On 5 October 2020, a one-year-old Malaysian girl in Sabah succumbed to Covid-19, the first paediatric death in Malaysia. She was brought to the Tawau Hospital Emergency and Trauma Department on 1 October. She tested positive and died on 5 October despite breathing support.
Since our first three Covid-19 cases were confirmed among tourists from China in Johor Bahru on 24 January, and the first two deaths on 17 March, there are now 157 deaths and 15,657 cases (11 Oct). The youngest fatality had been a 23-year-old female university student in Sarawak.
Although at least 20% of all cases were aged 18 years and below, there had been no death in this age group in Malaysia until this current tsunami of cases. Our youngest Covid-19 case was a new-born baby born to a positive mother.
On Google search, the world’s youngest reported Covid-19 death is a two-day-old baby who was born prematurely in South Africa on 21 May to a Covid-19 positive mother.
Prior to that, on 2 May, the world’s youngest victim of the disease was reported to be a 20-day-old infant, who died of complications related to Covid-19 in India. The boy was admitted for diarrhoea and vomiting with no history of contact or travel. He was treated for septicaemia at the J.K. Lone Children’s Hospital, Jaipur, Rajasthan, where the paediatricians had ruled out intrauterine infection.
On 20 May, the U.S. Centre for Disease Control and Prevention (CDC) had issued new guidelines calling for all new-borns delivered to Covid-19 positive women to be tested. CDC said that babies are most likely to be exposed to the virus through respiratory droplets from mum, other caregivers or visitors. A few reports suggest exposure occurring right before or during labour, but this has still to be proven.
The perinatal transmission risks are still unclear, so doctors should presume such new-borns are infected and isolate them from healthy babies. They should be separated temporarily from their mothers to reduce transmission until the mother’s and child’s test results are negative.
The optimal timing for testing neonates born to infected mums is not known. CDC suggests the first testing 24 hours after birth. If the test is negative, doctors should test them again the next day. Where available testing is limited, CDC recommends these new-borns should be prioritised.
If there is no room to separate an infected mother from the baby, CDC suggests the mother use a face mask and practice good hand hygiene. CDC does not recommend masks for any child under the age of two years. Health care providers should use protective clothing and masks when handling the infants of infected mums.
As with older children, the majority of Covid-19 positive infants tend to be asymptomatic, or have a mild form of the disease, and recover without complication. The symptoms are similar to adult patients, i.e. fever, cough, breathing difficulties or diarrhoea and vomiting. Infants may also appear lethargic. Infants may be at a higher risk for severe forms of the disease compared to older children.
Covid-19 in Children
In the United States and globally, fewer cases of Covid-19 have been reported in children (age 0-17 years) compared with adults.
As of 12 Oct 2020, more than 7.99 million Covid-19 cases and 219,695 deaths have been reported in USA. The true incidence of SARS-CoV-2 infection in children is not known due to the lack of widespread testing and the prioritisation of testing for adults and those with severe illness. Although children make up 22.6% of the US population, they contribute less than 10% of cases (657,572 on 5 October). There has been a steady increase from 2.2% in April.
Although children make up a growing percentage of total cases, hospitalisation and death due to Covid-19 is still uncommon. Hospitalisation rates in children with Covid-19 (8.0 per 100,000 population) are significantly lower than adults (164.5 per 100,000), suggesting that children may have less severe illness from Covid-19 compared to adults.
However, hospitalisation rates in children are increasing. While children have lower rates of mechanical ventilation and death than adults, one in three children hospitalised with Covid-19 in the United States were admitted to the intensive care unit, which is the same as in adults.
As of September, children represented 1.7% of total hospitalisations and 0.07% of the deaths. About 2% of child cases resulted in hospitalisation. About 0.01% of children with a known case of Covid-19 have died, according to the report.
How To Recognise Covid-19 In A Child
The incubation period of SARS-CoV-2 in children is about 2-14 days with an average of 6 days, as in adults. This means that symptoms will only develop 2-14 days after the child is exposed to an infected person, not immediately. 16% – 45% of children remain asymptomatic despite being infected (RT-PCR positive).
Infected children may have any of these symptoms: fever, fatigue, headache, muscle pains, cough, nasal congestion or running nose, recent loss of taste or smell, Sore throat, shortness of breath or difficulty breathing, abdominal pain, diarrhoea, nausea or vomiting, poor appetite or poor feeding. The most common symptoms in children are cough and/or fever.
These signs and symptoms are similar to other infections e.g. influenza or bacterial respiratory infections or allergic rhinitis, making it difficult to diagnose Covid-19 without a nasal swab.
Severity Of Illness In Children
Infected children are less likely to develop severe illness or die compared to adults. However, they are still at risk of developing severe illness and complications especially infants (age <1 year) and those with certain underlying medical conditions.
Current evidence suggest that children with genetic, neurologic, metabolic conditions, or with congenital heart disease might be at increased risk. As with adults, children with obesity, diabetes, asthma and chronic lung disease, sickle cell disease, or immunosuppression might also be at increased risk for severe illness.
Similar to adults, children with severe Covid-19 may develop respiratory failure, myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure. Children infected with SARS-CoV-2 are also at risk for developing multisystem inflammatory syndrome in children (MIS-C).
It is unclear whether children are as susceptible to infection by SARS-CoV-2 compared with adults and whether they can transmit the virus as effectively as adults. Recent evidence suggests that children are likely to have the same or higher viral loads in their nasopharynx compared with adults, and that children can spread the virus effectively in households and camp settings.
Take Home Message
Do cooperate with the health authorities and go for RT-PCR testing when required after travel to a “red-zone” or possible exposure, even if you feel well or your child is totally asymptomatic. The person who catches your virus may not be as lucky.
A fusion opinion from a Sarawakian public health specialist, paediatrician, ex-associate professor, disaster relief and medical volunteer, passionate about helping people learn.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.