Children and Coronavirus Covid19

Introduction

In the few days whilst writing this article in between patient consults, there have been an unprecedented, once-a-century tsunamic-type response globally to the coronavirus Covid19. Singapore itself went from “ stable cluster “ type coronavirus Covid19 infections, to exponential rise of numbers largely from imported cases. The world went from a “let’s just be careful approach” to that of many panic and lock-downs. Travel bans became the norm, and SHN became the new must-know abbreviation. 

The focus in this current coronavirus Covid19 pandemic has largely been on adults and the elderly. Significantly fewer kids have been sickened, and fatalities are fortunately rare amongst children and teenagers. Nonetheless, coronavirus Covid19 needs to be taken seriously even amongst those under twenty.

 

1. Coronavirus Covid19 Does Affect Children

Currently available WHO statistics note that children are much less likely to show symptoms of, get seriously ill or die from coronavirus Covid19. In China, studies have shown for example, that 18% of adults get seriously ill, but only 6% of kids are seriously affected. Experts are still unsure if this is because children have immune systems that respond better to coronavirus Covid19; or if it is because coronavirus Covid19 virus does not attach itself well to the child’s cells even. Nonetheless, experts believe that the true number of infections in children, if it includes those with mild or no symptoms, is far higher than what has been reported. As the coronavirus Covid19 situation is still evolving rapidly globally, even amongst adults, the definitive transmission and outcome numbers will not be available for some time. The exact figures will differ between countries, the stage of progression of coronavirus Covid19, the resources available, the measures implemented to stop the disease, and the social mindedness of the population.

Kids do test positive for Covid19 in studies, but is it not yet clear what their exact role in transmission of the disease yet as they show few symptoms and are relatively well. It is unclear how many children get infected, and how many go on to have symptoms and are sickened mildly as these well patients would not usually see a doctor. A month ago, no travel history would not make one a “Suspect” case should there be mild upper respiratory tract symptoms. However, the situation is changing with the increase in numbers of imported cases and start of community transmission. There is no room for complacency either, as emerging research has shown that the viral load before a patient shows symptoms can be higher than when a patient is showing symptoms. Before we have the full answers, it is important to continue to practice social distancing and enforce hygiene measures, especially if there are elderly grandparents at home. Though China had only one confirmed cases of death in a someone younger than twenty through February 11 2020, by March there have now been the few rare reports of fatality in children in other countries.

 

2. Coronavirus Covid19 May Not Present with Fever

Unlike the flu, fever is more often low grade for coronavirus Covid19 in the early stages. As only 50% of those affected may have fever, passing a temperature check does not mean one is coronavirus free. The incubation period is usually up to 5 days, but can be for 2 weeks. Coronavirus Covid19 symptoms are varied and mimic those of the common flu like sore throat, cough, headache, body ache and lethargy. Some have only mild diarrhoea. Unlike the flu where runny nose is a common symptom, the nose may only feel slightly blocked. Some report loss of sense of smell. Usually, flu cases would improve within the week, but severe infections of Covid19 may suddenly feel breathless and need ventilator support, with deaths often happening in the 2nd or 3rd week. 

In Southeast Asia, many children have year-round perennial allergic rhinitis that cause nose symptoms. Common allergens include house dust mites, cockroach, mould, grass and tree pollen, dog and cat dander. Many children also get flu, cold or bacterial infections of the nose and throat all year round. Young children do often have nose block from adenoid enlargement between the ages of 2 to 8 too. Hence, it can be extremely challenging for a parent to differentiate between allergies, flu, adenoid or coronavirus Covid19 symptoms. 

When in doubt, have your child checked by a general practitioner or paediatrician. Do not doctor hop, as the diagnosis becomes clearer with observation of disease progression after starting simple treatments. The same doctor can refer for Covid19 testing if that is deemed to be necessary. Usual nose swabs done during non-Covid19 times cannot detect the coronavirus Covid19; it is used to detect the common viruses like flu virus and bacteria. Flexible nose scopes done by Ear Nose Throat doctors cannot detect the Covid19 virus. Rather, the scopes are done to exclude anatomical differences and exclude polyp and tumour and adenoid hypertrophy. Skin prick allergy testing can only be done after the acute upper respiratory infection is over, when the child is off antihistamine and cough medications.

 

3.Parents Can Help Keep Their Child Coronavirus Free

This coronavirus Covid19 pandemic is a global threat that can affect each and every one of us. It is expected that 40 to 80% of the population can eventually get it, and about 20% will have serious illness. This means that if 40% of a 6 million population is infected, 480 thousand will get seriously ill and may need ventilator support. Assuming a death rate of 2% in these severe cases, it means 9600 may die. These are terrifying figures.  We need to have a war-like mentality to overcome Covid19, we must be prepared to do whatever it takes with an eye on the big picture. Yet, we need a zen-like equanimity to carry on with life, and not forget to give thanks. With this enemy that is super smart in evading early detection, supremely agile in transmission, and without a cure currently, it is natural to fear it. Parents are understandably stressed, especially as their kids may not understand the gravity of the situation. 

Compared to SARS, coronavirus Covid19 patients produce 1000 times more viral load  and is more infectious. Unlike SARS, coronavirus Covid19 is most contagious during the first week of symptoms, when most patients are not very sick. In fact, viral shedding has been noted for 2 days before symptoms start. This means there can be a lot of transmission unwittingly in the community as the patients will not be self-isolating or wearing masks then, and others will not be avoiding them.

It is of critical importance thus, that kids also practice social distancing – “Together we fall, Apart we stand”. If there is any essential gathering, keep them short, and stay 1 to even 2 metres apart – not an easy task. It is now a good time to rediscover the simple joys of staying at home, reading, developing creative tasks and games together, cleaning out the cupboards. 

Kids must do hand washing properly, not touch their face, put things in their mouth, or dig their nose. Draw a smiley face on their hands, and challenge them to wash it all off! Fortunately, the Singapore childcare centres and schools do a good job of teaching that too. Let the child know that he or she is saving a life by masking up and self-isolating at the first sign of sickness. Remember to go on to tell them their face is a diamond that is not to be touched, and that their mask must be kept pristine and untouched too. The masks must be well fitting, and discarded safely in the bins, not left flung onto the sofa or stuffed into the pocket.  Make sure they are eating and sleeping well to keep their immunity tip-top. 

Children may be stressed witnessing the sea change at home and hearing the endless barrage of Covid19 news. Talk to them and help them make sense of what is happening, there are good lessons to be learnt, as this coronavirus Covid19 may come again,  and this will not be the last microbe to challenge them. 

 

4. Closing schools is a weighty decision

With many countries shutting schools, many parents may wonder why the Singapore schools remain open. As different countries are seeing different speeds of evolution of the disease and extent of community transmission as they have different measures and challenges in place – there is no one size fits all kind of measure. The Singapore government is monitoring the situation closely and most people trust them to keep the population safe. It is still unclear if stopping schools is effective in reducing Covid19 infected cases, and if the kids infect the adults or vice versa. Pulling kids out of school comes with its own set of challenges besides disrupting education. Caregivers may need to stop work and there could be income disruption and job loss if this is prolonged. If kids and teenagers still gather in or out of their house at tuition or play, that may be worse. School closures may be needed at some point, and at an optimal time – the difficulty is in not knowing how long this will last and how bad it is going to get. This issue remains nonetheless, a very stressful one for parents. Many children take the public transport, and many teachers, support staff and elderly cleaners in the education realm are involved in the schools. 

 

5. How will Covid19 pan out, when will it end

It is going to take up to the middle of the year at least; there may be a 2nd wave, and coronavirus Covid19 may come again next year. It also depends on how we collectively respond to it and take care of one another. I am eternally optimistic; we all need to be. Despite this being a much trickier and formidable virus than SARS, Swine Flu or MERS for its ferocity of transmission and difficulty of early detection, history has shown that humanity will overcome this. 

The statistics will change, the government advisories will change by the day. It is a rapidly evolving situation as global infection rates rise. By necessity, Singapore is an open economy and business hub. The virus behaviour may change with the months; the healthcare resources and response maybe stretched. It is imperative that each one of us do part to slow the progression of the disease so that the healthcare system can continue to help keep the fatalities low. It is a stressful time, but I personally cannot think of another place I would rather be right now. Take heart, and let us all press on together!

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