EC PAEDIATRICS Special Issue - 2020

Paediatric Review on Corona Virus (COVID-19)

Dr. Dipti Y Sorte1* and Dr. Amol Rajendra Gaikwad2

1
Associate Professor, Child Health Nursing Department, Himalayan College of Nursing, Swami Rama Himalayan University, India
2
Physician, Pune, India
*Corresponding Author: Dr. Dipti Y Sorte, Associate Professor, Child Health Nursing Department, Himalayan College of Nursing,
Swami Rama Himalayan University, India.

Received: February 17, 2020; Published: February 29, 2020

Corona Virus (COVID-19) is an RNA virus that has been affecting the global scenario for quite some time since the December of
2019. Prior to the S.A.R.S. outbreak (2002 - 2003), the coronavirus was deemed classically as a causative agent of the common cold with
clinical features close to that of rhinoviruses (Harrison’s Infectious Diseases, 3rd edition).

As of 2019 - 2020 the paediatrics cases being presented as infected is a notable group that is still under review and study [1].

Although there is a dearth of data, Children are easily affected by the virus as much as an adult. Infants being more vulnerable to
the disease. Most not if all present signs of viral pneumonia, indicated by presence of infected fluid within the lungs. What children and
infants don’t seem to present is hypercytokinemia (A fatal immune reaction consisting of a positive feedback loop between cytokines
and immune cells, with highly elevated levels of various cytokines. Synonymous to the “Cytokine Storm” implicated in the high mortality
rates of the Spanish flu outbreak of 1918-1920.) which is purported as a cause of mortality in adults and the elderly [2,3].

Research indicates that Innate immune cells seed the airways during early life and there is good evidence that the lung leukocyte
profile does not change significantly after 3 years of age. Thus, it may be theorised that once children have established an immune
system by the ages of 3 - 4, there is a manifold reduction of the risk [4].

The reasoning states that a child has a more robust immune innate immune system indicating that they are able to resist the disease
much more. This is substantiated by statistical data indicating the IFR (Infant Mortality Rate) to be 25 times less likely compared to
those of adults.

Observing as to how a coronavirus works, it is a positive sense single stranded RNA virus and without going much into the specifics
of the strain, the genome study has revealed 10 subunits of which researchers are mainly concerned with genes encoding the infectivity
factors such as the peplomers(surface glycoprotein) that cause the virus to adhere to cell membranes.

The body’s main method of attack in infected cases of viral origin is to trigger apoptosis and phagocytosis. In children this takes place
at a higher rate, accuracy and response compared to that of adults [5].

The induction of apoptosis and subsequent phagocytosis of virus infected particles seems to be an innate antiviral mechanism among
multicellular organisms. The model of S.A.R.S. Virus to which the current COVID-19 model shows 96% similarities to, indicated in earlier
S.A.R.S. studies that the phagocytic pathway is prominent in recovery.

Citation: Dr. Dipti Y Sorte and Dr. Amol Rajendra Gaikwad. “Paediatric Review on Corona Virus (COVID-19)”. EC Paediatrics SI.03
(2020): 01-03.
 Paediatric Review on Corona Virus (COVID-19)

02

Additionally, once with the help of vaccines, when passive immunisation is achieved within the host organism with anti-covid-19
antibodies, they will provide greater elimination efficiency thus both of these processes working synergistically [6].

In humans it is the innate immune response that acts as a first defence against new infections. This is reduced much more in adults
and the elderly with set immune systems. The detrimental aspect of this is that there is no immunological memory left of the defence
provided by the cells in the body and thus no benefits of an active or adaptive immunity are conferred to the child. Unless Naive T cells,
and B cells are able to adapt, work synergistically and present an immunological response to the infection, adaptive immunity will not
be conferred to the patient.

What we do know at this point in time based on early studies is that Placental transmission of the virus has not occurred, based
on the understanding that COVID-19 is a respiratory virus which usually do not follow the placental transmission model The current
understanding is that it spread by respiratory droplets, contact with infected persons, and aerosolized particles in vicinity present on
contact surfaces or in the atmosphere [7].

Previous studies have shown that S.A.R.S. (another significant coronavirus infection) during pregnancy is associated with a high
incidence of adverse maternal and neonatal complications. These include:

• Spontaneous miscarriage,
• Preterm delivery,
• Intrauterine growth restriction,
• Application of endotracheal intubation,
• Admission to the intensive care unit,
• Renal failure,
• And disseminated intravascular coagulopathy.

However, pregnant women with COVID-19 infection in the present study had fewer adverse maternal and neonatal complications and
outcomes than would be anticipated for those with SARS-CoV-1 infection. Some markers to note is that infection with COVID-19 did not
cause pneumonia in the mothers but in some cases lead to premature membrane rupture and foetal distress [8].

Similarly known is that infants and children who are breastfed and are nutritionally balanced are much more capable of resisting
most viral infections [9].

An important marker of the COVID-19 viral infection is that of adults with comorbidities being affected much more seriously.

Children are also less likely to have exposure to stress, and adverse environmental factors like pollution, cigarette smoke, which
definitely hampers recovery and reduces the natural protective responses of the body.

An important aspect to note is that while the T cells and s are still maturing. there are more cells to spare as the pluripotent/cell
numbers are much higher in children as well as there being a healthier average telomere length.

Conclusion
While the milder symptoms are a promising aspect in paediatrics there is still the concern that prolonged repeated exposure will be
detrimental to any group in the demographic. The case for prolonged exposure to viral origin pathogens conferring adaptive or active
immunity is very poor. Thus, while children are showing the strength to resist, we must follow strict healthcare guidelines and care for
them in an even stricter sense, so that in a case of COVID-19 infection, the children’s own innate immunity will fortify them enough to
escape its more serious consequences in the present and foreseeable future till a vaccine can be found.

Citation: Dr. Dipti Y Sorte and Dr. Amol Rajendra Gaikwad. “Paediatric Review on Corona Virus (COVID-19)”. EC Paediatrics SI.03
(2020): 01-03.
 Paediatric Review on Corona Virus (COVID-19)

03

Bibliography
1. Qun Li., et al. “Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia”. New England Journal of
Medicine (2020).

2. De Chang., et al. “Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan,
China”. Journal of the American Medical Association (2020).

3. Chaolin Huang., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 395.10223 (2020):
497-506.

4. Anastasia Georgountzou and Nikolaos G. Papadopoulos. “Postnatal Innate Immune Development: From Birth to Adulthood”.
Frontiers in Immunology 8 (2017): 957.

5. Firzan Nainu., et al. “Induction of Apoptosis and Subsequent Phagocytosis of Virus-Infected Cells As an Antiviral Mechanism”.
Frontiers in Immunology (2017).

6. Codagenix partners Serum Institute of India on Covid-19 vaccine (2020).

7. Huijun Chen., et al. “Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant
women: a retrospective review of medical records”. Lancet (2020).

8. Jie Qiao. “What are the risks of COVID-19 infection in pregnant women?” Lancet (2020).

9. Nicole Theresa Cacho and Robert M Lawrence. “Innate Immunity and Breast Milk”. Frontiers in Immunology 8 (2017): 584.

© All rights reserved by Dr. Dipti Y Sorte and Dr. Amol Rajendra Gaikwad.

Citation: Dr. Dipti Y Sorte and Dr. Amol Rajendra Gaikwad. “Paediatric Review on Corona Virus (COVID-19)”. EC Paediatrics SI.03
(2020): 01-03.