Protecting children at high risk of severe illness linked to COVID-19

A recent study published in Pediatrics investigated 2 143 cases of suspected or confirmed COVID-19 in children in China. The study found that most cases were mild (50.9%), or moderate (38.8%). Only 5.9% of cases were severe or critical (compared to 18.5% of cases being severe or critical in adults looked at in this study). Infants (children younger than a year) were also found to be most susceptible to the virus compared to older children.

Authors note that, "Why most of the children's COVID-19 cases were less severe than adults' cases is puzzling." They speculate that the trend may be linked to:

• Children being well cared for at home and having fewer opportunities to be exposed to pathogens
• The fact that children experience more respiratory infections than adults and may have higher levels of antibodies than adults
• A child's immune system is still developing they may respond differently to pathogens than adults

"On the whole, studies that are emerging do seem to show that while children are as likely as adults to contract COVID-19, children appear to experience a lower severity of illness," says paediatric nephrologist (kidney specialist for children) Prof Errol Gottlich.

"However, there are children who are potentially more vulnerable to developing a more severe form of illness if they contract COVID-19. And there is limited data around the impact of COVID-19 on these high-risk children. With this in mind, it is crucial that parents who have children who fall into the high-risk category be aware of the preventive measures that curb the spread of the disease, and of precautions required to protect their children."

Which children are at high risk of a severe case of COVID-19?

Several groups of children can be classified as high risk when it comes to COVID-19 and other viral illnesses:

• Children who:

• Have cystic fibrosis, a hereditary disease that affects the lungs and digestive system as the body produces thick and sticky mucous that can clog the lungs and obstruct organs
• Have bronchopulmonary dysplasia, a form of chronic lung disease that affects newborns and mostly premature babies, and that can also result in long-term breathing difficulties
• Are on continuous oxygen therapy for any chronic lung disease

• Children who are on immunosuppressive treatments as a result of:

• Having had a kidney, liver, heart or lung transplant, or bone marrow stem cell transplant
• Having a chronic autoimmune disease such as systemic lupus erythematosus (SLE) or juvenile rheumatoid arthritis
• Having a chronic immunodeficiency disorder that requires ongoing medical management

Understand the guidance on protecting high-risk children from COVID-19

• Read our article on teaching children to protect themselves from COVID-19.

"The preventive measures and precautions to be taken in the face of COVID-19 are the same for vulnerable children as for every other population," says Prof Gottlich. "But specific attention needs to be paid to ensuring these measures are strictly in place around a high-risk child."

These measures include teaching children to:

• Wash their hands correctly. Clean hands often by washing them with soap and water for at least 20 seconds or, if soap is not available, use an alcohol-based hand sanitiser that contains 60% to 95% alcohol. Use soap and water if hands are visibly dirty. Hands must be washed when dirty, after playing, going to the bathroom, sneezing or coughing or blowing the nose, and before eating.
  • Read all about the right way to wash your hands.
  • Watch our video about the right way to wash your hands
• Avoid touching or coming close to sick people.
• Avoid touching their face, especially eyes, nose, and mouth, with unwashed hands.
• Practise cough etiquette: When you cough, stand away from others. Cover your mouth and nose with clothing, a flexed elbow or a tissue. Throw away the tissue at once and wash your hands afterwards.

The role parents play in protecting a high-risk child from further illness

"Stringent national measures aimed at 'flattening the curve' and physical distancing have the effect of slowing the spread of COVID-19. A particular result of this is that vulnerable groups of people such as high-risk children, people over age 65, those with chronic illness and people who are immunocompromised for any reason, are protected from acquiring COVID-19," adds Prof Gottlich.

"It's so important that parents are aware of the symptoms of COVID-19 so that they can notice any change in their child's usual state that might indicate a mild illness developing in the child," says Prof Gottlich.

COVID-19's most common symptoms:

• Cough
• Sore throat
• Shortness of breath
• Fever (body temperature of 38 degrees or more)
• Loss of smell
• Loss of taste
• Diarrhoea
• Nausea & vomiting
• Chills
• Body pains
• Headaches

"Parents who suspect their child may have an additional illness such as the flu or COVID-19 must ensure that they keep in touch with their treating doctor telephonically or through a virtual consultation so it can be determined if the child should go for a COVID-19 test, be seen in a doctor's rooms, or be admitted to hospital. This pre-communication is fundamental to protecting both the child and their healthcare provider from unnecessary exposure to the COVID-19 virus," advises Prof Gottlich.

What else parents can do to protect their high-risk children:

• A high-risk child and everyone who lives with them should have their yearly flu vaccine as soon as possible. "Considering that the COVID-19 virus reached South Africa at the start of the influenza (flu) virus season, there is a significant risk that these children may be faced with both diseases at once. We must do all we can to minimise the challenge to these children's immune systems," adds Prof Gottlich.

• Read up on FAQS on COVID-19 and flu.
• Access this year's flu vaccine at your local pharmacy or healthcare professional

• Children must continue to take their chronic medicine. Make sure you re-orders this medicine in time so that your child is never without access to their medicine.
• Keep managing your child's underlying health condition. Call your healthcare provider and ask them how to continue regular check-ups.
• If your child needs to go to hospital or a clinic, they should wear a cloth face mask at all times. You and your child should wash and sanitise hands at all times. Avoid getting into lifts or areas where people gather. "Rather than risk bringing a child into a busy waiting area, your doctor may suggest that you wait in the car until they are ready to see your child," says Prof Gottlich. "Also avoid taking a child to a busy pathology lab for any required testing. Speak to your healthcare provider about getting around this."
• Speak to your child's doctor before giving your child any medicine that contains ibuprofen. Ask if you can use paracetamol instead.
• Do not take your child with you to the pharmacy at any time. Enhanced containment measures in place in South Africa suggest that children must stay at home while parents conduct essential visits to the shops or a pharmacy.
• Avoid exposing a child to healthcare services unnecessarily.
• The family follows local and global travel restrictions.
• Regularly clean and disinfect commonly touched objects and surfaces that the child may interact with. The virus that causes COVID-19 can survive on common surfaces such as plastics, ceramics, glass and stainless steel for three days and longer.

Avoid eating raw or undercooked animal products. Handle raw meat, milk or animal organs with care to avoid cross-contamination with other uncooked food. Use different cutting boards and knives for raw meat and other food. Wash your hands between handling raw food - especially meat - and any other food. Do not eat the meat that comes from animals that have died of diseases.

ALL MEDICAL INFORMATION FOUND ON THIS WEBSITE INCLUDING CONTENT, GRAPHICS AND IMAGES, IS FOR EDUCATIONAL AND INFORMATIONAL OBJECTIVES ONLY. DISCOVERY HEALTH PUBLISHES THIS CONTENT TO HELP TO PROTECT AND EMPOWER ALL SOUTH AFRICANS BY PROMOTING A BETTER UNDERSTANDING OF COVID-19.