COVID ward of the Sirimavo Bandaranaike Children’s hospital

If a child has signs of feverish illness with high fever during the first two days of illness, seek medical advice, urged Dr. Aruna Herath in charge of the COVID ward at the Sirimavo Bandaranaike Children’s Hospital, Peradeniya.  He said that it was difficult to diagnose a child with COVID based on specific symptoms alone, with several other viral flus spreading around the country. 

Dr. Herath pointed out that it was best to rule out Dengue and other viruses at the earliest, as various complications could arise from COVID even several weeks after infection.  

These rare COVID related complications, including Long COVID and the deadly - Multi-System Inflammatory Syndrome in Children (MIS-C), have been seen in those coming for treatment to them from most parts of the country, Dr. Herath who also manages the Long COVID clinic at the hospital said.  

Shortness of breath, Cough and tiredness, abdominal pain, palpitations, lethargy and poor concentration are some signs of Long COVID; while non-resolving high fever, skin rashes, red lips and eyes are MIS-C symptoms. 

The most vulnerable are children with congenital heart disease, chronic kidney disease, cerebral palsy and other neurological disability, those with severe, uncontrolled asthma and those born prematurely

A child is considered to have Long COVID when symptoms drag for more than 12 weeks. MIS-C can arise 2 weeks onwards after contracting COVID and occurs in 1 in 5,000 children.  

“However, previously healthy, active kids who have shown no symptoms of the virus (Asymptomatic) or very mild symptoms during acute infection (the first three days of infection), are the most prone to Long COVID and MIS-C,” the doctor explained.  

 He added that while these complications were rare, parents should be vigilant. “Even if you think your child or a family member has previously contracted the flu, and your child shows symptoms of these complications during the mentioned time period, seek medical advice immediately,” he said.  

Sirimavo Bandaranaike children’s hospital

Skyrocketing Numbers and New Symptoms in Children
While the first two COVID waves that hit the country in 2020 and 2021 saw fewer children affected, the third wave of the virus especially during mid-January of this year, saw cases skyrocket.   

In the Kandy district from December 1, 2021 to February 28, 2022, 6,092 cases have been reported, out of which 732 cases were under 14 years of age (12.1%) according to regional epidemiology figures.   

 Convulsions and high fever in children coming in with COVID to the hospital, has been a marked difference in symptoms during this time period, according to Dr. Herath.   

If your child tells you of any signs that imitate Long COVID, seeing a doctor as early as possible is very important to manage the disease better

The seizures mostly occur on the first day of the child coming down with a high fever and can happen more than once. Nearly 50 children have come to the hospital with these symptoms since mid-January of this year, Dr. Herath pointed out.   

 “Mostly these children have had a previous history of convulsions or a family history of convulsions and a very few have had no prior history as well,” the doctor said adding that all children who came to the hospital made a complete recovery from all symptoms.  

“We could be seeing this new symptom because the rise in numbers infected naturally result in a rise in complications from the disease as well,” he explained.  

Children with COVID Show Varying Signs 
Describing some of the symptoms, the doctor said that if a child gets a blocked and runny nose, cough sore throat with or without fever it could indicate COVID.  

“However, there can be no respiratory symptoms as well,” he said, such as low or high fever, poor appetite, vomiting and diarrhoea.  

He added that teenagers sometimes come in with fever, giddiness and vertigo.   

“Dengue is usually associated with fever, headache, body aches and stomach pain,” the doctor continued. “But over the last few weeks, we have seen children coming to us infected with both Dengue and COVID.”  
Dr. Herath said this was why it was hard to pinpoint COVID with so many other viruses and infections going around.  

He further explained that symptoms can vary from mild to severe and that children under 2 years of age and those with underlying medical issues are the ones most prone to severe infection and even death during acute illness.   
The most vulnerable are children with congenital heart disease, chronic kidney disease, cerebral palsy and other neurological disability, those with severe, uncontrolled asthma and those born prematurely.  

Long COVID and MIS-C in Children
In normal cases, acute symptoms usually improve latest by four weeks, but children who come in with Long Covid and MIS-C show signs and symptoms well beyond it. However, what is most intriguing is that Asymptomatic children who are healthy and active and children who have had mild infections have come in with these significantly debilitating symptoms as well.  

Long COVID signs include:
Shortness of breath, cough, tiredness. Chest pains and palpitations. Episodic vomiting, diarrhoea and headaches. Neurological symptoms like poor attention and lethargy known as brain fog, and sometimes hyperactivity.  
“While we still do not know the exact cause of Long COVID, there are several aspects that are being considered,” said Dr. Herath.  

He said that some of the Long COVID symptoms in children are very similar to symptoms of anxiety and depression.   

“The extended lockdown, and as a result of it addictions to longer screen times, along with financial constraints in the family, have brought about new social issues for children,” the doctor explained. In his opinion, these circumstances, along with the mechanism of the disease itself causing a neurological change in the brain - could be one of the factors leading to Long COVID.  

He urged parents and teachers not to take any complaints made by children lightly, or consider them ‘made up stories’. “If your child tells you of any signs that imitate Long COVID, seeing a doctor as early as possible is very important to manage the disease better,” he said.  

MIS-C 
It is a disease that affects several systems of the body and is most likely brought on by the Antibody created by the COVID virus attacking and inflaming parts of the body like the heart, blood vessels, kidney, liver and brain.  
“While the disease is deadly, it can be treated if diagnosed early,” Dr. Herath said.  

Symptoms include:  
Very high fever, skin rash, red eyes, lips or tongue, severe headache and severe diarrhoea, along with fatigue and lack of activity.  

what was most concerning was that the psychological implications of lockdown were far more in children after facing disruptions to their normal activities as a result of COVID

Dr. Aruna Herath

Procedure at Hospitals and How to Treat your Child at Home
When a sick child is brought to the OPD of any government hospital, a doctor would first check the history of the patient.   

No Antigen test will be recommended if the doctor is certain that the patient has a mild illness and will instruct how to treat the child at home.  

If the child is showing signs of acute symptoms, the doctor will decide to admit the patient and then recommend an antigen test to check for COVID. If the test comes out positive, the child will be isolated with a parent or guardian and kept in hospital till full recovery.  

Dr. Herath said that if treating a sick child at home suspected of COVID, adequate sleep and rest is very important.  

For fever, only Paracetamol is recommended and other types of fever medication should be avoided. Keeping the child hydrated and giving the oral hydration solution ‘Jeewanee’ if there is diarrhoea or vomiting too is important.   
“Avoiding artificial food or drink as these can cause allergies should be kept in mind,” the doctor said, adding that a healthy diet is advised.  

if treating a sick child at home suspected of COVID, adequate sleep and rest is very important

If a child should have convulsions that may occur on the first day of high fever, do not panic, turn them to the left on a flat surface. The convulsions should stop in about 5 minutes, after which immediately take them to the nearest hospital. If the convulsions should continue beyond 5 minutes, keep them turned to the left side and take them to a hospital even if they continue convulsing.  

Dr. Herath said that what was most concerning was that the psychological implications of lockdown were far more in children after facing disruptions to their normal activities as a result of COVID.   

“So shutting down schools is not the answer,” the doctor said reiterating that parents should be aware of signs and symptoms in their children and keep them at home if they get sick.  

Vaccinated Adults reduce risk of  COVID in Children

Kandy district Regional Epidemiologist Dr. Pasan Jayasinghe said that it was the responsibility of adults to be fully vaccinated, in order to reduce the spread of the COVID virus in children.

He said that vaccinating children under 12 years was still under discussion, as the development of COVID vaccines are relatively new, and it is not fully known how it will affect them in the long run.

despite island-wide figures being at a low, close to 78 per cent of adults have received the COVID booster dose in the Central Province. This was a positive sign in reaching community immunity, which hopefully would extend throughout the country too

Dr. Pasan Jayasinghe 

“Adults getting fully vaccinated will lead to community immunity, which will help the COVID virus become less virulent,” Dr. Jayasinghe explained. This would help any variants of the virus to become less powerful than its predecessors. 

This in turn would mean that children would be even less affected by COVID along with others in time. As a result, the Doctor said that adults had a duty to their children to be fully vaccinated in order to increase resistance to the virus and reduce its spread.

Furthermore, Dr. Jayasinghe said that a minimum of 18 months are needed in order to develop a vaccine. The COVID Vaccine was developed before this necessary time period, with significant gap areas that are yet to be determined. 

He said that a vaccine to mitigate the spread in children could not be solely depended on because of this reason, and a careful study had to be done before giving it to children under 12 years.  

“Vaccines cannot be used to completely prevent a virus,” the doctor added. “The COVID vaccine too helps only in reducing the effects of morbidity (complications) brought on by the virus, as well as reduces the chances of mortality (death) if you contract COVID.”

Speaking about the spike in cases from mid-January of this year, Dr. Jayasinghe said that despite the numbers going up, the percentage of children who have contracted COVID remains at 12.1 per cent, the same as since the start of the epidemic.

 “In an epidemiological perspective, it is clear that so far there has been no mortality pattern in children when it comes to COVID,” Dr. Jayasinghe said adding that death was the least likely in healthy children who contracted the virus. “So it is evident that they are the most robust and are more capable of fighting the virus if it enters their bodies without the help of a vaccine.”

He went on to say that vaccines were targeted at those who were more vulnerable in society, the above 60-year-olds. “78.6 per cent of COVID deaths in Sri Lanka over the course of the epidemic have been from the 60+ age group, a quarter of the deaths have been below 60 years, and only 1 per cent of deaths are accounted for in the below 30-year age group,” he explained. Dr. Jayasinghe went on to add that despite island-wide figures being at a low, close to 78 per cent of adults have received the COVID booster dose in the Central Province. This was a positive sign in reaching community immunity, which hopefully would extend throughout the country too.