Covid: Mild symptoms in children puzzle experts

Researchers from Indian Council of Medical Research argue that childhood vaccination could have played a role in minimising impact of Covid among children

By Author  |  Published: 23rd Jul 2020  12:33 amUpdated: 23rd Jul 2020  12:40 am

Hyderabad: Due to their immature immune system, children are traditionally vulnerable to respiratory ailments like pneumonia, viral influenza and bacterial infections. However, what has perplexed paediatricians and epidemiologists is the fact that Covid-19 has manifested in the form of mild symptoms among a majority of children not only in Telangana but across the country.

This is not only true in India but also is a fact in other countries like China and the West, where the elderly and people with pre-existing medical conditions had to bear the brunt of the impact of SARS-CoV-2 while children had mild symptoms.

Researchers from the Indian Council of Medical Research (ICMR), in a paper titled ‘Coronavirus diseases 2019 in children: clinical and epidemiological implications’, published in the Indian Journal of Medical Research (IJMR) on Wednesday, have enumerated possibilities that could have caused mild symptoms among Covid positive children in India.

Immune system differences between children and adults

ICMR researchers said the difference in immune systems of children and adults needs special attention while considering why children are less impacted.

“The immune system in children is not fully developed. There is a possibility that children are not mounting an intense inflammatory response, and hence, the host-mediated damage is limited. On the other hand, adults may be at risk of severe disease due to their different immune response characterised by excessive inflammation,” researchers said.

Role of vaccines

Researchers in the IJMR paper have argued that childhood vaccination could have played a role in less impact of Covid among children. As part of the National immunisation programme, from birth, children in India receive several doses of different vaccines. The researchers pointed out that the immune stimulation that comes from these vaccines and its role in protection from Covid must be further explored. “Cross-protection by antibodies generated following measles vaccination and cell-mediated immune response generated by BCG vaccination also need evaluation’, they said.

Role of other infections

Children frequently suffer from mild infections by the respiratory and GI (Gastro-Intestinal) viruses. It needs to be seen whether pre-existing antibodies against these viral infections causing common cold or other respiratory virus infections or GI infections confer cross-protection against Covid-19 among the children, the researchers said.

Role of co-infections

The researchers have said that there is a need for further research on the possibility of waning of vaccine-mediated immunity among adults from bacterial pathogens, which could be a possible reason for severity in Covid-19 among them while there was none among children. The researchers have acknowledged that there is a need to fill the knowledge gap on why epidemiology and clinical patterns of Covid-19 among children is different when compared to adults.

Should we re-open educational institutions?

As policy makers continue to explore and debate the possibility of physically opening schools in the near future during the ongoing Covid-19 pandemic, epidemiologists and researchers have advised that certain risks and possibilities must be considered before taking such decisions.

There is a risk of Covid transmission among the community from children with asymptomatic or mild infection, especially during re-opening of schools and even in day-care centres, researchers from the Indian Council of Medical Research (ICMR) in their recent paper on Covid-19 and children, said.

The paper said that asymptomatic carriers (i.e. children) with prolonged viral shedding in the respiratory and faecal samples pose a risk to the contacts. The ICMR has made it clear that specific precautionary measures aimed at breaking the transmission chains of SARS-Co-V2 must be taken in schools and day-care centres, once they re-open such institutions.

Senior public health officials have said that there are aspects that are often unique to schools and other educational institutions in Hyderabad. More than half of the students are ‘dropped’ and ‘picked-up’ at and from schools by their parents, which causes mass gatherings at the entry and exit points of schools. Such conditions are ideal for proliferation of SARS-CoV-2, which must be addressed by school managements and authorities, before opening schools.

On its part, the Centres for Disease Control (CDC) and Prevention, United States in its advisory has said that schools must make provisions that can help protect students, teachers, administrators and staff, aimed at slowing the spread of Covid-19.

Based on the guiding principles that have to be kept in mind before thinking about reopening the schools, the CDC, United States says that the highest risk of Covid-19 transmission happens when full-sized, in-person activities and events are organised in schools. Students are not spaced apart, share classroom materials or supplies and mix between classes and activities.

The Covid-19 transmission risk is also more or high in settings like small, in-person classes, activities and events. Groups of students staying together and with the same teacher throughout and across school days also carry a risk.

Before or while reopening educational institutions, schools should consider promoting behavioural change among staff, administration and children in schools, aimed at reducing the spread of Covid-19.

 


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