Source: idsMED Malaysia
The Royal College of Nursing recently reminded us that we still need to be alert to Covid-19 infection in children. It said, “Children and young adults generally did not feel the biggest immediate impact of the pandemic, but the long-term effects on them are now becoming apparent.”
In conjunction with protecting children from the risks of getting Covid-19, RespoKare recently interviewed Dr Rakhee Yadav, the Consultant Paediatrician and Head of the Department of Paediatrics in Ara Damansara Medical Centre. She was also recently awarded as one of the ‘Successful People in Malaysia 2021’ by Britishpedia.
- What are the most common symptoms of the Covid-19 virus in children?
Generally, COVID-19 symptoms in kids and babies are milder than in adults, and some infected children may not have any signs of being sick (i.e., asymptomatic). COVID-19 symptoms for children include cough, fever and/or chills, shortness of breath or difficulty breathing, muscle or body aches, and sore throat. Also included among the symptoms are loss of taste or smell, diarrhea, headache, fatigue, nausea or vomiting, nasal congestion or runny nose.
However, serious illness in children with COVID-19 is possible, and parents should stay alert if their child is diagnosed with, or shows signs of the disease. Parents should immediately seek urgent medical care if they notice these warning signs:
- Difficulty breathing
- Inability to keep down any liquids
- Confusion or inability to awaken
- Bluish lips
- How is Covid-19 transmitted?
COVID-19 can be transmitted when people breathe in air contaminated by droplets and small airborne particles. The risk of breathing these in is highest when people are in close proximity, particularly indoors.
- Can children have the flu and coronavirus at the same time?
Yes, they can. Influenza and Covid-19 are two different viruses that can infect the body separately or at the same time. The signs and symptoms of Covid-19 and influenza have been summarized below:
- What can Covid-19 do to children?
Covid-19 infection can be asymptomatic in some children but can also cause severe illness and multi-organ failure. A rare complication is known as Multisystem Inflammatory Syndrome in Children (MIS-C) can happen in children 2 to 6 weeks post-infection. Long Covid can occur in 10% – 25% of children previously infected.
- Can children be asymptomatic? How many children with coronavirus don’t have symptoms?
Children can be asymptomatic. A recent study showed that up to 15% to 50% of children remain asymptomatic during their infection.
- Can asymptomatic or pre-symptomatic children spread the virus to others?
Yes, they can. This is known as the incubation period, where a child can remain asymptomatic but still contagious and can spread the virus to others.
- When are children with coronavirus most contagious?
The incubation period of SARS-CoV-2 appears to be about the same for children as in adults, at 2-14 days with an average of 6 days. Children remain contagious throughout this period.
- What are the risk factors for serious cases of Covid-19 in children?
According to CDC, some children may be at a higher risk for a serious case of COVID-19 and may require medical care in a hospital. These include:
- Those below two years old
- Children who were born prematurely
- Those with obesity or chronic lung disease
- My children already had Covid-19. Can they still get reinfected?
Yes, they can get reinfected, especially with so many variants out there. The current variants affecting a majority of children in Malaysia are the Delta and Omicron variants. We also have to remember that children below five years old cannot be vaccinated as there are no available vaccines at the moment. This leaves them vulnerable to infections and reinfections.
I would also like to stress here that there is no interval gap necessary even if your child has been infected with Covid-19 and them getting their 1st or 2nd dose of the Covid-19 vaccine. As long as your child is well and out of quarantine, they can proceed with their vaccination.
- Would you advise parents to get their children vaccinated?
I would recommend parents with children five years and older to get their children vaccinated as soon as possible and complete both doses according to the recommended intervals. There are two types of Covid-19 vaccines available for children in Malaysia for those aged five years and above.
The Covid-19 Pfizer vaccine for children between the ages of five to eleven years old is only one-third of the dose of the adult vaccine. It is 10mcg (0.2ml) given as a 2-dose regime with an 8-week interval (Pfizer). This dose was proven in Phase 1, 2, and 3 trials to produce the same antibody response as the higher doses given to adolescents (also known as non-inferiority trials) but with a reduced side effect profile. This means that this smaller dose is enough to provide young children with the same amount of protection.
The Covid-19 vaccine Sinovac dose is the same as for adults at 3mcg (0.5ml) with a 4-week interval (Sinovac).
- Can fully vaccinated children still get breakthrough Covid-19?
Yes, they can. However, the rate of infections (especially severe infections) is much higher in an unvaccinated child compared to a partially or fully vaccinated child. The severity of symptoms is also milder in those fully vaccinated.
- Are any of these new Covid-19 variants more dangerous for children?
All Covid19 variants can be dangerous for children. There are many factors at play when a child gets infected. The type of variant, the age of the child, the location (urban versus rural may affect their medical treatment availability), their underlying comorbidities and the severity of their infection.
- Are post-Covid symptoms different in children than in adults?
Post-Covid symptoms (long covid or complications) are something that is still being studied and a large proportion of this remains unknown. However, we do know that children have a risk of developing MIS-C within two to six weeks of getting infected. The potential long-term effects of SARS-CoV-2 infection remain a major concern among many parents. Unfortunately, data remains scarce on long covid in young people compared to adults.
Reports suggest that more than half of children who did not have Covid-19 experienced symptoms such as headaches, fatigue, sleep disturbance, and concentration difficulties during the pandemic. Distinguishing long-term symptoms caused by SARS-CoV-2 infection from pandemic-related symptoms remains a challenge as well.
Currently, a third of all children and adolescents report negative emotions, such as sadness or anxiety, highlighting the toll of the pandemic on this age group. Vaccinating children might help reduce some of the indirect harms caused by repeat testing, isolation, lockdowns, school closures, and reduced social activities. As Covid-19 remains predominantly a mild infection in the paediatric population, the incidence of long covid is a critical factor in the risk-benefit equation for policy and parental decisions on Covid-19 vaccines for children.
- We have transitioned to living with Covid-19 with the reopening of schools and international travels on 1 April. What steps can parents take to reduce the risks of children getting Covid-19?
While it’s rare for children to become severely unwell or die from COVID-19, children can get very sick with the disease, therefore vaccination can help prevent the need for hospital or ICU care. Vaccination can also help prevent milder but still uncomfortable symptoms like headache, sore throat, cough or fever.
Vaccination can also reduce the risk that your child will spread COVID-19 to others. Many people in our community are at greater risk of serious illness from COVID-19. The more people who choose to get vaccinated, the greater the protection is offered to our community as a whole.
There are also other benefits to vaccinating children in this age group. Vaccination of children can lower the probability of schools needing to close to help control the spread of COVID-19. This lessens the likelihood for children to miss out on activities and events, and for their parents and caregivers to make special arrangements (i.e. missing work) to look after them and isolate them because they have caught COVID-19.
- What “underlying conditions” can put children at higher risk of bad outcomes with Covid-19?
Current evidence suggests that children with medical conditions such as those with genetic, neurologic, metabolic conditions, or congenital heart disease might be at increased risk for severe illness from COVID-19. Similar to adults, children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, or immunosuppression might also be at increased risk for severe illness from COVID-19.
- What are the complications for children if they contract severe Covid-19?
Similar to adults, children with severe COVID-19 may develop respiratory failure, myocarditis (heart inflammation), shock, acute kidney failure, coagulopathy (bleeding tendencies), and multi-organ system failure. Some children with COVID-19 have developed other serious problems like intussusception, diabetic ketoacidosis and Multisystem Inflammatory Syndrome in Children (MIS-C).
- As a doctor, have you seen many children admitted to the hospital for Covid-19, or worse, getting admitted to the critical care unit?
Yes, we are seeing a rise in the number of children getting infected or being admitted to the hospital over the past few months. Our Minister of Health recently announced that there was a 160% rise in the number of children being infected in Malaysia. Those requiring ICU admission are usually those below one year old or with underlying commodities and MIS-C cases.
- What is MIS-C? How many children get it? Does it only affect children who have had severe Covid-19? What are the signs of MIS-C?
Multisystem inflammatory syndrome in children (MIS-C) is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. It can present itself similar to incomplete Kawasaki disease (KD) or toxic shock syndrome. We do not yet know what causes MIS-C., and it can be serious and even deadly in some children. While the incidence of MIS-C is uncertain, it appears to be a relatively rare complication of COVID-19 in children, affecting one in 3200 children.
In Malaysia, 174 children experienced MIS-C after being infected with Covid-19 between June 2020 and December 2021. Here is the breakdown of cases:
- 25 cases: below one-year-old
- 38 cases: one to five-year-old
- 64 cases: five to nine years old
- 36 cases: nine to 12-years-old
- 11 cases: above 12-years-old
In Malaysia, seven children aged 18 and below have died of the multisystem inflammatory syndrome (MIS-C) due to Covid-19 infections.
- What is the treatment for children with Multisystem Inflammatory Syndrome?
MIS-C can be treated if children get an early diagnosis and appropriate medical attention. However, some children deteriorate rapidly or do not medical attention on time. Without early diagnosis and appropriate management and treatment, MIS-C can lead to severe problems with vital organs such as the heart, lungs or kidneys. In rare cases, MIS-C can result in permanent organ damage or even death. As there is no specific treatment for MIS-C, children are treated symptomatically and, on some occasions, require high-dose steroid therapy.
- How long do children with MIS-C need treatment?
It depends on what complication of MIS-C the child has as different organs affected may require different treatment and duration of treatment. The most important thing is to seek treatment or early advice if MIS-C is suspected in a child. The treatment should not be delayed as this could lead to death.
- You mentioned Covid-19 is an airborne virus. How important is wearing a mask?
We must remember that protection against Covid-19 is multilayered. Wearing a well-fitted mask along with vaccination, self-testing, and physical distancing, help protect you and others by reducing the chance of getting infected or spreading COVID-19. Masking is a critical public health tool and it is important to remember that any mask is better than no mask. Wear the most protective mask you can that fits well and that you will wear consistently.
The American Academy of Paediatrics has recommended safe mask-wearing for those above 2 years old. In children younger than this, it is recommended that those around them wear a mask to reduce further spread. With the rise in variants and infection rates, upgrading your mask to a properly fitted mask would be more beneficial, especially in crowded areas. Currently, there is no real benefit of wearing a cloth mask, especially for children.
- An adult will touch their face 23 times per hour and children even more often than adults. Will a high-quality anti-viral mask-like RespoKare Child Mask that kills harmful bacteria and viruses, including Covid-19, be useful in protecting children?
As we move into the endemic phase, mask mandates may not remain. However, wearing a mask to protect yourself and your loved ones does not need to be something forced. We should still wear a mask in crowded spaces especially when indoors. We should still advocate wearing a mask especially if we are around younger children who are still unable to be vaccinated or keep a mask on.
When deciding to choose the right mask, we need to look at several factors that includes fitting (comfort), material, patterns (especially for children) and any other added advantages, such as antiviral or antibacterial properties. Finding the right mask is essential to provide the best protection for you and your family.
Tan Sri Dato’ Sri Dr Noor Hisham, Health Ministry Director-General, recently reminded us that Malaysia had not entered the endemic phase yet, therefore wearing a mask is still required. With international borders lifted and the start of the vaccination process for children aged five and above, it is crucial to provide better protection to reduce the risks of children getting Covid-19.
RespoKare Anti-Viral Mask, available for both adults and children, is the first and only stringent United States’ Food and Drug Administration (FDA) cleared for its capacity to kill 99.99% coronavirus under 1 minute and other 15 viruses in 5 minutes. It is also listed as an approved respirator by United States’ Central Disease Control (CDC.gov) and registered with the Medical Device Authority of Malaysia. RespoKare provides the wearer with active protection via its patented ViraxTM technology, killing viruses and pathogens. This breakthrough innovation provides active and a much higher protection than any other masks in the market.
The ultimate difference between an ordinary mask and the RespoKare mask is that the infected droplets may remain on the surface of the ordinary mask, thus running the risk of contamination when touched. In comparison, the design technology of RespoKare anti-viral mask quickly absorbs said droplets, traps and destroys them.
The outer layer of the RespoKare masks is coated with a hydrophilic layer which allows infected droplets to be rapidly absorbed and trapped. The coating’s low pH environment denatures and damages the surface membrane of viruses within 5 seconds. Infected droplets are quickly wicked away from the outer surface into the second ViraxTM virucidal layer where the viruses are trapped and destroyed by copper and zinc ions. The RespoKare masks have also been tested in an independent laboratory with simulated conditions of continuous virus exposure. They are outstandingly proven to effectively destroy 99.99% of the virus challenge over an 8-hour period.
The RespoKare masks ensure the breathing area (nose and mouth) are protected against fluids, microorganisms and particulates at ASTM F2100 Level 3, the highest standard performance requirements in bacterial filtration efficiency. RespoKare’s anti-viral surgical mask is designed to achieve low airflow resistance for easy breathing and is therefore suitable for daily use. It is also hypoallergenic and safe for children with sensitive skin.
RespoKare Anti Viral masks are available online at https://t2m.io/Shopee-FB and https://t2m.io/Lazada-FB. You may also find it at the following pharmacies: Caring Pharmacy, Big Pharmacy, Health Lane Family Pharmacy, Ascen Plus Pharmacy, De Care Pharmacy and Marina Pharmacy.