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The pandemic throws up new child-related problem

2 years ago

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  • Parental vigilance could help prevent MIS-C ‘syndrome’

  • Health professionals’ diagnostic skills important

  By Sumudu Chamara   The Covid-19 pandemic shows signs of evolving in ways that the world has not anticipated, and it is a major threat to countries like Sri Lanka that are struggling to fight the pandemic with limited resources. In the recent past, Sri Lanka too had to pay more attention to the evolving nature of the virus, with a number of new and foreign variants of the virus being reported in the country, the latest being the B.1.617.2 Delta variant of the virus, which is also known as the “Indian” variant. Even though it is prevalent in over 80 countries and is becoming more and more common, it just added another burden to Sri Lanka’s fight against the pandemic. Another recent development is the Covid-19-infected lion found in the Zoological Garden in Dehiwala, and this is the first such case reported in Sri Lanka. It is still to be investigated. According to some media outlets, Sri Lanka will seek Indian assistance in this regard. Last week, the newest Covid-19-related development, i.e. a medical condition called the Multisystem Inflammatory Syndrome in Children (MIS-C), was reported in Sri Lanka, and local medical experts have warned of its seriousness and have emphasised the importance of parents being more vigilant in this regard, as it can be deadly if not treated on time.   What is MIS-C? According to many international studies, there are reasons to suggest a certain link between MIS-C and Covid-19, as many (children) who have MIS-C had either recovered or are recovering from Covid-19, or had associated adults who had contracted Covid-19. According to the US national public health agency, the Centres for Disease Control and Prevention (CDC), MIS-C is a condition where different body parts can become inflamed, and so far, as to what exactly causes MIS-C has not been identified. However, the CDC has identified that many children with MIS-C had the virus that causes Covid-19, or had been around someone with Covid-19. Even though MIS-C can be serious, even deadly, most children who were diagnosed with it have got better with medical care. However, there is a discussion among the global medical community as to whether MIS-C can be called a “disease”, because information about what causes it and risk factors associated with it are inadequate to call it a disease. Therefore, most of the time, MIS-C is referred to as either a “condition” or a “syndrome”. Symptoms of this syndrome include, among others, fever that lasts 24 hours or longer, vomiting, diarrhoea, pain in the stomach, skin rash, feeling unusually tired, fast heart beat, rapid breathing, red eyes, redness or swelling of the lips and tongue, redness or swelling of the hands or feet, headache, dizziness or feeling lightheaded, enlarged lymph nodes, severe stomach pain, difficulty in breathing, pale, gray or blue-coloured skin, a change in the colour of lips or nails depending on the skin tone, confusion, or the inability to wake up or stay awake. Researchers also say that children with MIS-C usually have symptoms resembling toxic shock syndrome or Kawasaki disease, in which the coronary arteries enlarge or form aneurysms. Most children recover to an excellent state of health with careful observation and treatment. Children with MIS-C are recommended to be hospitalised. Also, so far, only a very small percentage of children have died as a result of such, according to researchers specialising in children’s medical conditions. According to international sources, some researchers suspect that MIS-C is caused by a delayed immune response to Covid-19 that somehow goes into overdrive, causing inflammation that damages organs. It is also possible that the antibodies that the children form within their bodies in connection with the virus, or some of their immune cells, are creating the illness, and since only a small number of children develop MIS-C, it is possible that there are genetic factors that make some children susceptible, they note. It is, however, important to remember that overall, children fare very well with Covid-19 compared to adults, and only a small number of children seem to develop signs and symptoms of MIS-C. Even though most children suffering from MIS-C have been infected with Covid-19 before starting to show symptoms of MIS-C, there is an ongoing discussion as to whether these children should receive the Covid-19 vaccines. Even though this is a rather new syndrome in Sri Lanka, it was initially reported as far back as May 2020, and the initial cases were reported from Europe and North America. These cases were more prevalent among children and adolescents, and case reports and small series have described a presentation of acute illness accompanied by a hyper inflammatory syndrome, leading to multiple organ failure and shock, according to the World Health Organisation (WHO). The WHO said that due to the lack of data and research about this syndrome, there is, therefore, an urgent need for the collection of standardised data describing clinical presentations, severity, outcomes, and epidemiology. The WHO has developed a preliminary case definition and case report form for MIS-C, and the preliminary case definition reflects the clinical and laboratory features observed in children reported to date, and serves to identify suspected or confirmed cases both for the purpose of providing treatment and for provisional reporting and surveillance. The case definition, however, will be revised as more data becomes available.   Prevention Even though the exact reasons behind this syndrome have not been identified yet, according to some researchers, there are, however, several precautions the public can take to prevent severe symptoms. According to a non-profit American medical academic centre, among these precautions are, keeping hands clean (wash hands often with soap and water for at least 20 seconds and if soap and water are not available, to use a hand sanitiser that contains at least 60% alcohol), avoiding people who are sick (avoid people who are coughing, sneezing, or showing other signs that indicate that they might be sick and contagious), practise social distancing (parents and children should stay at least six feet or two metres away from other people when outside the home), wearing cloth-based facemasks in public settings (when in indoor public places or outdoors where there is a high risk of Covid-19 transmission, such as at a crowded event or a large gathering, both parents and children – if the children are at least two years old – should wear face masks), avoiding touching one’s nose, eyes, and mouth (encourage the children to do the same), covering one’s mouth with a tissue or elbow when sneezing or coughing (parents and children should practise covering mouths when sneezing or coughing to avoid spreading germs), cleaning and disinfecting highly touched surfaces every day (this includes areas at home such as door knobs, light switches, remotes, handles, counter tops, tables, chairs, desks, keyboards, faucets, sinks, and toilets), and washing clothing and other items as needed (advisable to follow manufacturers’ instructions, using the warmest appropriate water setting on your washing machine). In a context where Sri Lanka’s neighbour, India, too, has reported MIS-C cases in the past few months, Sri Lanka cannot afford to be careless.   MIS-C in Sri Lanka Information about how MIS-C has started affecting Sri Lanka was recently revealed to the media by the Lady Ridgeway Hospital for Children’s (LRH) Paediatric Intensive Care Unit’s (ICU) Dr. Nalin Kithulwatta, who strongly urged parents to be extremely vigilant about symptoms in their children, as it can result in serious complications or even death. During the weekend, he said that six children with MIS-C were receiving treatment in the LRH’s ICU, and that they were between eight and 15 years of age. Dr. Kithulwatta also said that all reported MIS-C cases had tested positive in at least one of the three tests usually employed to check a person’s Covid-19 status – PCR test and rapid antigen or antibody tests – and that it is a sign that those children had contracted Covid-19 at some point. He added: “Even though we believe that they had contracted Covid-19, we cannot say at what point in time. Some of them still show Covid-19 symptoms. Some had earlier contracted the virus without anyone noticing, because most children do not show symptoms (asymptomatic) which makes it difficult to identify their Covid-19 status. Sometimes, even parents do not know whether their child has been infected with Covid-19 as they are asymptomatic. The children receiving treatment in the ICU were sent from hospitals located around Colombo such as Ragama and Kalubowila. One case was reported from Welimada; however, the child in question had recovered after getting treatment from the Badulla Hospital.” He warned that there is a possibility that MIS-C could be spreading in all parts of Sri Lanka, and that according to the cases that have been reported in the country, it can be confirmed that children are most likely to experience this condition from two to six weeks after recovering from Covid-19. According to him, MIS-C can affect a number of organs including the skin, eyes, heart, lungs, kidneys, and liver. “Any disease can worsen if necessary treatments are not sought at the appropriate time. If a child shows symptoms, regardless of the severity of his/her health situation, steps should be taken to consult a medical professional immediately,” he said, stressing that delaying treatments may put children’s lives in danger. Among the most prevalent symptoms identified from the cases reported in Sri Lanka are fever, severe body ache, abdominal ache, vomiting, and diarrhoea. However, MIS-C can also cause less prevalent or severe symptoms such as red eyes and skin rash, and in extreme circumstances, it can affect the heart and result in a decrease in blood pressure and perhaps death as well. “This is a new disease, which was first reported in England in April 2020, and we can see that it has now come to Sri Lanka, and we have come across children with MIS-C from several parts of the country,” Dr. Kithulwatta said, adding that even though Sri Lanka has not recorded any deaths owing to this syndrome, several countries including the US and the UK have reported such deaths. He noted that Sri Lanka, therefore, needs to be vigilant about this syndrome and take appropriate steps promptly. Speaking to The Morning on 20 June, Dr. Kithulwatta said that even though the number of children obtaining treatments at the LRH is six, so far, 15 MIS-C cases have been reported in the country. Also, he added that even though this syndrome is mostly found in children, it can affect any person up to 20 years of age. He also said that even though early detection of the syndrome is the best way to successfully treat it, that is not easy, as PCR and rapid antigen or antibody test results could be negative, which could lead to the conclusion that the child is not infected with MIS-C. Even though most experts and researchers in the medical field have assured that the vaccines for Covid-19 are strong enough to fight even the newly found Covid-19 variants, owing to the evolving nature of the virus, conducting new studies and updating theoretical knowledge about the virus has become an ongoing process. That is the best way to make sure that the theoretical strategies to fight the virus translate into effective and tangible measures. Therefore, it is important to keep in mind that prevention is always more effective than cure.

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