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 Table of Contents  
PERSPECTIVE
Year : 2021  |  Volume : 23  |  Issue : 2  |  Page : 208-209

Coronavirus disease 2019 - A pediatrician's perspective


1 Sr Adv and Intensivist, Department of Pediatrics, INHS Asvini, Mumbai, India
2 Sr Adv and Neonatologist, Department of Pediatrics, INHS Asvini, Mumbai, India
3 Sr Adv and Neonatologist, Department of Pediatrics, CH(CC), Lukhnow, India

Date of Submission03-Oct-2021
Date of Acceptance05-Oct-2021
Date of Web Publication21-Oct-2021

Correspondence Address:
Dr. Bal Mukund
Department of Pediatrics and Neonatologist, INHS Asvini, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_127_21

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How to cite this article:
Mukund B, Bhat V, Kumar A. Coronavirus disease 2019 - A pediatrician's perspective. J Mar Med Soc 2021;23:208-9

How to cite this URL:
Mukund B, Bhat V, Kumar A. Coronavirus disease 2019 - A pediatrician's perspective. J Mar Med Soc [serial online] 2021 [cited 2021 Dec 9];23:208-9. Available from: https://www.marinemedicalsociety.in/text.asp?2021/23/2/208/328437



Toward the end of 2019, a novel coronavirus causing a cluster of pneumonia cases was reported from Wuhan City, in the Hubei province of China. As per the World Health Organization update dated September 23, 2021, there have been 229,858,719 confirmed cases and 4,713,543 deaths worldwide, making it one of the worst pandemics in the history of mankind.[1] Coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection manifests with varying severity in different age groups. Whereas, the elderly with comorbid conditions manifested with severe disease, children have thankfully been relatively spared till date. India too, suffered from devastating the second wave under which the health-care infrastructure of the country crumbled, causing unprecedented mortality and morbidity in relatively middle age group adults.

Several differences in pathogenesis have been proposed as the cause for the relatively milder disease due to COVID-19 in children. The possible protective factors are relatively lesser exposure to virus due to closing down of schools, day care centers, restriction of movement, strong innate response due frequent viral infections in early life and exposure to live attenuated vaccines, high angiotensin-converting enzyme 2 expression metabolizing angiotensin-2, lack of immune senescence, better lung regeneration capacity, lack of ageing related co-morbid conditions, and difference in B-cell memory through CD27 dull and CD27 bright epitope (which varies with age). These lead to children generating a better natural antibody response compared to adults.[2] However, a more severe disease has been described in infants and children with comorbid conditions such as neurological disorders, chronic lung diseases, heart diseases, and genetic diseases. Three clinicoimmunological phases described in this form of the disease are early flu-like symptoms with high viral load, critical phase, and recovery phase. Gastrointestinal symptoms are more frequently seen in children with COVID-19. A clinical different syndrome, akin to incomplete Kawasaki disease and Toxic Shock Syndrome was reported in April 2020 from the United Kingdom. Since June 2020, a similar syndrome termed Multi-system Inflammatory Syndrome in Children (MIS-C) was also described from India, which was also referred to as pediatric inflammatory multi-system syndrome temporally associated with SARS-CoV-2.[3] Antibody-dependent enhancement or possible immune dysregulation due to COVID-19 virus has been proposed as a putative mechanisms for MIS-C.

The management involves admission for moderate-to-severe COVID-19 cases and admission with close monitoring for MIS-C cases. Patients with risk factors for likely disease progression, oxygen requirement, and on ventilation are prescribed corticosteroids, although robust evidence from the clinical trials in pediatric patients is so far lacking. Ministry of Health and Family Welfare, Govt. of India guideline mentions the management principles including intensive care management of severe COVID-19.[4],[5] Mainstay of treatment of MIS-C is immuno-modulation by intravenous immunoglobulin and/or corticosteroids given early and supportive therapy in an intensive care setting.[5],[6]

Vaccines to prevent SARS-CoV-2 infection are considered the most promising approach for curbing the pandemic and are being vigorously pursued. Inactivated vaccines, live attenuated vaccines, recombinant protein vaccines, vector vaccines, and DNA/ribonucleic acid vaccines are either in trials or have been accorded emergency use authorization in this pandemic to assuage further suffering. BNT162b2 (Pfizer BioNTech COVID-19 vaccine) has been granted approval for the use in adolescents >12 years of age by the US Food and Drug Administration. Studies with other vaccines and in younger children are underway.[7] Recently, ZyCoV-D, a DNA vaccine was authorized for emergency use from the Drug Controller of India for those above 12 years. Children aged 2–6 years are presently also participating in a clinical trials for Covaxin by Bharat Biotech under aegis of AIIMS, New Delhi.[8] As the possibility of the third wave is looming, the Indian Academy of Pediatrics has said in its statement that though children remain susceptible to COVID-19 infection, it was “highly unlikely that the third wave will predominantly or exclusively affect children.” It also said that there was no evidence to suggest that most children with COVID-19 infection would have severe disease in the possible third wave.[9] We need to be prepared with more in-patient beds and intensive care beds for children with augmentation of existing infrastructure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO COVID-19 Dashboard. Available from: https://covid19.who.int/. [Last accessed on 2021 Sep 23].  Back to cited text no. 1
    
2.
Dhochak N, Singhal T, Kabra SK, Lodha R. Pathophysiology of COVID-19: Why children fare better than adults? Indian J Pediatr 2020;87:537-46.  Back to cited text no. 2
    
3.
Mukund B, Sharma M, Mehta A, Kumar A, Bhat V. Pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 – An emerging problem of PICU: A case series. J Pediatr Crit Care 2020;7:271-5.  Back to cited text no. 3
  [Full text]  
4.
World Health Organization. Corticosteroids for COVID-19. Living guidance; September 2, 2020. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1. [Last accessed on 2021 Sep 23].  Back to cited text no. 4
    
5.
6.
Takia L, Angurana SK, Nallasamy K, Bansal A, Muralidharan J. Updated management Protocol for multisystem inflammatory syndrome in children (MIS-C). J Trop Pediatr 2021;67:fmab071.  Back to cited text no. 6
    
7.
Food and Drug Administration. Emergency Use Authorization letter for Pfizer-BioNTech COVID19 Vaccine. May 10, 2021. Available from: https://www.fda.gov/media/144412/download. [Last accessed on 2021 Sep 23].  Back to cited text no. 7
    
8.
9.




 

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