ऐसा नहीं है कि गए साल पहली कोरोना लहर में नौनिहाल संक्रमण से अछूते रहे थे ,बेशक गैर -लाक्षणिक रहे हमारे नौनिहाल लेकिन एक फीसद को यह संक्रमण छू कर चुपचाप निकल गया था। इस बरस अनुमान है संक्रमण की दर बालकों में 1. २ फीसद है। कोई प्रामाणिक आंकड़ें बाबत सामने नहीं आये हैं।
माहिरों की राय में डबल ,ट्रिपल अन्य वेरिएंट्स सबकी सब के प्रति बालक टोली ज्यादा अरक्षित है निहथ्थी है ,इनके लिए फिलाल कोई कोरोना प्रोटोकॉल भी अभी सामने नहीं आई है।जिन घरों में माँ बाप में से कोई एक या अन्य कोई भी संक्रमित है वह घर से बाहर न निकलें इसमें ही अन्यों का बचाव है बच्चे अभी भी कितने ही अलाक्षणिक (asymptomatic )बने रह सकते हैं लेकिन अन्यों को सुगमता से संक्रमित कर सकते है।
कोरोना का डबल म्युटेंट खुद प्रतिरक्षातंत्र के पहरुवों का भेष धरके बैठ जाता है इम्यून सिस्टम को चकमा दे प्रतिरक्षा व्यवस्था को चौपट कर अपना काम कर जाता है।
यही वजह है दूसरी लहर में बालकों में मल्टीसिटेम इंफ्लेमेटरी सिंड्रोम दिखलाई दिया है।
गए साल के ३१ फीसद की वनिस्पत अब इससे तीस बरस के नीचे के ३२ फीसद लोग असरग्रस्त हो सकते हैं। ऐसा प्रतीत होता है यह लहर नहीं कोरोना सुनामी है।
श्वसन तंत्र को निशाने पे लेने के अलावा इसके अन्य लक्षणों में चिल्स (शरीर में कम्प का होना ),उच्च ज्वर ,बे-दमी सांस की धौंकनी का जल्दी-जल्दी चलना ,उदर -आंत्र संक्रमण के लक्षण ,भूख न लगना उलटी दस्त ,माइएल्जिया (पेशियों की दुखन ,पेशीय शूल ),श्लेष्म -त्वचीय शोथ (mucocutaneous inflammation )आदि हो सकते हैं।
कुछ अन्य मामलों में अग्नाश्य -शोथ ,यकृत की असरग्रस्तता ,लीथारजी ,सीज़र्स आदि भी दर्ज़ हुए हैं।
भारत में नेत्रश्लेष्मल शोथ (conjuctivitis ),के अलावा कुछ मामलों में चमड़ी पर चकत्ते रैशिज़ भी दिखलाइ दिए हैं। सबके लक्षण यकसां नहीं होंगे।
Covid-19 second wave and children: What are the symptoms, what should parents do
Why are more children testing positive for Covid-19 in second wave? What are the symptoms usually shown by children? What precautions should parents take? We dissect each question by talking to experts
"If Covid-19 affected 1 per cent of children last year, it is about 1.2 per cent now. But it is a huge increase in terms of numbers in India," Dr Anjan Bhattacharya, consultant pediatrician, Apollo Hospital, told IndiaToday.in. Presently, there is no government data on Covid-19 among children.
While there is no vaccine for kids yet, several companies have started clinical trials among adolescents and young children. India is yet to come up with a treatment protocol for children.
Why are more children testing positive for Covid-19 in second wave? What are the symptoms usually shown by children? What precautions should parents take? What have other countries done to check Covid-19 infections among children? We dissect each question by talking to experts.
Why is the second wave of Covid-19 affecting more children and adolescents?
Experts say the double mutant coronavirus variant alongside a cocktail of other strains have a higher tendency to infect children. Children getting infected from members of family who go outside and are lax in maintaining Covid-19 appropriate behaviour are also part of the spread seen during the second wave.
"The double mutant variant has immune escape phenomena. It masquerades as our own body system and then escapes our immunity protection. This is why more children are contracting Covid-19," said Dr Anjan Bhattacharya.
Dr Jaydeb Ray, Department of Pediatric Medicine, Institute of Child Health, Kolkata, said children were getting infected by Covid-19 in the first wave as well, but most cases were asymptomatic. "But now, we are seeing kids coming to hospitals coming with MISC (Multisystem Inflammatory Syndrome in Children). This time it is showing parallel to an active infection," he said.
However, Dr Sagnik Biswas, Senior Resident, AIIMS, said that given the rapid spread of the virus, the overall number of patients (both young and elderly) is expected to rise, but there doesn't seem to be any indication that the virus affects younger population more than the elderly. "The percentage of afflicted individuals under 30 years can be placed to around 32% as compared to 31% in the previous wave," Dr Biswas told IndiaToday.in.
What symptoms are children showing?
The second wave has shown that Covid-19 symptoms are not limited to just the respiratory system. The most common symptoms observed in children include high fever, chills, shortness of breath, cough, loss of smell, sore throat, myalgias, and mucocutaneous inflammatory signs. In the second wave, more Covid-19 positive children are showing gastrointestinal (GI) symptoms like loss of appetite, vomiting and diarrhea.
"Case reports are now emerging from several countries saying that Covid-19 may even lead to episodes of pancreatitis and decompensated liver disease, although these are based on clinical experience of few cases," said Dr Sagnik Biswas.
Dr Jaydeb Ray said warning signs such as elevation of inflammatory markers, fast breathing, lethargy and seizures should be monitored by parents for early detection of Covid-19 in children.
Why are Covid-19 positive children showing more gastrointestinal (GI) symptoms this time?
Although respiratory symptoms are more prominently highlighted, gastrointestinal manifestations are seen in up to 40-50 per cent cases, said Dr Sagnik Biswas, Department of Gastroenterology, AIIMS.
"Novel coronavirus uses ACE2 as a viral receptor for entering the GI tract. It is highly expressed in the glandular cells of gastric, duodenal, and rectal epithelia, supporting the entry of coronavirus into the host cells," he said.
Several studies have identified the presence of SARS-CoV-2 in stool samples. "A study comprising 10 pediatric patients evaluated their nasopharyngeal and rectal swabs. Eight children persistently tested positive on rectal swabs even after nasopharyngeal clearance of the virus. Furthermore, a cohort study demonstrated a significant enhancement of ACE2 expression in cholangiocytes as well as liver cells, indicating that the virus can lead to direct damage to intra hepatic bile ducts," Dr Sagnik Biswas said.
ALSO READ | Covid-19: Children exhibiting behaviour disorders due to curfews and lockdowns
What should be done when a child tests Covid-19 positive? What precautions should be taken?
Experts say children showing mild symptoms should be home quarantined for 14 days. "If symptoms are mild and oxygen saturation is greater than 94 per cent, we have to give supportive care, adequate hydration, proper nutrition and paracetamol," said Dr Jaydeb Ray. If CRP (C-reactive protein) and ferritin (blood protein that contains iron) levels are elevated, then children must be admitted to a hospital, he said.
In the absence of any definitive therapy, social distancing, wearing masks, and hand washing are still the gold standard in prevention of disease among this age group, experts told IndiaToday.in.
What has the government said on Covid-19 affecting children?
Union Health Minister Harsh Vardhan told Parliament that children in the age group of 0-14 years were less affected by Covid-19. He said infection among children was mild and most of them remain asymptomatic.
"Hence no specific action plan has been formulated in the current response phase to minimize the adverse effects of Covid-19 on such children," Dr Harsh Vardhan said in a written reply.
Dr Vardhan further said that rarely a severe illness, in form of multi-system inflammatory syndrome, had been identified. This usually happens three to six weeks after the infection, he said. The Department of Pediatrics, AIIMS, is documenting the long-term effect of Covid-19 in children.
Are there any Covid-19 vaccines for children?
No, presently there is no Covid-19 vaccine that can be administered to those below 18 years of age. The Health Ministry has said clinical trials are underway to test the safety and efficacy of Covid-19 vaccines among children.
In February, Hyderabad-based Bharat Biotech had sought approval from the national drugs regulator for Phase 3 clinical trial of its Covid-19 vaccine -- Covaxin -- in children between the ages of 5 and 18 years. However, it was not granted permission since it did not produce efficacy data on adults.
Last week, Pfizer announced that trials of its vaccine in children aged 12 to 15 showed 100 per cent efficacy and a strong immune response, with no unusual side effects. It has now sought emergency approval from the US Food and Drug Administration to use its vaccine in this age group.
The University of Oxford had started testing the Covid-19 vaccine it developed with AstraZeneca in children and teenagers (this vaccine is available in India under the brand name Covishield). However, it has paused the trial following blood clotting issues in adults who received the jab.
Can newborns get Covid-19?
A very small number of cases have emerged where pregnant women infected with coronavirus have passed the disease on to their babies. Infants can also become infected shortly after being born. The US Centers for Disease Control and Prevention (CDC) has said that most newborns who test positive for Covid-19 have mild symptoms or none at all, and recover, but serious cases have occurred.
How have other countries dealt with child Covid-19 patients?
In the US, children represent about 13 per cent of all Covid-19 cases, according to the American Academy of Pediatrics and the Children's Hospital Association. The National Institutes of Health, which is the US's medical research agency, has formulated guidelines for treatment of children with Covid-19.
According to the NIH, most children with mild or moderate disease can be managed with supportive care alone. The NIH says Remdesivir can be considered for hospitalised children of all ages with Covid-19 who have an emergent or increasing need for supplemental oxygen. It also suggests that dexamethasone may be beneficial in pediatric patients with Covid-19 respiratory disease who are on mechanical ventilation.
The UK and Israel are planning to start inoculating children within the next six months, reports said. In other countries, specific strategies are being taken to treat severe cases as per the symptoms.
While there is no vaccine for kids yet, several companies have started clinical trials among adolescents and young children. India is yet to come up with a treatment protocol for children.
Why are more children testing positive for Covid-19 in second wave? What are the symptoms usually shown by children? What precautions should parents take? What have other countries done to check Covid-19 infections among children? We dissect each question by talking to experts.
Why is the second wave of Covid-19 affecting more children and adolescents?
Experts say the double mutant coronavirus variant alongside a cocktail of other strains have a higher tendency to infect children. Children getting infected from members of family who go outside and are lax in maintaining Covid-19 appropriate behaviour are also part of the spread seen during the second wave.
"The double mutant variant has immune escape phenomena. It masquerades as our own body system and then escapes our immunity protection. This is why more children are contracting Covid-19," said Dr Anjan Bhattacharya.
Dr Jaydeb Ray, Department of Pediatric Medicine, Institute of Child Health, Kolkata, said children were getting infected by Covid-19 in the first wave as well, but most cases were asymptomatic. "But now, we are seeing kids coming to hospitals coming with MISC (Multisystem Inflammatory Syndrome in Children). This time it is showing parallel to an active infection," he said.
However, Dr Sagnik Biswas, Senior Resident, AIIMS, said that given the rapid spread of the virus, the overall number of patients (both young and elderly) is expected to rise, but there doesn't seem to be any indication that the virus affects younger population more than the elderly. "The percentage of afflicted individuals under 30 years can be placed to around 32% as compared to 31% in the previous wave," Dr Biswas told IndiaToday.in.
What symptoms are children showing?
The second wave has shown that Covid-19 symptoms are not limited to just the respiratory system. The most common symptoms observed in children include high fever, chills, shortness of breath, cough, loss of smell, sore throat, myalgias, and mucocutaneous inflammatory signs. In the second wave, more Covid-19 positive children are showing gastrointestinal (GI) symptoms like loss of appetite, vomiting and diarrhea.
"Case reports are now emerging from several countries saying that Covid-19 may even lead to episodes of pancreatitis and decompensated liver disease, although these are based on clinical experience of few cases," said Dr Sagnik Biswas.
Dr Jaydeb Ray said warning signs such as elevation of inflammatory markers, fast breathing, lethargy and seizures should be monitored by parents for early detection of Covid-19 in children.
Why are Covid-19 positive children showing more gastrointestinal (GI) symptoms this time?
Although respiratory symptoms are more prominently highlighted, gastrointestinal manifestations are seen in up to 40-50 per cent cases, said Dr Sagnik Biswas, Department of Gastroenterology, AIIMS.
"Novel coronavirus uses ACE2 as a viral receptor for entering the GI tract. It is highly expressed in the glandular cells of gastric, duodenal, and rectal epithelia, supporting the entry of coronavirus into the host cells," he said.
Several studies have identified the presence of SARS-CoV-2 in stool samples. "A study comprising 10 pediatric patients evaluated their nasopharyngeal and rectal swabs. Eight children persistently tested positive on rectal swabs even after nasopharyngeal clearance of the virus. Furthermore, a cohort study demonstrated a significant enhancement of ACE2 expression in cholangiocytes as well as liver cells, indicating that the virus can lead to direct damage to intra hepatic bile ducts," Dr Sagnik Biswas said.
What should be done when a child tests Covid-19 positive? What precautions should be taken?
Experts say children showing mild symptoms should be home quarantined for 14 days. "If symptoms are mild and oxygen saturation is greater than 94 per cent, we have to give supportive care, adequate hydration, proper nutrition and paracetamol," said Dr Jaydeb Ray. If CRP (C-reactive protein) and ferritin (blood protein that contains iron) levels are elevated, then children must be admitted to a hospital, he said.
In the absence of any definitive therapy, social distancing, wearing masks, and hand washing are still the gold standard in prevention of disease among this age group, experts told IndiaToday.in.
What has the government said on Covid-19 affecting children?
Union Health Minister Harsh Vardhan told Parliament that children in the age group of 0-14 years were less affected by Covid-19. He said infection among children was mild and most of them remain asymptomatic.
"Hence no specific action plan has been formulated in the current response phase to minimize the adverse effects of Covid-19 on such children," Dr Harsh Vardhan said in a written reply.
Dr Vardhan further said that rarely a severe illness, in form of multi-system inflammatory syndrome, had been identified. This usually happens three to six weeks after the infection, he said. The Department of Pediatrics, AIIMS, is documenting the long-term effect of Covid-19 in children.
Are there any Covid-19 vaccines for children?
No, presently there is no Covid-19 vaccine that can be administered to those below 18 years of age. The Health Ministry has said clinical trials are underway to test the safety and efficacy of Covid-19 vaccines among children.
In February, Hyderabad-based Bharat Biotech had sought approval from the national drugs regulator for Phase 3 clinical trial of its Covid-19 vaccine --
Covaxin -- in children between the ages of 5 and 18 years. However, it was not granted permission since it did not produce efficacy data on adults.
Last week, Pfizer announced that trials of its vaccine in children aged 12 to 15 showed 100 per cent efficacy and a strong immune response, with no unusual side effects. It has now sought emergency approval from the US Food and Drug Administration to use its vaccine in this age group.
The University of Oxford had started testing the Covid-19 vaccine it developed with AstraZeneca in children and teenagers (this vaccine is available in India under the brand name Covishield). However, it has paused the trial following blood clotting issues in adults who received the jab.
Can newborns get Covid-19?
A very small number of cases have emerged where pregnant women infected with coronavirus have passed the disease on to their babies. Infants can also become infected shortly after being born. The US Centers for Disease Control and Prevention (CDC) has said that most newborns who test positive for Covid-19 have mild symptoms or none at all, and recover, but serious cases have occurred.
How have other countries dealt with child Covid-19 patients?
In the US, children represent about 13 per cent of all Covid-19 cases, according to the American Academy of Pediatrics and the Children's Hospital Association. The National Institutes of Health, which is the US's medical research agency, has formulated guidelines for treatment of children with Covid-19.
According to the NIH, most children with mild or moderate disease can be managed with supportive care alone. The NIH says Remdesivir can be considered for hospitalised children of all ages with Covid-19 who have an emergent or increasing need for supplemental oxygen. It also suggests that dexamethasone may be beneficial in pediatric patients with Covid-19 respiratory disease who are on mechanical ventilation.
The UK and Israel are planning to start inoculating children within the next six months, reports said. In other countries, specific strategies are being taken to treat severe cases as per the symptoms.
Reference:https://www.indiatoday.in/coronavirus-outbreak/story/covid-19-second-wave-children-infants-symptoms-treatment-what-should-parents-do-1794307-2021-04-23
