COVID-19 and the Change in Perspective: Musings of Two Seasoned Pediatricians

Suresh Chelliah*, Senguttuvan Duraisamy

Department of Paediatrics, Kauvery Hospital, Trichy-Cantonment, India

*Correspondence: chelliah.suresh@yahoo.in

Children commonly suffer from seasonal respiratory infections. They have always been the face of viral respiratory infections. Though this was not the case with the recent COVID pandemic, they risk among being its biggest victims, in particular by the socio-economic impacts and migration issues [1].

The big change we observed in our unit was the almost complete disappearance of severe respiratory infections in the last year. Our seasonal respiratory infections usually start in the second half of September and end by Mid-January.

Using High Frequency Nasal Oxygen (HFNO) as a surrogate marker for severe respiratory illness, we found that in the six weeks ending November 7th this year, HFNO has been used to treat 16 children as against one child in the same period in 2020.

Similar findings were recorded by Ippolito et.al [2], from Milan Italy. Compared with the average number of hospitalized children in the pre-COVID-19 seasons, 81 cases, during 2020/2021 the number was 16, a reduction of 80% that was statistically significant (cumulative Poisson probability, p < 0.00001).

Measures that made a difference include wearing a face mask, social distancing, hand washing and avoidance of overcrowding. Viral structure may also have played a role. Non-enveloped viruses have a longer stability and are able to survive outside the host for longer periods thus making non-pharmaceutical interventions less effective [2]. Viruses like Respiratory Syncytial Virus, Influenza and Para Influenza viruses can cause severe illness are enveloped viruses, whereas adeno and rhino viruses are non-enveloped [3]. The Italian study found that incidence of Rhinovirus and Adenovirus infections remained the same [2].

Day care centres and schools have been suggested as a significant risk factor for occurrence of respiratory infections. The present rise in the number of children presenting to the hospital, through primary school and day care centres have remained closed, belies the fact. Incidence of other tropical infections like Dengue, Typhoid and scrub Typhus was low during the pandemic, probably because of social isolation and decreased outdoor activities.  However, childhood obesity and psychosocial problems are on the rise because of the same reasons.

Few things we have learnt during this period are;

Face masks and social distancing cannot be a long-term preventive method in our country because of overcrowding and non- compliance by individuals.

Face masks will not prevent spread of viruses, if used only by symptomatic individuals.  Spread starts before symptoms appear.

Universal flu vaccination of all adults is not feasible.

Having learnt these, what are the suggestions?

Hand washing saves lives, not just in hospitals.

Face masks may be used when there are small infants at home, especially those with risk factors.

Cocoon vaccination as practiced for prevention of pertussis may be extended to add influenza vaccination.  This involves vaccination of those that may come in close contact with infants who will complete the vaccination only by seven months.

Indian academy of Pediatrics recommends Influenza vaccine for all children between six months and 5 years. Vaccination of adults against pertussis, pneumococcus and influenza virus should be taken up by the private sector.  Government will then consider taking it up, once the cost benefit ratio is demonstrated.

References 

  1. https://data.unicef.org/covid-19-and-children/Covid. Children and Covid 19 – UNICEF data
  2. Ippolito G, La Vecchia A, Umbrello G, et al. Disappearance of seasonal respiratory viruses in children under two years old during COVID-19 pandemic: a monocentric retrospective study in Milan, Italy. Front Pediatrics. 2021;9.
  3. Nelson PP, Papadopoulos NG, Skevaki C. Respiratory viral pathogens. Reference Module in Biomedical Sciences. 2020.
Dr.-D.-Suresh-Chelliah

Dr. D. Suresh Chelliah

Senior Consultant Paediatrician (Head – Academics)

 

Dr.-D.-Senguttuvan

Dr. D. Senguttuvan

Chief Consultant Paediatrician & Executive Director

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