Covid-19 in children: Is it time to panic?

Of the estimated 12 million people that have tested positive for Covid-19 globally since the outbreak, only 6 percent are children. Children also make up for less than 3 percent of the hospitalized patients, though hospitalization rate is higher in children less than five years, compared to older children. There are many reasons speculated as to why Covid-19 has had a lesser impact on children.

One explanation is that the virus can’t attach to body linings (e.g. nasal mucosa) as the receptors are less in children; another is that children are protected by antibodies produced by other viruses they are exposed to, and these antibodies are protective, points out Dr Swati Garekar, Consultant, Paediatric Cardiology, Fortis Hospital, Mulund.

Yet another reason is that children are staying at home during the pandemic, and hence are less likely to be exposed to people who may be Covid-19 positive, she adds.

India is the second most populous country in the world and has demographic profile of a young nation with 26 percent (367million out of 1.4billion) being children less than 15 years of age. This could have translated into huge number of Covid-19 positive cases. However, Indian population’s recovery rate from Covid-19 is faster than most countries, and the death rate is much lower too.

There have been several reports that highlight a peculiar illness affecting children these days; in which, children have had persistent fever (more than three days), rash, red eyes, stomach pain and nausea/vomiting, informs Dr Garekar. “Sore throat and cough/cold is much less common. Blood tests show generalized inflammation and the heart is involved in a major way. Here the typical adult finding of bad Pneumonia is missing. There may or may not be positive COVID-19 test (PCR or the antibody test) and they may have had close contact with a COVID-19 patient. The involvement of the heart is the most worrisome” laments the expert.

“The heart muscles could have weakened and the coronary artery walls may have been damaged. Special intravenous medicines (steroids and Immunoglobulins) are required to bring the disease under control. These medicines are most effective when given early in the course of the disease.”

The peculiar disease affecting multiple organs in children has been termed ‘Multisystem Inflammatory Syndrome in Children’ (MIS-C), she says.

The World Health Organisation (WHO) and Centre for Disease Control (CDC) US, has now given it a distinct definition. MIS-C was first reported from Europe and then the US. It seems to be occurring at the end wave of the epidemic that is 2-4 weeks after peak infection rate is seen in the population.

Dr Garekar advises parents to contact paediatrician if their child has persistent fever, along with a rash or red eyes or stomach ache/ vomiting. Suspicion of MIS-C should be aroused and investigated in sick children. Typically, the Paediatrician will rapidly rule out more likely causes like Typhoid, Dengue Fever, Malaria, etc, she says.

“Another mimicker is ‘Kawasaki Disease’. Kawasaki Disease affects younger population (less than 5years of age), here platelet counts are high, unlike MIS-C. Also, Heart muscle damage is more frequent in MIS-C. Heart involvement can be picked up by Echocardiography and certain blood markers of Heart inflammation. Early diagnosis and treatment will ensure early recovery and less chance of long term damage. In short, there is no reason to panic, but parental vigilance is the key,” she concludes.