolescence when they are 10 to 19 years of age. Adolescents should be supported to grow into healthy and responsible adults.
During the mandatory lock-down and social distancing to stop the CoVID-19 pandemic, we must take care for the physical, mental and emotional health of our children and adolescents. We must encourage them to continue with school activities, engage in physical exercise and stay safe by practicing maximum levels of hygiene like hand washing. We should also encourage children and adolescents to use their free time gainfully and catch up with their school work and assignments.
According to a recent UNESCO report of 30th March 2020, over 1.5 billion children are currently out of school for a long duration because of the current ‘lock-down’ imposed by governments to prevent the spread of Covid-19. The dangers of children not being in school are known including losing their ability to be creative, engaging in risky behaviors such as alcohol binging; sexual activity and other harmful practices. Adults and guardians should therefore be mindful of their duty to protect these children and adolescents. There is a tendency for children to have their sleep habits affected during this long school break. This could vary from having very little sleep while they catch up with their friends via various social media apps, to having excessive amounts of sleep and risking excessive weight gain.
Children and adolescent care approaches must remain holistic during this time and innovative ways of parent-teacher interaction must allow children and adolescents to maximize on their educational growth.
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About Sabrina Bakeera-Kitaka
Senior Lecturer; Pediatric & Adolescent Health Specialist - Department of Paediatrics; Makerere University College of Health Sciences; Mulago National Referral Hospital, Kampala-Uganda